Tag Archives: Healthcare

An Interview with Stephen Johnston: Tech and Aging Innovator

Innovating services for aging adults means bringing together different perspectives and aligning common marketing goals which typically do not overlap. This is what Aging2.0 co-founder Stephen Johnston set out to do when he launched an innovation network that would be global, inter-generational, and interdisciplinary.

Several years ago, Johnston had a light-bulb moment when transitioning from the mobile industry to health services innovation. He saw an opportunity to bridge entrepreneurship, technology, and aging to bring people together and meet real-life needs. Johnston is also passionate about strengthening communities to have sustainable impact.

Aging2.0 is an innovation network focused on technologies specifically for aging adults (gerontechnology). The network supports innovators and entrepreneurs dedicated to challenges and opportunities affecting over one billion older adults worldwide. It was founded by Stephen Johnston and Katy Fike in 2012, with headquarters in San Francisco, and has a global footprint in over 20 countries.

Their network includes some of the largest and most innovative companies in aging and senior care, including leading organizations, individuals, and entrepreneurs. They offer competitions, advice and boot-camps to startups, as well as a networked platform to connect their target audience. So far, Aging2.0 has hosted more than 400 events, connected over 15,000 people in over 20 nations, and grown to over 50 volunteer chapters in North and South America, Europe, and Asia Pacific.

I met with Johnston to find out more about the latest events in aging and Aging2.0 expanding to Europe.

How did you get into addressing aging issues through technology?

I had no particular ambition or ideas to go into aging, but I was very interested in technology from when I studied in business school at Harvard. I did a lot of courses in technology and got excited about innovation and disruption. After business school, I went to Nokia. It turned out that mobile had a much broader value proposition than just phone calls and texting. At that time, I did two very formative things while at Nokia. One is that I got interested in healthcare and mobile health (mHealth) and how the two worlds connected. Another thing was being in a good company that was being disrupted and trying to develop a model for change. So, I created Nokia 2.0 to build a global community of innovators at the company with this idea of leading an innovation revolution within Nokia.

After I left Nokia, there was the opportunity to work with doctors developing mobile apps. One of the clients was a billionaire from Texas who was diagnosed with a rare dementia. I got brought in to do venture-philanthropy research to find a cure for this individual’s disease with a network of researchers. While working with a group of experts in dementia research, there was this lightbulb moment for me was when the family was talking about how they didn’t have access to products and services that would help them as caregivers. I realized there was my opportunity if my mission in life was to build a community of innovators and support these innovators to help families with dementia and older adults.

Nobody was doing anything like this and there wasn’t a playbook for how to build global ecosystem for innovation in aging, so I had to just start making it up. That meant I needed to build a community around me via blogging and events, and that’s how I met Katy who became my co-founder. It became clear that, outside a small group, there weren’t that many experts working in innovation and technology and aging. And that became the genesis of Aging2.0.

What were the starting steps for Aging2.0?

Since my career up until then was pretty corporate, I had a hunger to really do things my way, build something on my own and create a small team that would be super agile. We started by having coffee and meetups in local places and inviting people to come along who were interested in the topic. That was the start of what we are doing now and what we have been doing ever since. The local events had some of the biggest impact on launching Aging2.0 and they kept us grounded. We had older people and startups attending and we were really making those connections. We were starting to build a strong community. Since then, there have been over 400 meetings where 1000+ people attend. We get a lot of validation from people who come to our events and tell us that this is valuable. It’s been growing steadily, but at the heart, it’s still about bringing people together to talk about topics in aging.

It comes back to being a bridge between innovation, technology, and startups on one hand and older adults, aging, and the senior care space on the other hand. We see ourselves as a bridge and that allows us to work with both sides and make sure each side sees the others’ perspective. There’s not a lot of overlap in the technology and startups and aging and senior care worlds and that’s where we’ve really been focusing on building a bridge.

What are some of the biggest challenges you see to using technology to enhance and improve the lives of aging adults?

There are a number of key challenges that we consistently here about that startups face. The first is getting access directly to customers and the user insights about what older adults need. We support startups here by being a bridge to both sides – building trust with customers, with local assisted living communities for example, and connecting technologists to older people and caregivers.

The second challenge is that the space is very fragmented. There isn’t one industry, but we are crossing over several industries and people have to learn to speak the same language. Distribution channels are fragmented which makes it hard for a product to get to market, in particular to reach older people in their homes. Business models are a further challenge. A lot of these companies are doing good and helping people save money for the healthcare system, but at the same time, the healthcare system isn’t rewarding them. Often, it is a private pay model where the companies are actually doing public benefit. I’m looking forward to something like social impact bonds which could start to make some interesting connections between risk sharing and startups on the one hand and with healthcare payers on the other hand in order to open up some funding for these new business models.

