1. The demographic trends are baked in: By 2030, 1 in 5 Americans will be over 65. The UN projects the global 65+ population will double to 1.6 billion by 2050. This is not a forecast that depends on assumptions. It’s driven by current demographics, and you can’t argue with the math.

2. Big money is involved: Those aged 70+ control 32% of US wealth. Medicare alone spent $944 billion in 2022. By 2029, the federal government is projected to spend half of its budget on social services and healthcare for people aged 65+.

3. Low technology adoption despite clear need: Older adults face real, daily challenges (declining mobility, cognitive changes, social isolation), yet the tools available to support an aging population don’t meet people’s needs. Many senior care facilities still run on paper records and disconnected systems. Remote monitoring, fall detection, and caregiver coordination tools exist but none have achieved wide-scale adoption. Three in five adults 50+ say that technology is not designed with their age group in mind. The gap between what technology could do and what it actually does for older adults remains surprisingly wide.

Through the lens of a technologist, this looks like a space of enormous opportunity. The math is straightforward: an aging population coupled with healthcare spending that dwarfs most other sectors, all underpinned by genuine quality-of-life problems, creates what should be a venture capitalist’s dream. On paper, the thesis is perfect.

But the Math Doesn’t Add Up

In a prior post on AgeTech unicorns, we took a closer look at the billion-dollar outcomes in the space. The picture was sobering.

Much of what gets counted as AgeTech is really healthcare technology that serves an older patient population. The harder, less explored category is technology built around the daily experience of aging: staying independent, staying connected, staying safe at home. Almost all billion-dollar outcomes in the space have come from healthcare platforms. The companies tackling aging-specific problems outside of clinical care have produced very few.

For the purposes of this post, I define AgeTech as technology that directly serves older adults and their caregivers, whether through healthcare delivery, daily living support, safety monitoring, social connection, or care coordination. "Longevity Tech," by contrast, targets people who want to avoid the impacts of aging, not people who are already navigating it. To put it simply: Longevity Tech is for the 35-year-old looking to stay fit while AgeTech is for the 75-year-old trying to stay in her home.

The contrast between AgeTech and Longevity Tech is stark. In 2025, AgeTech attracted $700M in venture funding. Longevity Tech attracted $8.5B the year earlier. Though these two categories are often lumped together, their fates could not be more different. Longevity Tech benefits from consumer enthusiasm for wellness, anti-aging, and biohacking — markets with existing demand and viral appeal. AgeTech is building for a population that the tech ecosystem has largely overlooked.

So what’s going on? The opportunity is real, but the path to scale is riddled with structural challenges. These challenges look different depending on whether a company is selling directly to consumers (B2C) or to organizations (B2B). In both cases, the standard tech playbooks fall apart.

I share these observations not to discourage anyone from entering the space, but so that founders and investors can go in eyes wide open about how their startup needs to be built to address them.

The B2C Challenge

Most consumer tech companies grow through some combination of low-cost distribution, virality, and high retention. The historical pattern is predictable: build something compelling, make it easy to find, rely on word-of-mouth to accelerate growth, and keep people coming back. In AgeTech, each of these levers is harder than it looks, and in some cases, they don’t work at all.

Product design approach must be inclusive

User requirements for ease of technology are incredibly high in this market. Older adults have less patience for products that don’t deliver immediate value. The tolerance for buggy MVPs or “figure it out as you go” onboarding doesn’t fly here. Things need to work immediately, in the first couple minutes. If they don’t, the customer churns, often permanently.

Design requirements are also specific to older adults and need to be considered from the start. Swiping gestures, for example, are harder for people with reduced dexterity. Small text and low-contrast interfaces create barriers. Standard UX patterns that work for younger users can be unusable for the target audience.

The identity barrier

Beyond usability, there is a deeper identity issue: people generally don't like to adopt technologies that make them feel old, and very few preemptively seek out assistive technologies that may come in handy at a later date. The dedicated fall detection pendant is a case in point. The technology has been around since the late 1980s, when Life Alert first launched. Nearly four decades later, only about one in ten adults 65+ uses a medical alert device, even though one in three falls each year and fall-related injuries cost $80 billion annually. The product works, but it signals frailty.

