AGEING-IN-PLACE WITH SMART HOME TECHNOLOGY
Perspectives from both family caregivers and community-dwelling older adults
Research team: Gordana Dermody, Roschelle Fritz, Courtney Glass, Melissa Dunham, Lisa Whitehead
REVIEWERS
Community Science Club
Pomona & District Community House
ARTICLE INFO
Article type: LIVED EXPERIENCE
Issue date: 11/10/2024
Issue No. 5
Authors: Dr Gordana Dermody, Dr Kathryn Broadhouse
Original peer reviewed articles:
WHY READ THIS ARTICLE
Many of us would prefer to live at home as we age. Remaining living at home or “ageing in place” allows us to maintain social connections with our neighbourhood and proximity to friends and family. However, chronic disease and cognitive decline, more common with advancing age, present hurdles to safely ageing-in-place. Ageing-in-place could be more feasible with the support of smart home technology. If set up well, smart home technology could reduce the risks to living at home, maximize our independence and enhance our well-being and quality of life, while decreasing the financial burden of residential care costs for us as individuals. Unfortunately, the uptake of smart home technology is very low among older adults owing largely to a lack of communication, knowledge and understanding of what smart homes are and what they can do for us. This article takes a dive into the world of health assistive smart homes and explores the factors that influence 1. family caregiver and 2. community-dwelling older adults’ readiness to adopt health smart home technology.
Dana is a seasoned expert in gerontologic nursing who has dedicated her career to improving health assistive technology to keep us living independently for longer. Watch Dana explain what a smart home is in the video above.
Science communicator’s take
When I first heard about health assistive smart home technology for ageing-in-place I had my doubts, even as a researcher in the healthy ageing field. Most of my research work has looked at age related brain changes association with cognitive decline and interventions for them. Findings across the field show that to have the best chance of ageing well we must remain physically, cognitively and socially active throughout our lifetimes. My knee jerk reaction to smart home tech was that rolled out poorly, it would lead societies, particularly ones facing the ageing population crisis, to swap face-to-face care for online monitoring, leading to more isolation, inactivity and mental health issues. Much in the same way that social media platforms originally billed as revolutionary tech to connect us, have only lead to further division and disconnect. But then I read the original papers from Dana and the team to translate for this edition of the newsletter I changed my mind.
The first-hand accounts and perspectives from family caregivers and older adults reminded me of my grandmother, Mimms. Not her real name or even close, she just hated “granny”, or “nan” so decided we should call her Mimms the Christmas before my brother, sister and I were born (we are triplets). Being three of us my mum and Mimms shared the child rearing duties equally and all three of us see Mimms as our second mum rather than a grandmother. Mimms had a wicked sense of humour, selfless to a fault, fiercely independent and was the most stubborn person I have ever met. She started losing her eyesight at 80 and each morning would walk around her house with a blindfold for an hour to practice “functioning blind” to prepare for the future. We would often find her making a cuppa like this.
She reached the age of 87 before dementia took its toll and she needed extra help for the last three years of her life to stay living in her home until the end, which she managed all but the last three weeks. As well as the council provided carer that visited once a day to check she was ok, the three of us took it in turns to visit her twice a day, prepare meals and help her with bathing. Early one morning she got out of bed for her “nighttime wander”, that was common in the later stages of her dementia, misjudged where she was and fell and broke her hip. She survived the operation but then passed away peacefully in a post-op care facility. Reading the conversations in these two articles struck a chord with me. Smart home technology could have potentially monitored and detected her wanderings, perhaps reducing or preventing the risks of a fall, providing us with a few more months or years with her. It wouldn’t have inadvertently reduced the amount of times we went round to see her, it would have aided our care of her while she stoically soldiered on making blind cups of tea.
Dr Kathryn Broadhouse
INTRODUCTION
Understandably, many of us would prefer to live at home as we age. This is known as ageing-in-place. The familiarity of our own home and neighbourhoods provides comfort to older adults who may be suffering from hearing loss, loss or eyesight and/or memory loss associated with cognitive decline. The knowledge that one can stay living at home as they age can provide an immense sense of relief. However, chronic disease, cognitive decline and disability present hurdles to safely ageing-in-place and frequently result in older adults becoming care-dependent. Either leading to the need for families to monitor their well-being and provide informal care or the need to move into a care home.