What keeps you motivated and passionate about your work?

At the end of the day, it is about making an impact. For me, the way I thought about it was looking at what I think is needed in the world, what I’m good at and like to do, and what can bring in an income. And this is essentially why I got into running a for-profit, for-purpose business. I didn’t want to be purely in the corporate side or purely in the non-profit side, and I wanted to create something sustainable.

My grandmother was one of the most important people to me growing up and inspirational as she was also an entrepreneur. She was extremely kind, compassionate and wise and great with younger people. Aging2.0 hopefully captures some of that; it’s not only young people coming together to build technologies to make older people live better, it’s about how older people can have access to ways to share their perspectives, insights, and values, and discover more purpose. And I think both sides will benefit.

How does Aging2.0 approach challenges and opportunities in health and aging?

Everything we do is human-centric and we are working on the needs of older people, such as health, finance, transport, food, and access to services. This year, we have launched our Grand Challenges which takes 12 big topics relating to fixing today’s care system (such as care coordination and staffing issues), addresses topics relating to thriving in the community (such as social engagement, mobility, and lifestyle products), and also looks towards the more complex issues to be resolved (such as end-of-life planning, dementia, and new models for financial wellness). Our network provides ideas for the priority topics to be worked on, and also helps provide the answers.

What solutions have you come across that you use in your own life?

A big thing for me is the adjacencies, where we have seen services come into the aging space from outside, ones that aren’t designed to be aging products, like ones to count steps. For example, wearables, the Misfit wearable is one that I’m using. I use Amazon Echo a lot, too and we all benefit from having smart homes, not just older people. I imagine self-driving cars, robots and wearables will be categories in which older adults will be the first movers which will generate a good deal of interest by tech companies here in Silicon Valley and beyond.

Why is Aging2.0 expanding into Europe?

We’re building this global community and want to be in 100 countries by 2020. The US is where it started but, being from the UK, I’m excited to be bringing this into Europe. I am really excited for 2 main reasons 1) the amount of innovation, government recognition of the issue and financial support for new solutions is really tremendous in Europe. It’s more of a strategic priority partly because of the aging population in Europe is a higher proportion than in the US. 2) There is a big need for innovative, startup thinking and ways of doing things – bringing in the “Silicon Valley mentality.” There is a good opportunity to build up an innovation ecosystem that has an impact beyond aging – in particular, to spur economic development, which will help companies and cities thrive. In Europe, there’s a lot of energy around smart-, healthy-, and age-friendly cities. Many parts of Europe have strong, community-based cultures, and connecting communities is one of my bigger passions. I was really inspired by a recent meeting in Geneva with the World Health Organization and meeting other organizations and the work they are doing, thinking about where we could be a network and then build global innovation platforms on top of the Age-Friendly Cities Network. I think Europe is going to be a good testbed for that.

Aging2.0 recently held a Startup Bootcamp and Summit in Belgium, what were some of the highlights from the event?

It was our first major European event (previously we have been having local chapter events, but nothing European-wide) and we had people there from 15 countries. The aim was really to get people together on the same page and start a conversation about innovation in aging from the perspective of the continent. There was quite a lot of talk about living labs and how we need to bring older people – for connecting technologies to older people. There was quite a lot of discussion around integrating the needs of older adults and practical applications in this area. One of the things that came out of the event was this need for sharing perspectives and best practices, such as a database of what works. Often, we have been doing this work in silos and making the same mistakes again and again. There was also a strong focus on outcomes, the use of data, measuring impact, and return on investment for services in the aging space.

One theme was ways in which older people can keep living safely in their homes longer. So far, this hasn’t been easy and we have been seeing a lot of fragmentation – a lot of people doing different things, using different and new technologies, and none of it is really tied together. So, that’s one of the things we are going to try to do more of, to make things easier and more holistic. Europe has the potential to have a much more integrated approach. So far, we are still behind, as far as technology companies being in their silos. This is an opportunity where Europe has the potential to take a leading role in building holistic platforms.

What exciting events does Aging2.0 have planned for the rest of the year?

We have many local meetups and events going on, listed on our website.

There is our first Asia-Pacific event and Startup Bootcamp in Taipei on October 12. We are excited for people to bring ideas and for big companies to get involved. The theme this year is “Fun Long Life,” and we will focus on investing in longevity at the individual, organizational, and governmental levels.

We have our annual global innovation conference, OPTIMIZE, November 14-15 in San Francisco. There will be some great speakers, networking and partnership opportunities, a Startup Bootcamp, exhibitions, and over 1,000 innovators, senior and healthcare executives, tech companies, investors, and aging adults coming together around common goals.