The most successful consumer products for older adults tend to be the ones that don’t look or feel like “aging products” and are straightforward and easy to use. This is a narrow design window that most startups struggle to hit.

No viral loops

Most consumer tech companies grow through some combination of organic sharing, referrals, and network effects. This playbook breaks down when the user base is less digitally connected. Many older adults aren’t on Instagram, aren’t browsing Product Hunt, and aren’t texting friends referral links. Even when an older adult loves a product, the likelihood of organic sharing is meaningfully lower than in other demographics.

In consumer tech, a great product can acquire millions of users through organic sharing alone. In AgeTech, even the best product might need to be hand-sold one family at a time.

No natural distribution channels

The distribution channels that do exist for reaching older adults are expensive and blunt. Facebook is one of the few digital platforms where older adults are active, but reaching them there means competing for attention through paid ads, not organic discovery. Television still works, but it is a mass-market tool with high costs and limited ability to target. Neither channel lends itself to the kind of capital-efficient growth that consumer tech investors expect.

The channels that do reach older adults in person (healthcare providers, the Village Network, senior centers) are fragmented and slow to recommend solutions. There is no equivalent of the App Store “featured” page for the 75-year-old market. Companies end up relying on direct mail, in-person demos, and referral relationships. All high-touch, and all hard to scale.

Complex buyer dynamics

In many AgeTech use cases, the person paying isn't the person using, like when an adult child signs up for a monitoring service their parent never asked for. This split between buyer and user creates friction that most consumer tech companies never have to deal with.

Starting with the question of “who pays”, the adult child might cover the cost out of concern, but on the other end, the older adult on a fixed income scrutinizes every new subscription. Medicare and Medicaid cover certain devices and services, but reimbursement pathways are narrow, slow to update, and vary by state. Private insurance rarely extends to products focused on daily living or social connection. There is no single, reliable payer for most AgeTech products, and startups end up navigating a patchwork of willingness and ability to pay.

Even when someone does pay, the incentives between buyer and user can conflict. The adult child wants peace of mind. The older adult wants independence. A monitoring system that sends alerts every time a parent gets up at night might reassure the child but makes the parent feel watched. The value proposition that closes the sale is not always the one that keeps the product in use.

This is where adoption breaks down. Even when everyone agrees the product is a good idea, the older adult may have limited comfort with technology or physical limitations that make onboarding difficult. The adult child who bought it may not live nearby to help set it up. Poor Wi-Fi, no smartphone to pair with, or no one to troubleshoot when something goes wrong — all these can lead to many products that are purchased but never fully adopted.

The B2B Challenge

If B2C is hard, B2B presents its own structural headwinds. The organizations that serve older adults are not like the enterprise customers most B2B SaaS companies are built to sell to. This mismatch creates compounding friction at every stage of the sales process and erodes the unit economics that venture-backed companies depend on.

Fragmented and small players

The organizations serving older adults (home care agencies, senior living communities, adult day care centers) are overwhelmingly small businesses. Many are independently owned. Others are franchise players where each location operates semi-autonomously.

Home care is a good example: Visiting Angels, one of the largest home care franchises in the US with over 600 locations, operates through independently owned agencies that each have only a few dozen employees. Selling to Visiting Angels’ corporate office doesn’t mean you’ve sold to its network. Each franchise makes its own technology decisions.

This means that even when a company lands a contract, the deal size is small, and the sales process is just as long and complex as selling to a Fortune 500 company. In senior living, a sales executive of a well-known consumer product shared that the time from first contact to a pilot can be a 6-8 month conversation, followed by a 3-month trial period before any commitment to a broader rollout. The sales cycle may compress when the product solves a sharp, immediate pain point, but many months before seeing meaningful revenue from a single customer is not unusual.

Outdated tech Infrastructure

Many senior care organizations still rely on fax machines, paper records, and disconnected point solutions. Systems are complicated, out of date, and largely un-digitized.

