Robots and other high-tech help are close at hand. But is it the kind of help we want?

In the picturesque hills of California wine country, 87-year-old Ernesto is enjoying retirement. He plays cards, naps in the sun, snips roses from his garden and largely takes care of himself -- despite suffering from heart trouble and forgetfulness and having only occasional visits from his far-flung children.

When it's time for a dose of medication, Ernesto's watch beeps to rouse him from a nap and even tells him that he needs to take the pill with food. When Ernesto leaves the stove on and walks away, the burner soon shuts off automatically.

Even the card games are more than they seem. When Ernesto plays solitaire on the computer, his physician is able to peek in to monitor the older man's response time and cognitive functioning. Sensors placed throughout Ernesto's house track whether he gets out of bed, bathes and eats regular meals. Though his children live 100 miles or more away, they are able to check frequently to see how and what their father is doing, with just a click of the mouse.

Welcome to the future of aging, or at least what the technology industry would like it to be. Companies such as Intel Corp., Philips Electronics NV and Accenture Ltd. are hoping to turn an aging population into a new customer base by developing tools for the home that try to be as unobtrusive as possible while keeping people safe and connecting them to the outside world. Although Ernesto is a fictional character, in a promotional DVD co-sponsored by Intel, many companies are testing prototypes of tools similar to those he uses.

Numbers, of course, are driving the trend. By the year 2050, about 21% of the U.S. population will be age 65 or older, compared with 12% in 2000, according to the Census Bureau. Already, almost 40% of U.S. spending on health goes toward people 65-plus, much of it from the government programs Medicare and Medicaid, according to the nonprofit Kaiser Family Foundation.

With health-care budgets stretched to the breaking point -- and with health-care workers in short supply -- improved use of technology is widely thought to be a solution to meeting the growing needs of an aging America. 

Ideally, new tools will help people live in their homes longer, thus reducing the need for care in costly settings like nursing homes and hospitals. Another goal is to help make monitoring of conditions like diabetes and heart disease more affordable and efficient.

"Where we've spent money on technology is in hospitals and operating rooms...but we do so little to care for a person before they get to the hospital and after they get out," says Russ Bodoff, executive director of the Center for Aging Services Technologies, a Washington, D.C., group formed three years ago to advocate for greater attention to the potential for technology to respond to the problems of aging.

Orwellian Overtones

A major question for technology companies developing systems for home use is whether people will want to be monitored. Intel's market research shows that, "in general, the answer is yes. They see value in the system," says Stephen Agritelley, acting director of health research and innovation in the company's digital health group. But they don't want information simply to be collected and sent to a third party. While that might be appropriate in some cases, it's "kind of big-brotherish," Mr. Agritelley says. Instead, he says, older adults prefer to have more control and to get reminders to take a pill sent to them.

Other challenges are to create products that will be easy for older people to use and will blend into their homes, to avoid stigmatizing them as needing extra help. Health-monitoring technology would advance more quickly if there were a uniform set of standards for recording and transmitting electronic health information, an effort only recently begun by the government and the private sector.

Recently, dozens of companies and university researchers demonstrated products targeted at older adults at the White House Conference on the Aging in Washington. Many are still in the testing phase.

Intel is making one of the biggest commitments to health-care technology. The company has sent ethnographers, who study human culture, to older adults' homes to figure out what products would be attractive. In Washington, the company demonstrated a program that resembled caller ID "on steroids," as Eric Dishman, a member of Intel's digital health group, put it at the conference. If someone knocks on the door or calls on the phone, a photo pops up on a computer screen, along with notes about who the person is and what was discussed the last time they were in contact. "It helps reduce dependence and social isolation," Mr. Dishman said.

One major category of technology at the exhibition included tools to improve remote monitoring of patients, so physicians and nurses can frequently check on patients without an in-person visit or so older individuals become more involved in their own health care.

Philips Electronics recently released Motiva, a broadband-based platform that delivers health information through a person's television. The system can send personalized educational information, such as videos about health conditions. 

Patients also can monitor their weight, heart rate and blood pressure using Philips wireless devices, and get feedback through the television system about how they're doing.

Robo-Doctor

Another example of remote health care comes from robotics company InTouch Health Inc., which has developed what it calls a Remote Presence robot. The robot stands 5½ feet tall and has a computer screen where a person's head would be; the screen broadcasts the face of a physician, who controls the device remotely. At the moment, about 60 of the robots are being used in hospitals and some nursing homes for checking on patients.

With the robot, "you can do anything you can do in person, but you don't have your hands," says Yulun Wang, chief executive of Santa Barbara, Calif.-based InTouch and an electrical engineer by training. "You can talk to the patients, interact with them. You can tell if they're alert or in pain and look at the fluids around the bed." Another advantage of the robot, says Dr. Wang, is that it alleviates some privacy concerns by coming in and then leaving after the exam is over, just as a person would. "Patients don't like having cameras on them all the time," he says. It also permits a physician to speak privately with family members or health professionals.

Another use of technology is to track seniors' whereabouts, making sure they're safe or checking that they're doing normal daily activities like eating and taking medications. HomeFree Systems Ltd.'s Personal Watcher wristwatch can track its wearer, by beaming signals back to a wireless network. It also can show the person's temperature and indicate whether the device is being removed.

ADT Security Services Inc., a unit of Bermuda-based Tyco International Ltd., has a new line of digital devices that monitor medication compliance, track vital signs and send reminders for healthy behaviors. Cleveland-based Eaton Corp.'s Home Key, which looks like a key fob with a small screen, can be paired with sensors to help older adults living on their own make sure they have closed a garage door or turned off the kitchen faucet.

Accenture, based in Bermuda, is testing an online medicine cabinet, complete with face-recognition capabilities and a female robot voice. Instead of a mirror, one door of the cabinet is outfitted with a computer screen. For a person with allergies, the screen would show the day's pollen count and recommend taking a pill if necessary. If the person chooses the wrong pill bottle, sensors in this "smart appliance" will pick up the mistake, and the robot voice will intervene.

Lots to Prove

No matter what good ideas are in the works, many of the companies pushing the technology acknowledge there are big barriers to widespread adoption. A big issue is money. Even though the technology is designed to reduce treatment costs in the long run, the prices of many of these gadgets -- whether the potential market is a hospital, nursing home or a family -- are likely to be high. And in most cases, companies have yet to prove that they will accomplish their stated goals of higher quality medical care, improved lifestyles or lower health costs.

"Right now I think everyone is trying to prove these things work," says Gregg Malkary, managing director of Spyglass Consulting Group, a Menlo Park, Calif., provider of market research for technology companies. That's a crucial hurdle if companies want government programs or health insurers to begin reimbursing for care provided electronically or by robots.

Perhaps the biggest issue is to get the nation, including the government, to think seriously about how to deal with the aging population.

"Our crisis is going to hit in the next 10 or 15 years," says Mr. Bodoff in Washington. "We're generally not preparing for it."

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