Our big strategic push is around the Grand Challenges initiative I mentioned before, which connects needs + design + products + market. Through this, we work with our members to understand what aging adults really need, the issues we should be prioritizing, and how to collectively address them best.

Going forward, we will be looking to deepen our partnerships with organizations in Europe and support our Chapters to become a vital part of the local innovation ecosystems.


A big thanks to Stephen Johnston for taking the time to answer my questions! Make sure to check out Aging2.0 for more information.

*This interview has been lightly edited for content and clarity.*

Carrie Peterson is a gerontologist and consultant in eHealth and Innovation.


The Promises and Pitfalls of Global Health Volunteering

Hoping to Help: The Promises and Pitfalls of Global Health Volunteering, written by Judith N. Lasker, shines light on healthcare-based volunteering in developing contexts. While it does not explicitly focus on aging, this book poses a bold and poignant question: Does international medical volunteering really help patients?

Developing countries struggle with both acute diseases such as malaria that are less prevalent in developed countries, as well as many of the same chronic diseases, such as diabetes, that routinely affect people in nations like the United States. According to the World Health Organization, chronic diseases, which often impact older adults, are the leading cause of death or disability in the world. Many medical professionals who volunteer abroad often end up treating patients with such chronic diseases.

For example, International Volunteer HQ – a large volunteer-host connection service – offers North American medical tourists the opportunity to work with older adults in Argentina, Colombia, Guatemala, Sri Lanka and Zambia. Another NGO, UBELONG, offers short term volunteer trips to Ecuador, Costa Rica, and Peru. Other programs, such as the volunteer surgeons who perform cataract operations, also target diseases that primarily impact older adults.

In Hoping to Help, Lasker investigates the impact of global medical volunteerism on patient health. She finds little evidence that global medical volunteer trips are actually helpful to the patients:

  • Lasker points out that most trips have no follow-up. Thus it is impossible to determine whether the patient benefited from medical care.
  • Most trips do not provide long-term solutions to chronic diseases; many individuals were prescribed medication –for example, blood pressure – without having access to a sustainable supply of the medicine. Once the volunteer leaves, the patient may become worse. Even a seemingly innocuous treatment, such as medication to reduce hypertension, can lead to a rebound hypertensive effect.
  • Finally, volunteer medical students or nurses will often conduct procedures or give treatment that is outside their scope of practice in their home countries.

The positive or negative effect on the health of patients treated by these practitioners are not well known, but it is safe to say that the impacts of global health volunteering are not all positive. There are many debates about the possible good or harm international medical volunteers can do to host communities – while some have compared the practice to colonialism, others have defended the noble intentions of these programs. What this debate leaves out, however, is the patient’s version of the story.

For individuals who wish to volunteer and contribute to aging in developing nations, Lasker’s book serves as a useful guide. She clearly delineates the positives and negatives of the programs. Volunteering is one way to help aging individuals in developing countries, but an investment in infrastructure development in the health sector will have a more meaningful, long-term, and sustainable impact.

Grace Mandel is a project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND) at the Baltimore City Department of Health.

Open Your Eyes: A Journey from Darkness to Sight

Open Your Eyes is a recently produced documentary on the impact of cataract surgery in Nepal. The film shows the transformation of health-related quality of life for older adults with access to medical care. In the film, Manisara and Durga make the long journey to get cataract surgery. Both husband and wife are blind and depend on family members for their most basic needs. Despite being blind, Manisara and Durga help care for their grandchildren and have an important place in the family. Their journey to the city is filled with nervous trepidation, but after the surgery, both are able to see their grandchildren and contribute to valuable work that benefits the entire family and community.

Open Your Eyes highlights the successful use of foreign funds to combat treatable diseases. The funding helps develop sustainable infrastructure and pays for many public health interventions such as cataract surgeries. In a previous article titled Hoping to Health, Global Health Aging reviewed the impact of NGO’s working on health including the effect of global health volunteering. Such efforts look very different in the Lions Club of Nepal – a club established by the service membership organization Lions Clubs International – where medical volunteers are Nepali citizens.

Overall, some questions were not addressed in the documentary. It was unclear if there was adequate follow-up care to prevent infection. And while Manisari and Duraga had no complications, both would have been virtually unreachable if they needed medical attention after they returned home. Cataract surgeries have a positive health impact due to their low complication rate and high degree of efficacy. It is not clear, however, that this model would translate for more risky procedures. In the end, Open Your Eyes does not discuss the challenges of bringing medical care to rural areas. Instead, it makes a compelling case for older adults as valued members of society who deserve quality care. Check out the trailer!


Grace Mandel is a project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND) at the Baltimore City Department of Health.