For a startup selling into these environments, the implementation lift is enormous. It’s not just “install our software.” It’s “help us get your data out of this spreadsheet your office manager has been maintaining since 2009.” Every deployment risks becoming a consulting engagement. Consulting doesn’t scale, and it also doesn’t create lasting leverage for the startup. A company that succeeds through custom implementation work has built a business that requires custom implementation work to grow.

Staff turnover compounds training costs

Even when an organization adopts new technology and trains its staff, the benefits are fragile. The senior care industry has notoriously high turnover. Annual turnover in nursing homes can exceed 50%. The person trained last month might not be there next quarter.

This means that customer retention for B2B AgeTech requires ongoing re-training and re-engagement, a cost most early-stage startups struggle to absorb. Training one staff member on a platform doesn’t mean anything if they’re gone in three months and their replacement has never heard of it. The cost to keep the customer successful never really decreases. It’s a permanent drag on profitability.

So Where Does that Leave Us?

Scaling in AgeTech requires more patience than in other tech categories. The sales cycles are longer. The learning curve for customers is steeper, and it takes time for older adults and the organizations that serve them to become comfortable with new technology. Companies that succeed in this space will likely need a larger service component than a typical SaaS business: more hand-holding during onboarding, more ongoing support, more in-person touch points.

This isn’t a weakness of the market. It’s a feature of it that needs to be built into the business model from day one.

The founders and investors who win in AgeTech will be the ones who accept these dynamics rather than fight them. Longer timelines, more service-intensive delivery, and unit economics that look different from typical SaaS benchmarks are not signs of a broken market. They’re the cost of entry into one of the largest untapped opportunities in tech.

Despite well-funded startups and existing incumbents, this space remains a greenfield of opportunity. There is still space to build, still space to establish category-defining companies, and still an enormous population whose needs are not being met by the technology available today.

The demographic wave is coming regardless. The question is whether we can build the companies and infrastructure to meet it.

Are you interested in building infrastructure solutions and collaborating across stakeholders to address these problems? We’d love to connect — reach out at jenny@lightswitchlabs.com.

Alzheimer’s may also be the most feared outcome of aging. In a national poll of adults 50+, Alzheimer’s and dementia ranked as the most-feared health condition, ahead of cancer and stroke.

Because of the magnitude of its impact, tens of billions of dollars have gone into the search for treatment. Progress has been significant, but the disease is biologically complex, and drug development has been slower than many had hoped. For many families, Alzheimer’s is still a painful reality.

What is changing is not that we suddenly “solved” Alzheimer’s, but the ecosystem is reorganizing around earlier identification and longer-term support, and technology is increasingly central to how that happens.

In this post, I map the Alzheimer’s technology landscape across the three stages of the journey: prevention, early detection & diagnosis, and care & management. The goal is practical: to understand what categories are emerging, what’s actually getting adopted in the field, and where the bottlenecks to adoption are.

Why now?

For decades, the dominant cultural narrative (and often the clinical one) has been grim: once you’re on the Alzheimer’s path, there’s little you can do to change it.

This view is starting to change in three ways:

1) Prevention science is getting clearer: The 2024 Lancet Commission report identified 14 modifiable risk factors through a person’s life course, ranging from high LDL cholesterol to hearing loss, that could prevent or delay up to 45% of dementia cases. Most of these risk factors are generally correlated with better health outcomes, but some companies are going a step deeper and developing products that target cognitive health specifically.

2) New drugs are increasing the value of early diagnosis: Recently approved anti-amyloid drugs like Leqembi (Eisai/Biogen) and Kisunla (Eli Lilly), as well as other drugs in the pipeline, have the potential to slow the course of Alzheimer’s for many. But this category of drugs is meant for people with early-stage disease. This necessitates a system where we can detect disease earlier to successfully intervene, which is a capacity it lacks today.

3) Care can still change outcomes: Even after diagnosis, there is still meaningful room to improve daily function, caregiver burden, and quality of life when appropriate treatment and care programs are delivered. Previously, the fragmentation of AD care delivery had made coordination challenging, but more companies, aided by the recent CMS GUIDE introduction, are developing solutions to address that.