Although living at home as we age would be the ideal choice for many of us, it comes with considerations and impacts not just for us but also our family. In Australia, about 91% of community-dwelling older adults with dementia rely on an informal caregiver (family member or friends) for support. Understandably, informal care delivered over time takes a toll on family members who are also balancing jobs and their own families. Missed work time, chronic stress and poor physical and mental health outcomes are commonly associated with caregiver burden.
Furthermore, as health declines with age, family caregivers may find it difficult to sustain the intensity of care and monitoring on a long-term basis that their family member needs.
Ageing-in-place could be more feasible with the support of smart home technology. If set up well, smart home technology could reduce the risks to living at home, maximize our independence and enhance our well-being and quality of life, while decreasing the financial burden of residential care costs for us as individuals. Smart home technologies could support our family caregivers by assisting with monitoring the day-to-day activities of daily living and alerting them and us if there is a deviation from our behaviour norms indicating an important change in our health. Previous studies with smart home technologies are promising, providing peace of mind for the caregiver and increased independence for the older adult. Encouragingly, the development of assistive technologies such as smart home systems to support older adults is on the rise. The Royal Commission into Aged Care Quality and Safety, 2021, have called to implement an assistive technology and home modifications category in the aged care program.
WHAT IS SMART HOME TECHNOLOGY?
The health assistive smart home encompasses a range of smart devices (sensors that are connected to the internet), which include wearables like fit bits or apple watches, remote monitoring systems which can have nurses logging into a system at a distance to determine that a person is following their normal routine at home. These sensors are predominantly used without cameras, so there are no videos or voice recordings. In addition, blood pressure cuffs, weight scales and other devices can connect to the internet using Bluetooth. The sensors can work harmoniously together with other health devices, and wearable sensors by collecting the usual, day-to-day routine of a person. The sensors collect information about a person’s routine in-home behaviours for example: time in bed or out of bed, interest in food, quality of sleep, duration of sleep, medications taken, time spent sitting in favourite chair/sofa, number of trips to the toilet and others. Because we are creatures of habit, the system can come up with a baseline for us. Even very small changes can now be spotted and could be an early sign that the person may not be feeling well, or experiencing a decline. This is a very important benefit of smart home technology, because we may not be aware of the small changes or we may choose to ignore them. However, the smart home can alert a nurse to have a look and determine if the deviation form routine may point toward a problem with a medical condition, in which case it can be caught and treated early.
Activities of Daily Living
The activities of daily living (ADLs) is a term used to collectively describe fundamental skills required to independently care for oneself, such as eating, bathing, and mobility
Detecting deviations in routine
In Kath’s example with Grandmother Mimms, there are sensors that can capture a person’s gait and balance patterns. This can be used to notice when someone may need the physio or some assistive devices before they fall, not after. The sensors may also help to identify worsening dementia, as night wandering and rumination in a particular room, or getting lost inside one’s own home can be clues to that. People with dementia often experience night time wandering and family members may even notice a change in the way they move around their own home (e.g. frequently returning to the kitchen without any real purpose, or falling asleep in their arm chair most nights) even before diagnosis. Monitoring a person’s ADL and deviations from the norm may provide an early warning systems for cognitive decline. For example, contact sensors could capture whether a pill box has been opened at a particular time of day or not. The system could then send an electronic message that the pillbox was not opened or not opened on time. Leveraging this data, the health smart home offers real-time feedback, reminders and alerts to individuals, family caregivers and healthcare professionals. This is only one example but you can see how real-time monitoring could provide early warning systems for a number of issues that may arise from ageing-in-place that would allow us to remain independent for longer and provide peace of mind for our families.
THE PROBLEM
Unfortunately, the uptake of smart home technology is very low among older adults. One reason could be that as the integration and refinement of smart homes evolves, older adult and family caregivers are not involved in sharing their perceptions that could help guide the practical design, deployment and utilization of smart home technology. There are also real issues with knowledge and understanding of smart homes. Most older adults have never heard of the possibility of the smart home.
Dana and the team dedicate their research to improve smart home technology uptake and user experience. A big part of this is improving translation of research findings to practice so that the community can benefit from, and guide the advances made in this field. In this article we will read about two of the team’s scientific papers to understand and explore factors that influence 1. family caregiver and 2. community-dwelling older adults’ readiness to adopt health smart home technology. Understanding the hesitations to, and perceptions of smart home technologies from both the individual and family caregiver’s point of view will help future research to improve the technology and uptake. It also allows us as the reader to understand concerns and in some cases frustrations, around ageing-in-place from both sides.