Alone Together: Why We Expect More from Technology and Less From Each Other

Sherry Turkle is a professor at MIT who views artificial intelligence and technology through a sociological and psychological lens. In the first half of her most recent book, Alone Together: Why We Expect More From Technology and Less from Each Other,  Turkle addresses the impact of technology on older adults. Technology advances such as robotics and assistive technology are making headway in society, especially in elder care. These new technologies can provide some comfort or care for older adults with chronic diseases. Turkle’s focus, however, is on the substitution of robots for human interaction and the emotional aspect of care performed by another human being.

Turkle conducts experiments where she brings different types of robotic technology such as AIBO, My Real Baby, and Paro the Seal into nursing homes. These robotics provide companionship and not practical assistance. For instance, many older adults began speaking to their robots, going over important life events and reminiscing about old times. They found that spending time with the robot reduces anxiety and isolation. The impact of My Real Baby, an “interactive learning doll”, was particularly significant in experiments because it gave older adults a sense of purpose. The My Real Baby doll needed comfort, changing, and other activities that made older adults feel needed (105). This promotes higher quality of life for older people.

Turkle also conducts research involving children, where children discuss the role of robotic technology in their lives. The children profiled in the book worry about technology replacing real human interaction. One child says, “that grandparents might love the robot more than you… They would be around the robot so much more.” (75). Another child worries “that if a robot came in that could help her [grandmother] with falls, then she might really want it… she might like it more than me.” (75). In her discussion of experiments conducted in nursing homes with the doll, My Real Baby, Turkle finds that older adults do not want to give the doll back at the end of the experiment (111). One grandmother even ignores her grandchild who is visiting to take care of the hungry doll (118).

What Turkle does best in this book sharply contrasts the ideal situation of having loving children or family who can visit and provide social interaction to the reality of isolation in many older adults. While Turkle acknowledges the barriers to artificial intelligence and technology as companionship for older adults, they surpass the alternative of no social interaction at all. She notes, “If the elderly are tended by underpaid workers who seem to do their jobs by rote, it is not difficult to warm to the idea of a robot orderly”. (p. 107).  She then points out that when given the choice between interacting with robots and interacting with a member of the research team, almost all of the older adults chose a member of the research team (p. 105). At the end of the day, these robots are not capable of producing the same amount of interaction and support as a human being. Turkle muses, “An older person seems content; a child feels less guilty. But in the long term, do we want to make it easier for children to leave their parents? Does the ‘feel-good moment’ provided by the robot deceive people into feeling less need to visit?” (p. 125). Robots providing clinical care may be an ideal solution to the shortage of workers caring for an aging population, but are no replacement for social interaction.

Grace Mandel is the project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (BFRIEND) at the Baltimore City Department of Health.

One Child: The Story of China’s Most Radical Experiment

One Child: The Story of China’s Most Radical Experiment by Mei Fong presents a compelling analysis of the impact of China’s “One-Child Policy” on older adults. The one-child policy, a compelling story of population control for economic growth, has long term implications that are only now apparent. Fong describes the challenges of a rapidly aging population as she focuses on families who are struggling to care for older adults, and those who have no children to care for them in old age.

Published November 2015

One of the book’s most gripping stories is of parents during the 2008 Sichun earthquake. According to official reports, “eight thousand families lost their only children in the disaster.” (p.3) These parents, and other parents who have lost their only children, face barriers in accessing nursing homes, health care, and burial plots. Fong notes, “they are also more financially vulnerable than ordinary retirees, and more prone to depression, studies show.” (p. 41) While these challenges are tangible, the emotional challenges of losing support systems in old age is also a prominent problem. Fong addresses the growth of China’s hospice industry, stating that many older adults without family feel unable to contribute to society. (p.151)

The book also digs into the cultural complexities in aging and filial obligation. In one notable story, that received national acclaim in china, Liu Ting brought his mother with him to college, when she was too ill to care for herself. His mother suffered from kidney disease and uremia. Although Ting received fame and attention, his job opportunities after college were limited at the expense and time required to properly care for his mother. (p. 92)

While Fong discusses other implications of China’s one-child policy such as rise in adoptions, increase in bride prices to compensate for the greater number of men than women, and the further consequences of sex-selective abortions, the primary implications of the policy relate to the care and treatment of older adults. With only one child per two aging parents, the traditional way of caring for Chinese parents will cause economic slow down, and place burdens on the younger generation.

Fong is at the forefront of a wave of journalism that will detail the challenges of aging in China. She acknowledged that it could be difficult to find many children who were burdened by caring for aging parents, as more parents of children from this time period are in their 50’s and 60’s (p. 86) However, her book is at the forefront of a problem that will only become more prominent in the coming decades.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

Breaking Down the Stigma of Loneliness in Denmark

In Denmark, there is a stigma associated with being alone. In fact, it may be more socially acceptable to say you have depression, than to say that you are lonely. As a result, there are no cultural safeguards that tackle loneliness in Denmark, especially among the aging.