Thanks to the many experts who spoke with me about the latest developments in Alzheimer’s disease and technology. In particular, I would like to thank Reza Hosseini Ghomi (Medflow), who inspired me to write this article and was instrumental in shaping it, and Meg Low (Boston University), who helped me better understand the realities of implementing and validating these technologies.

Crash Course: Alzheimer’s 101

1) What is the difference between dementia and Alzheimer’s disease?

Dementia is a syndrome, or a set of symptoms that affect memory, thinking, and daily function. Alzheimer’s disease (AD) is a specific disease process and the most common driver of dementia symptoms. Other causes (e.g., Vascular dementia, Lewy body dementia) have different diagnosis and management pathways and are beyond the scope of this post.

2) What is the underlying cause of Alzheimer’s disease?

Scientists still do not fully understand the main cause of Alzheimer’s in most people, or why it starts when it does. The leading view is that it develops from a mix of age-related brain changes, along with genetic factors, health, lifestyle, and environmental influences.

APOE ε4 is the most well-known common genetic risk factor for Alzheimer’s. About 25% of the general population carry one copy of APOE ε4, and about 2–3% carry two copies, which corresponds to the highest risk. Separately, rare genetic variants can cause early-onset Alzheimer’s, and people with Down syndrome have elevated risk.

3) How has Alzheimer’s traditionally been diagnosed?

Diagnosis often begins with clinical history and cognitive assessment, followed by additional testing to clarify cause. In the U.S., the “obvious” scalable entry point for this evaluation is routine cognitive assessments conducted during Medicare Annual Wellness Visits (AWV). Unfortunately, this still isn’t happening consistently: a nationally representative survey found that among beneficiaries who had an AWV, only 31% underwent cognitive testing.

To properly diagnose AD, clinicians look beyond cognitive performance to underlying brain pathology, most notably beta-amyloid plaques and tau tangles. Structural neuroimaging (MRI/CT) is commonly used, but these are often insufficient to identify Alzheimer’s at the earliest symptomatic stages. More definitive diagnostic approaches have historically been cerebrospinal fluid (CSF) and PET scans, but these are more invasive and costly procedures that are rarely used by non-specialists.

A major recent shift in AD detection is the approval of blood tests as a step to diagnosis. On May 16, 2025, the FDA cleared Fujirebio’s Lumipulse G pTau217/β-Amyloid 1-42 Plasma Ratio to aid in diagnosing Alzheimer’s in symptomatic adults (aged 55+). Though blood tests are not intended as a stand-alone diagnostic test, it is much easier to implement than other diagnostic evaluations.

4) How are pharmaceuticals used in Alzheimer’s treatment?

Drugs play a part in three areas of AD treatment:

1. slowing the disease early on,

2. easing symptoms for a period of time, and

3. treating complications common in dementia, like agitation or sleep problems.

No available drug cures Alzheimer’s or restores neurons that have already been lost.

The major recent advance has been anti-amyloid immunotherapy. Lecanemab (Leqembi) and donanemab (Kisunla) are approved for early symptomatic Alzheimer’s, and in clinical trials, they lowered amyloid levels and were associated with modestly slower decline on clinical measures over roughly 18 months. Uptake has been limited to date, in part because many clinicians and patients question whether the benefits justify the risks and monitoring burden, and in part because these therapies typically require IV infusions that can be logistically difficult to deliver. Next-generation anti-amyloid candidates in the pipeline hold promise to improve on these tradeoffs.

Alzheimer’s Tech Market Map

The Alzheimer’s tech landscape is being rebuilt around one simple reality: the earlier you can identify risk and underlying disease, the more options you have. That matters for reducing lifestyle-related risk, planning care, and using the new wave of disease-slowing drugs, which are most useful early on.

This market map groups Alzheimer’s technology by stages of the patient journey: prevention, early detection & diagnosis, and care & management.

Note: This map reflects how companies are positioning products across the Alzheimer’s journey, and it does not imply clinical validation or proven efficacy. The map also excludes pharmaceutical biotechnology innovation (therapeutics discovery/development).

Stage 1: Prevention

The prevention layer attempts to move dementia risk management upstream of specialty neurology by operationalizing what we already know: a meaningful share of risk is tied to modifiable factors across one’s lifetime, including cardiometabolic health, sleep, physical activity, mental health, social connection, and cognitive engagement. Most lifestyle intervention products that address these factors do not target brain health specifically, and the few that do are either grant-funded or early in traction.