Reviewers comments
All reviewers are semi retired or retired and over 65 but are very tech savvy and are all very pro smart home tech. As they saw it the main barrier is re-educating members of the older generation who are not so tech literate to show them the benefit of smart home tech. The reviewers were also really keen to set up educational talks, demos and info on pricing in their retirement villages and/or communities and wondered if there was scope for this.
METHODS
A total of 10 participants (aged 29–70) were recruited in the family caregiver study. Participants were eligible to participate if they spoke English, identified themselves as a family caregiver (e.g. partner, child, grandchild, family friend, other relative), either providing care to an older adult or they anticipated caring for a care-dependent family member shortly.
A total of 19 participants (aged 68–87) were recruited in the community dwelling older adult study. Participants were eligible to participate if they spoke English, were community-dwelling (family home or apartment) or living in their own home in an aged care village which is a cluster of single-family homes for older adults in a ‘village-like’ atmosphere. Older adults who live in their own home in an aged care village are free to introduce smart technologies on their own accord, without permission from the administration of these villages.
Structured flexible interview questions were used to understand the factors that affect 1) family caregivers' and 2) community-dwelling older adults' willingness to adopt health smart home technology. Interviews were audio-recorded and transcribed verbatim. Transcripts were then analysed thematically to identify recurring talking points, ideas and themes discussed. Readers of the beach assistive technology newsletter will remember this research analysis method, which involves careful reading and coding of conversations to extract meaning and understanding of different subjects.
Before the interview, participants viewed a 10-min audio-visual presentation about the smart home and its capabilities and were given the opportunity to ask clarifying questions. Participants understood that in a smart home, a clinical team would be monitoring their health status using sensor data in graph or chart form.
Reviewers comments: The reviewers really liked Dana's video explaining smart home technology and wondered whether delivering similar live educational sessions in their communities, much the same way participants were prepped for these two studies, would help with education, acceptance and uptake.
Researcher's response: This is a great suggestion. We are looking into working with our community partners to deliver educational sessions in a few local retirement villages.
RESULTS
Five major themes were identified from both the family caregivers and the community-dwelling older adult participants. When reading the two papers it struck us how similar the themes identified from both groups were. Below we have organized them into complementary pairs which highlight the crossover and difference of opinions between the two groups. Let’s dive right in and see how the discussions evolved.
CLICK TABLE TO ENLARGE
Theme 1
Reducing burden
All family caregivers agreed that adopting the smart home for their older adult could potentially reduce aspects of family caregiver burden and this was overwhelmingly perceived as an important factor that would influence caregivers' adoption of smart home technologies. One way the smart home could potentially reduce burden was decreasing the number of times a caregiver must be physically present to check on the older adult's health and well-being. The smart home was perceived as allowing the caregiver to be away from the home whilst knowing that they would be informed if a change occurred in their older adult. Furthermore, they saw the potential for it to give the older adult peace of mind. However, the sense of reduced burden and potential peace of mind for the older adult was tempered with the perception that older adults may view the adoption of a smart home as the family caregiver ‘making a fuss’–meaning that the family caregiver would be going overboard by adopting the smart home.
Independence
Many participants were positive about smart homes and stated that they could see the potential benefits with one participant describing smart home technology as “another brain” that could support ‘holistic’ health care. Some participants saw the advantages of smart home technology as an enabler for them to stay in their own homes, maintaining their independence for as long as possible, with less reliance on family members and reduce burden and stress on family caregivers.
Participants recognized that the risk of sustaining a fall increased with age and agreed that early intervention was imperative. It was recognized that the data collected by the smart home sensors could provide knowledge and information to family members and health professionals who may not notice, or not believe (adult children) that a change in health status has occurred. Interestingly, none of the participants discussed interest in using smart home generated data for self-management purposes, for example to recognize their own health risks or using the data to make changes in their own behaviours to improve their own healthy ageing journey.
Interestingly, participants that supported smart home technology were generally not concerned about their privacy by being monitored as they understood that the monitoring was to detect changes in health, or safety concerns. However, there were concerns about the nurses/carers that would be monitoring the smart home data, whether they were competent, caring, and trustworthy and that these aspects would have an impact on the quality of the care.