According to a 2015 report titled *Ensomhed i befolkningen (Loneliness in the Population), 2.6 percent (12,000) of adults between the ages of 65 and 79 reported feeling lonely. Among adults over 80 years of age, almost twice as many (21,000 people) reported feeling lonely. It was also reported that some 210,000 Danes aged 16 years or older have experienced loneliness, over 15 percent of whom were 65 years or older.

One of the biggest reasons loneliness needs to be addressed in Denmark is that it poses several health risks. The risk for illness and early death *increases by 50 percent when people do not have meaningful contact with others. Additionally, loneliness has been linked to increased hospitalizations, and a need for psychiatric treatment. Several studies have also equated long-term loneliness to smoking and obesity.

The good news is that policies and programs to reduce loneliness among older adults in Denmark have been operating for several years, and are especially used in senior care homes. These programs include activities that aim to create opportunities for socialization and strengthening social networks, intergenerational activities – where older folks socialize with younger people instead of just their peers – shared meals, and baby and pet visits.

There are also programs put in place by specific neighborhoods to take care of the seniors living in the vicinity, such as storytelling evenings, outdoor trips, and exercise-buddy systems. In 2014, Ældre Sagan (Dane Age) established the social project *Folkebevægelsen mod Ensomhed (the People’s Movement Against Loneliness), which aims to reduce the number of people who experience loneliness in half by 2020, by raising awareness, breaking taboo, and fostering togetherness through targeted social arrangements.

Another such initiative, “Denmark eats together”, brings different generations and people from diverse cultures together during mealtimes. They currently partner with over sixty schools, organizations, municipalities. The national movement kicked off in five cities in April 2016, and saw hundreds of local and private teams, large and small, urban and rural, take a stand against loneliness by inviting others to join them for a shared meal.

Programs targeting loneliness in Denmark have reduced the number of lonely adults over age 65 from *65,000 in 2010 to *33,000 in 2015. Three prominent drivers that mark the success of these programs are

  • the range of activities they provide
  • the fact that they actively reach out to vulnerable groups
  • their ability to provide transportation to and from events

*WeShelter in Denmark, a community of social services working with people who are homeless or disadvantaged in Copenhagen, is participating in projects to share their experiences with social groups and social food clubs. One current project is documenting the effects of volunteer work on loneliness experienced by older, formerly homeless adults.

Apart from such targeted activities, a growing number of older learners are taking short education courses offered to adults in Denmark. Some education programs also specifically foster intergenerational environments, as they believe these types of courses have benefits for both younger and older learners.

As we have seen, there are a number of different ways in which pockets of Danish society are recognizing and dealing with the issue of loneliness. It is now time to destigmatize loneliness in mainstream culture as well.

*Some references are in Danish but can be translated to your language of preference Google Translate.

Carrie Peterson covers Europe for Global Health Aging. She is a Gerontologist and Consultant in eHealth and Innovation.

Technology for the Tech-Shy: Designing New Applications for Older Adults

In the digital and connected world, older adults are seemingly left behind. Tech companies continue to design products that cater to young adults, even in the generation of social media. As phone calls and snail mail are dangerously slow and outdated, why should the elderly not benefit from advances in communication? Fortunately there is a growing number of mobile and tablet applications that cater to the elderly population. These apps help to improve quality of life and communication channels with family, friends and healthcare providers.

For example, Oscar aims to enhance the lives of seniors as well as help seniors keep in touch with their family, friends or caregivers. Oscar is an easy-to-use, remotely managed communication tablet app that allows tech-shy elderly known as the ‘seniors’  to remain connected with family, friends and healthcare professionals known as the ‘juniors’. The app boasts of a simple interface which allows users to communicate via text, pictures, voice and video calls. Additionally, it provides a ‘Live View’ of the application on the elder’s tablet and allows the ‘junior’ to fix or update relevant items remotely. The technology also provides reminders, weather alerts and games. Apart from communication, Oscar is a platform for apps with the possibility of adding or removing applications depending on the user’s proficiency and interest. Keep your eyes peeled for the iOS version that is coming soon!

Photo Credit: Pixabay
Photo Credit: Pixabay

Two finance applications that target the elderly are Mint and Check. Like Oscar, both apps boast of simple interfaces which present relevant financial data in one simplified format. Both applications also provide reminders for paying bills, tracking payments, and helping with creating and managing budgets. A primary difference is that Check is only available on Apple iPads, while Mint is available on both Android and Apple operating systems.

In addition to communication and finances, healthcare is another important consideration with the elderly population. WebMD and Blood Pressure Monitor are great applications, allowing seniors to monitor and learn more about their health. Finally, there are a whole host of games apps to improve cognition and memory such as Luminosity and Elevate. Luminosity focuses on cognitive abilities, while Elevate focuses on reading, writing and mathematics. Both are fun, and we encourage everyone to check them out!

While being acutely aware that some of these apps are only accessible to people with adequate financial resources, such people can invest in mobile applications to remain connected, enlightened and lead an improved quality of life.

Seniors are part of the digital world, hence they should benefit from advances in communication than be left behind. The goal is to design products, free or cost-effective, which will improve the quality of life of older adults. It is, therefore, encouraging to see a number of companies collaborating with seniors to design great products. Since technology can also benefit this population, corporations are recognizing the value and contribution of older adults.

Oscar, Mint, WebMD, etc., have great potential to improve health outcomes among the elderly as well as provide a comfortable and healthy life. The video below shows more useful apps for the elderly.

Namratha Rao is pursuing a MSPH in Social and Behavioral Interventions in the Department of International Health at the Johns Hopkins University Bloomberg School of Public Health. 

Aquatics Programming

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 4 in this series. Part 1 focused on the aquatic therapy marketplace, Part 2 focused on selecting an aquatic practitioner and Part 3 focused on selecting an aquatic facility. Thank you for reading!

Aquatics Programming may be found in a class format or individual, one-on-one, personal training. Variances occur when the instructor is in the water or on the pool deck; the instructor can be demonstrating moves or simply observing.  In one-on-one training, a physical therapist may demonstrate on the pool deck and then oversee land-based exercises to be performed in water. This article will present an overview of just aquatic therapy programming–oftentimes misconstrued by physicians and other healthcare providers as water aerobics, as they have not learned to differentiate between aquatic exercises and therapies.

Photo Credit: Pixabay
Photo Credit: Pixabay

Within aquatic therapies, class formats are usually considered “active” therapies, meaning the therapist is demonstrating moves to be performed by the participants using visualization or verbal cueing to effect the desired movement(s). “Passive” therapies require the therapist to be in the water with the participant, physically manipulating the participant in a one-on-one mode of care.

Active therapies are by far the more commonly observed practices in either class or personal format. In active therapies, the practitioner can be demonstrating the moves whether on the pool deck or in the water. Many participants prefer a practitioner on deck where moves can be easily seen and more closely modeled by the participant.  However, there are unknown advantages to having the practitioner in the water with the participant(s). The practitioner can more concisely cue the participant to specific considerations that may be experienced in water, not commonly observed or experienced when the move is performed out of the water. For instance, a leg lift to the side, when performed on deck, is more easily aligned when the buoyancy and resistance of the water is not altering the form of a truly lateral abduction. When a practitioner instructs from the water, he or she may lift the leg sideways but it may be forward of the midline of the hip joint. By cueing the participant to turn the toes inward, the outside of the ankle leads the abduction, effecting a more true lateral abduction. The slight turn inward of the toes strengthens the leg muscles needed to perform the movement, which then translates to a more stable leg lift on land. This is because the muscles have been trained more strongly against the added resistance of the water.

Physical therapists who do not have aquatic training may never come to understand this variance in experience between land and water. Therefore, they can not ever use the water to its fullest multi-planar or “omni-directional” benefit. To be fair, even people trained in aquatic therapy may not become fully aware of this omni-directional efficacy unless they have spent a lot of time in the water, performing the movements they instruct the participants to carry out.

In class formats, there are many kinds of therapies that can be conducted: Yoga, Aqua Stretch, Aqua Pilates, Ai Chi and Watsu are some examples. While Watsu is a “passive” therapy, meaning the practitioner is usually the one to move the extremities of the participant, a therapist can lead a class of paired participants and cue and observe each pair in their therapy. Likewise, Ai-Chi-Ne is a paired participant therapy class. For the purpose of example, a brief explanation for Ai Chi will be included in this article.

Ai Chi, a Japanese aquatic therapy, is oftentimes confused with the land-based Chinese Martial Art, Tai Chi. In a lot of ways, the practices are similar and the newer Ai Chi is based upon the martial art. However, when done in water, Ai Chi accomplishes different objectives of wellness and mind/body self-care. It has a very restorative, if not healing effect when practiced regularly. Moreover, Ai Chi coordinates controlled fluid movements with deep, diaphragmatic breathing in through the nose, but out through the mouth. Its relaxation effects are bridging the mind’s control of the body through the control of breath. It is said that, “the breath is the bridge between the mind and the body.” When practiced regularly, the healing effects of the therapy can be profound. Ai Chi is a cultivation of the energies in and around the body, drawing in healing energy and expelling toxic or harmful stressors.