Theme 2
Monitoring
Although family caregivers felt that they would be most knowledgeable about deviations in activity patterns related to health changes they recognized the potential for the smart home to assist with care. The sensor-based data could provide a more holistic picture of the older person's health and well-being including psychological health, which could enable the older adult to retain their independence. They also recognized that combining their insider knowledge and automating this monitoring system could facilitate early interventions when needed. All family caregivers recognized that sensor-based monitoring would result in personal data being recorded. Consequently, some family members raised concerns about data privacy and asked about who would have access to the data. Many family caregivers saw the ability to recognize a change in the care-dependent's health that the older adult is potentially not verbalizing, and to note signs of, or progression of, dementia in their loved one as very valuable.
Monitoring
Some participants expressed concern about losing their autonomy if family caregivers were to take over their care and saw smart home technology as a potential way of avoiding this. Similar to the family caregivers, older adult participants wanted control over who could access the health-data. One participant expressed concern that family members could potentially undermine the autonomy of the older person by using the smart home data against them to determine the appropriate time for nursing home placement.
Theme 3
Big brother
Some of the family caregivers suggested that it was likely their older adult family member would perceive the smart home as ‘big brother’, that they were being watched and seen as an invasion of privacy. It is important to note that most smart homes do not use video or audio recording. Some family caregivers indicated cameras might be beneficial as part of a smart home monitoring system. These participants made some suggestions on how the video images could facilitate monitoring. Similar to the older adult participants, family caregivers recognized that inherent in smart home monitoring is a level of intrusiveness, which could be negatively perceive, making it challenging to accept the smart home. Some family caregivers expressed concerns about the actions that may be taken in response to the monitoring of activities of daily living.
Security
Most participants perceived the smart home technology would collect data to assist in tracking health and did not have concerns about their privacy. Initially many participants assumed that all smart homes would automatically use cameras, and that the smart home sensors would be able to hear what was being said in the home. Naturally, the use of cameras and/or sound was viewed negatively and was considered a deal-breaker in terms of whether they would consider adopting smart home technology. Most smart home technologies do not include video or audio recordings. Concerns were also raised about trusting clinicians to maintain privacy. Some had concerns about family members potentially ‘knowing too much’ and some were concerned that data could be used by families to the detriment of the older adult.
Several participants talked about the need to feel safe and could see the potential of smart home technology to detect intruders. One couple who were concerned about intruders were also mistrustful of wider data breaches, questioned whether the products were created to bug people and linked to an ‘intelligence agency’. The issue of being scammed through the system was also raised by one participant who was concerned that anything electronic provides an opportunity for people to be scammed.
Theme 4
Acceptance & framing
Family caregivers' readiness to adopt the smart home was directly linked to older adults' readiness to adopt the smart home. Although the general perceptions of family caregivers about older adults' readiness to adopt were positive, all family caregivers perceived the need to explain the purpose of the smart home so that their older adult would be more likely to accept it. Some participants suggested that they would emphasize to the older adults that the smart home could support independent living whilst also helping them with their caregiving responsibilities. Many family caregivers believed that their older adult would think they do not need a smart home.
Family caregivers indicated the right messaging would be required to address potential adoption barriers like older adults' privacy and cost concerns. They also agreed that it is important for the right messaging to be delivered by the right person. Timing for introducing the idea of a smart home to the older adult was deemed important.
Knowledge and timing
Having a good understanding of the smart home technology was a key factor for older adult participants to appreciate the potential benefits, and potential trade-offs. Participants who had some experience using personal computers or smartphones, were generally more accepting of the concept and expressed readiness for adoption if this technology was available to them. Those who were less involved with using computers or smartphones tended to be more sceptical and also described greater concerns about privacy of their data.
At the start of the interviews, older adults were generally concerned about the potential for privacy infringements and data breaches. However, perceptions transitioned organically into recognition of the potential benefits, and how the benefits may outweigh some of the negative aspects. Participants identified that those who have limited knowledge or experience with using technology may be more inclined to reject the idea of living in a smart home, recognizing increased age as a barrier to learning something new. Several participants were unaware of smart home technology and stated that further education and advertising tailored to the older adult would give older people a better understanding of the smart home technology and the potential benefits.