In a one-on-one aquatic therapy session, a powerful bond is created between the practitioner and participant when both are in the water. Inexplicably, the shared common experience endears the participant to the practitioner, establishing a stronger trust and respect than when a practitioner stays dressed in street clothes, sits on a chair on the pool deck and perhaps keys entries on their computer, while the participant completes the instructed movement(s) or repetitions of a move.

In sports therapy pools, the trainer is like the therapist on the pool deck, but expensive underwater video and monitor equipment enables the trainer to observe the form and kinesiology of the participant. This insures proper  form and alignment therefore maximum potential for improvement. The trainer is also acutely focused on the athlete whose sole objective is to increase maximal performance. Non-professional athletes do not have the luxury of such intensive observation and performance monitoring…unless, of course, the therapist puts on a dive mask or goggles and watches closely with their head under water. Granted, some observations can be made by either the trainer or therapist from above the water’s surface. However, the added benefit of underwater observation can improve the outcomes. If not, sidewall windows in therapy pools would not be created with outside video cameras transmitting or recording the movements within.

Finding an aquatic therapist who is willing to get into the water and observe under the surface can be one’s best investment in personal aquatic programming as well as possibly insure the best possible outcomes for the participant. In many cases of aquatic therapy, it is not reasonable or justified to have a physical therapist treat patients on the same day he or she works as an aquatic practitioner. After all, their time is billable hours and transitioning from land to pool and back again is valuable billable hours lost. Aquatic therapy associations can do more to benefit participants and promote best possible outcomes by lobbying for changes in both insurance coverage and licensing for their members.

Another consideration for programming is music. In many therapy settings, a background accompaniment of soothing music can enhance the experience, aiding in relaxing the participant and helping to center and focus the mind. Quiet times in natatoriums are a rare occurrence in some facilities hence the use of soothing music necessitates the quiet environment.

Physical therapy practices that have therapy or warm water pools are far more likely to have opportunities for quiet times as well as access to sound systems and music that fit the therapeutic objective. Community pools, YMCAs and other athletic clubs are not likely to provide such experiences, except at some limited or designated times.  However, many physical therapy practices do not have pools, largely because of the expense. They may only offer aquatic therapy using other facilities where the noise must be tolerated, and therefore cannot offer therapies in quiet classroom formats.

When considering aquatic therapy, programming is one component of the total experience that needs consideration. The skills and credentials of the practitioner, along with the features of a facility, make aquatic programming play a significant role in the participant’s decision to pursue one of the most effective means of self-care currently available in 21st century America.

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.

Selecting an Aquatic Practitioner

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 2 in this series. Part 1 focused on the aquatic therapy marketplace. Click here to read Part 3.

Photo Credit: Ann Fisher
Photo Credit: Ann Fisher

Over the last thirty years, the field of aquatic therapy has steadily grown in US allied healthcare. Insurance companies that reimburse for aquatic therapy ONLY reimburse for a licensed physical therapist or maybe a physical therapy assistant. Depending on the state, there are some workarounds like a certified instructor being employed by a physical therapy practice or hospital. All too often, though, the employers err on the side of legal caution, fearful of liabilities which may be inherent in land-based physical therapy but seem almost non-existent in aquatic therapy.

Out of respect for those licensed in physical therapy, Aquatic Therapy Rehab Institute (ATRI) certified instructors, who do not have a degree and license in physical therapy, are discouraged from calling themselves “aquatic therapists”. Physical therapists, however, are not required to have aquatic certification to bill for aquatic therapy. So, if you are in need of aquatic therapy, perhaps as pre-operative conditioning or after your insurance allowable coverage for physical therapy has been exhausted, what can you look for in an aquatic professional?

Many reputable organizations either post or offer access to staff biographies. Like they do in the physician offices, those practicing aquatic therapy should specifically display their credentials. A certificate, license or degree from a bona fide organization can be a first tier requirement. Certifications usually require professionals to obtain continuing education hours to maintain credentials. This must be done every two years or less, and professionals should display the one that is relatively current.

Certifications from organizations like ATRI, Aquatic Exercise Association (AEA) and Aquatic Therapy University (ATU) may give an indication that your practitioner has met certain stringent requirements to authenticate their expertise. ATU has more recently been established specifically to target degreed professionals in both physical and occupational therapy. In some instances, even speech pathologists are obtaining certifications as evidence is now emerging on warm water activities. The soothing effects of such activities can advance progress in remediating stroke, traumatic brain injury (TBI) deficits or other speech pathologies, including some oral cancers.

Across all three certifying organizations, a broad and sometimes intensive proficiency needs to be demonstrated. This includes sufficiently answering test questions governing anatomy, physiology, kinetics and some physics as it pertains to water properties, as well as skill demonstration, especially when performing physical manipulations in the water.