The right time to have a smart home installed depended on several factors including health status, living arrangements and family, for example, the death of a partner. Opinion was divided as to when the right time was to have a smart home installed. For some, it was before health declined as a preventative strategy against future events such as falls or illnesses. In contrast other participants, despite having several chronic health conditions and in some cases receiving home care services, felt that they would wait until their health declined further.
Theme 5
Cost
Finally cost, and cost benefit, were factors that family caregivers perceived to influence their readiness to adopt a smart home for their loved one. Some family caregivers raised concerns about whether their older adult could afford the cost of the smart home and the costs for potential upkeep such as monthly fees for a monitoring service.
Cost
The cost and cost benefit of smart homes was also the primary concern and a potential barrier to installing smart home technology for older adults as well. Some participants recognized there could be additional costs that included the ongoing monitoring and questioned how this would flow on to the customer.
DISCUSSION
Most of us would like to age-in-place. To be able to carry on living in our own home, in our neighbourhood, maintaining social connections we have held for years, is an important part of ageing. However, as we age we will all need some assistance and ageing-in-place generates its own set of challenges for both us and family. Ageing-in-place can be extremely worrying and isolating for older individuals if the right assistance isn’t provided. Trying to maintain independence, not wanting family to worry and coping with normal age-related cognitive and physical decline is hard enough without the added burden of a degenerative disease such as dementia. On the flip side, it is also difficult for family. Family caregivers are often juggling supporting their care-dependent older adults' activities of daily living, and maintaining a balance between work, personal life and caregiving responsibilities. As a result, they face a multitude of challenges in providing care to older adults, including physical, emotional, economic strains and social isolation. Long-distance caregiving also comes with its own set of challenges and considerations, and stress over the care of an older family member can often be exacerbated if the adult children live far away. Smart home technology with a health focus that can provide remote monitor of general health and well-being, detect falls, provide medication reminders could provide the assistance that both older adults and family caregivers need for ageing-place. Yet wide adoption of this technology has not yet happened.
One of the first participants to have smart home sensors installed in their home sits down with Dana to discuss the experience. you can watch the full interview by clicking on the link above.
Reviewers comments: As the reviewers see it, the main barrier is re-educating members of the older generation who are not tech savvy to show them the benefit of smart home technology. After reading these papers they were really keen to set up educational talks, demos and info on pricing in their retirement villages and communities and wondered if there was scope for this?
Researcher's response: Yes, there is scope to deliver educational seminars and we are looking at ways we can deliver educational content that is of most interest and of most use to people in these retirement villages and communities. Watch this space!
READINESS TO ADOPT
If the goal is to increase the number of people who are able to age-in-place and adoption of the smart home technology is a viable way of doing this then we need to understand factors that may impact readiness and actual adoption. What stands out above all when reading the comments from both family caregivers and older adults is the care and concern they have for each other. They share many of the same mirrored concerns (not wanting family to worry and make a fuss vs not wanting the older adult to feel they are being made a fuss of). Concerns that mostly come from the inevitable complex evolution of family relationships as we all try and navigate the transition from parent - child to older parent - adult child dynamic. Interestingly, once the benefits were understood, both groups viewed the smart home technology as a way to achieve more freedom and peace of mind for all. This suggests that the readiness to adopt among family caregivers and older adults may be complementary without either side being fully aware of the views and perceptions of each other.
The semi-structured interviews and conversations that followed in both of Dana’s studies showed that in general people can see the benefits of smart home technology, once they are explained fully to them. As the conversations evolved, there was a general acknowledgement of the tension between the desire to maintain privacy and giving up some privacy to remain independent from both family caregivers and older adults.
Both groups generally expressed a willingness to accept some perceived invasion of privacy, if it could enable them or their loved one to remain living in their own home. Once it was perceived that the smart home could support ageing in place, support independence and potentially decrease caregiver burden most participants in both groups had a positive attitude toward the technology.
Reviewers comments: Reviewers wondered whether HACA could produce and host educational videos where Dana and the team and members of the community trial, review and demo of all available tech so people can find this information in one place.
Researchers response: This is a fantastic idea and was actually Dana's original plan/concept for HACA. In response to this we are setting up a YouTube channel and videos will be hosted on the HACA Digital Health Technology page below.
CONCERNS OVER ELDER ABUSE
Sadly, a theme that cropped up in the older adult discussions was that often they are worried that if their true state of health was revealed then family members may think they are no longer able to live independently. Dana and the team’s study intuitively questioned whether ‘not making a fuss,’ or ‘big brother’, and perhaps even the reluctance to share the smart home data with family caregivers is less likely due to perceived stigma or ageism, and more related to fear of losing autonomy and as a result being moved into a nursing home. Underpinning conversations with the concept of trade-offs and focusing on gaining a meaningful understanding of the risks and benefits is crucial so that older adults and their right to self-determination is supported. Timing is key. Timing was an important factor discussed by both groups in getting this support right. It is clear that the “right time” is down to the individual and family involved coupled with the right person who could carefully frame or ‘pitch’ the idea. Whether is it a partner caregiver pitching to the rest of their wider family, adult children to the older adult or older adult to their family, timing is dependent on the people involved.
COST
Cost was also another shared concern. Adoption of smart home technology is influenced by the perceived benefits and cost-effectiveness of smart home technology related to caregiving outcomes. The question of who (government, healthcare providers, family or individual) would support the installation and maintenance cost was a talking point for both groups. Many participants were concerned about affordability and upkeep of the smart home system. The realization that a person will be needed to monitor the smart home data for clinical decision-making about potential health events impacted the apprehensions for how much the smart home and the associated supportive clinical services would cost, and how to ensure that the person monitoring the home would have the right qualifications. How affordability will evolve in the future and whether this technology becomes government funded will very much depend on the uptake and benefits seen in society.
NURSING PRACTICE
From a nursing practice point of view, it is likely that soon, ‘usual care’ will consist of nurses being at the helm of community-based ‘smart homecare’ using sensor collected data to augment clinical decision-making. Nurses will need educational preparation in the digital health space and to understand how to navigate the turbulent ethical issues that will become apparent with the emergence of novel application of technologies in the lives of older adults. As the most trusted health profession, nurses can be key drivers in the promotion of the adoption of the smart home by educating family caregivers and their care-dependent older adults. Nurses will need to support family caregivers using a positive approach to broach the topic to older adults, while balancing the need for advocacy for the autonomous decision-making of older adults.
Reviewers comments: The reviewers who live in retirement villages had some interesting insights. They pointed out that there is sometimes an expectation in these villages to look after your neighbours but some of the more able members begrudge this and comment that they did not move into a retirement village to become someone's carer. They suggested that this could be a away in to increase uptake and acceptance. Show these people the benefit of tech so they can advocate to their less abled neighbours. Having educational sessions in these communities could help to get these people on board and support them as they advocate to their less abled neighbours.
Reviewers were also thinking about future research and suggested a research trial to run - set up this tech for several people in the one of these villages and then have a public, live review after a few weeks inviting the rest of the village to attend over lunch as the trial participants and Dana discuss the tech, experience, outcomes and next steps.
Researcher's response: Dana was particularly interested in this trial idea and is looking into ways of funding such research and is in talks with research stake holders and community partners to try and get this off the ground.
FUTURE WORK
It is clear that in the case of deploying smart home technology on larger scales such as assisted living apartments, aged care providers and tech developers need to involve older adults, their families and community care providers at all stages: - design conception, development and testing. Smart home technology is as diverse as the people it aims to help. The range of sensors and potential monitoring available means there is potential to cater for all our needs and create homes as individual as the occupants. However, ageing and ageing-in-place is a human condition, one that can be alleviated by smart home technology, but one that needs to be driven by the humans involved, us. Above all, the thematic analysis carried out by Dana and the team show that this process must start with open and honest conversations between us, our families and care providers.
IMPROVING HEALTH
Contrary to previous research, in these two studies participants did not view the smart home as a way to postpone or delay deterioration of their physical health, but as a way to live independently and autonomously in their own home, while having clinical support when needed. We know that staying physically, cognitively and socially active throughout our lifetime significantly reduces risk of abnormal cognitive decline and dementia in later life. Therefore, there are wider reaching impacts to developing smart home technology with a health focus. It has the potential to help us all monitor our health trajectories not just when we are older but throughout our lifetime. Perhaps in an ideal world all homes would have health assistive technology, technology that could detect and even prevent major health events enabling us to live healthier for longer.
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