Even when a licensed physical therapist is practicing aquatic therapy, it is important to know what additional training and credentials the aquatic professional may have by a certifying organization. All the knowledge of anatomy, physiology and kinesiology may not be as helpful if the practitioner has not spent a significant amount of time in water experiencing how the body works differently on land and in waist or shoulder deep water. It is more important that the aquatic practitioner have a deep understanding of how the properties of the water can be used to best achieve the functional goals or milestones of the participant.

Thus, beyond finding credentials, seeing is believing. Take time to observe your aquatic practitioner and ask permission to observe – perhaps make a video with your cell phone or take notes. Compare one practitioner to another or better yet several others! Look to find many of the following qualities:

  • Clearly defined milestones and functional goals/expectations of outcome;
  • Workload progression that supports goals: meaning variances in
    • time to accomplish an exercise;
    • range of motion;
    • effort or exertion;
    • depth of water used;
    • length of extremity in activating a particular joint;
    • exercises performed where extremities are operating in different depths;
    • exercises performed where extremities are operating in different planes;
    • use of equipment such as drag and buoyancy equipment;
    • cadence/rhythm/speed;
    • breath cueing and control (when to inhale and exhale; diaphragmatic breath);
  • Attentive observation of and note-taking about the patient (some PTs bring their laptops poolside and pay more attention to their computer than their client);
  • Apparent knowledge of how to make modifications of exercises to insure progress without pain or injury;
  • Cheerful disposition and encouragement based upon progress toward goals.

With all or most of these objectives meeting your approval, ask to speak with the professional and ask for referrals. In some cases, aquatic practitioners are award winners in their fields. They may have published research articles or been written up in a local paper or support group newsletter. Be sure to contact references and add their comments to your observation notes. It is best to have a conversation with a prospective aquatic specialist to make sure you communicate easily and understand their instructions. Sometimes, communication disconnects can derail the most qualified professional’s efforts to guide you toward your functional goals.

This kind of upfront investment in your self care may prove the best return for not just your dollar, but more importantly your well-being. After all, your health is your greatest wealth!

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.


Ukraine: How War Affects the Elderly and Health Systems

Since the war between pro-Russian separatists and government forces in Eastern Ukraine began, living conditions have changed for the worse. A war always affects the weakest and most vulnerable population. In Ukraine, more than a million people have been displaced from their homes; 60% of those are elderly. In some cities and villages, most people stayed because they were too old, disabled, or just did not want to leave their homes. They had to find shelter in their basement or hide out in bomber shelters for months during gunfire.

Living conditions have been appalling and the winter especially caused havoc. The cold and stress worsened the health conditions of all Ukrainians, particularly the elderly, many of whom already suffer from chronic illnesses and cannot defend themselves like the younger population. Last November, the government cut off services to all rebel-held areas. As a result, the elderly have not received their pensions in months and are dependent on food donations for daily meals. People are in danger of starvation in many villages and most elderly have lived without electricity and water for the last few months. Water may be available at wells, however, those may be difficult to reach and the quality of the water cannot be guaranteed. Besides the lack of food, there is also limited access to basic health care and medical supplies for elderly. Health workers have left the hospitals, medical facilities are damaged, and shelves in drug stores are empty. Many elderly die from treatable chronic conditions such as hypertension or heart problems due to poor living conditions, lack of treatment and medicine. No one knows how many have died by now since no one keeps track of the deaths related to malnutrition or medical shortages.

Thankfully, non-governmental organizations have come to Ukraine to help. Médecins sans Frontières (MSF)/Doctors without Borders is an organization that has provided medical services for people in Eastern Ukraine. People can call and be seen by a nurse or doctor at home. MSF also provides mobile clinics where up to sixty people per day can be seen at any advertised location. Dr. Polyakov, a MSF doctor in Donetsk, Ukraine, tells the New York Times that so often he has to turn away patients because he does not have the right medications in stock or the prices for the ones available have risen substantially and can no longer be afforded by his patient. Around 90% of his patient population is elderly. The doctor’s work is challenging as Ukraine puts limits on the kind and amount of supplies that they can bring into the country and eventually use. In addition, United Nations workers need special documents to travel through the war-torn area, which limits the delivery of aid and causes the crisis to worsen.

During war time, the most vulnerable population is the one suffering the most. The elderly need special care and often do not have the coping mechanisms to deal with stress and anxiety. In Ukraine, the elderly are dependent on aid from non-governmental organization such as Doctors without Borders. We can now hope that the crisis will end soon and the elderly will receive the basic health care they need to survive.

Martina Lesperance is a Health Educator and Screening Technician in El Paso, Texas.