Cognitive training can improve performance on trained tasks and may improve memory for individuals with MCI. “Brain games” were widely popular in the 2010s, but evidence that consumer brain-training apps prevent dementia remains limited and inconsistent, with mixed results for transfer to clinically meaningful outcomes. Many products are marketed as dementia prevention tools despite this evidence gap, and regulators have challenged overstated claims in the category (e.g., the FTC’s 2016 action involving Lumosity’s advertising).

Reimbursement in prevention is therefore still the exception, not the rule. For example, Medicare reimburses some evidence-based prevention programs aimed at cardiometabolic risk (e.g., the Medicare Diabetes Prevention Program), but there is generally no standard Medicare reimbursement pathway for cognitive training programs, which are paid via out-of-pocket expense, employer wellness budgets or research funding.

Key Innovation Themes

The next generation of “mental fitness” products move beyond static brain games and toward closed-loop training powered by wearables, sensors, and real-time feedback. Companies like Pison and Vibes AI illustrate the direction of travel: cognitive training that is embedded into everyday routines, instrumented by hardware or audio-based feedback loops, and continuously personalized based on in-the-moment performance. The innovation is as much about engagement and habit formation as it is about the training itself, reducing drop-off by making progress visible and sessions easy to complete.

Commercially, many of these companies are choosing a “performance-first” wedge (athletes, gamers, younger professionals) rather than positioning as dementia prevention. That can be a practical way to drive adoption, while the evidence on long-term dementia prevention continues to mature.

Stage 2: Early Detection & Diagnosis

AD and dementia more broadly are frequently missed or diagnosed late. Although Medicare reimburses cognitive testing, imaging, and lab work, real-world diagnostic follow-through remains inadequate: about 40% of older adults with dementia symptoms either receiving a late diagnosis or no diagnosis at all.

Part of the problem is that clinicians are not always trained and well-prepared to conduct cognitive assessment. Digital cognitive assessment tools add value to providers and Alzheimer’s disease management by delivering standardized, objective, and often remotely deployable measures of cognition that can be repeated frequently with minimal staff time. Passive digital biomarkers can also help by making it easier to track changes over time between clinic visits and flag who should enter a diagnostic pathway.

Neuroimaging start-ups are also using AI to extract more Alzheimer’s-relevant signal from routine MRI and CT, helping to automate quantification of imaging biomarkers and helping generalist clinicians triage who needs further workup or specialist referral.

AI is unlocking new modalities for capturing cognitive and neurological signals with minimal friction, shifting detection from episodic testing toward continuous measurement. The most compelling approaches leverage data streams people already generate, from speech to device interaction, so that “screening” can happen passively without friction.

Key Innovation Themes

Voice is a leading example of a digital biomarker gaining traction in the space. Canary Speech and Sonde are building platforms that convert short, natural speech samples from everyday touchpoints (phone calls, telehealth visits, app check-ins) into repeatable signals that can be collected frequently without new hardware. The strategic value is not just detecting risk once; it is using high-frequency, low-burden data to support triage for next steps.

Stage 3: Care & Management

After diagnosis, dementia behaves less like a one-time medical event and more like a long-term care challenge across safety risks, caregiver strain, and progressive loss of function. Support at this stage is inadequate, and only 8.3% of caregivers of community-dwelling older adults living with dementia report receiving any caregiver training.

Companies in this layer are addressing this gap by building dementia-specific chronic care models via virtual or hybrid specialty care, care navigation, and function-preserving interventions, aiming to reduce crises and support caregivers.

The reimbursement pathways are generally strong for care & management solutions, but innovation is constrained by what insurers will pay for. Dementia care models commonly anchor around CPT 99483 (cognitive assessment and care planning) and therapy codes for cognitive function intervention such as CPT 97129/97130. Both require Medicare-enrolled clinicians to provide the services, which limits reimbursement for AI-only approaches.

A looming constraint for virtual rehab models is Medicare’s scheduled telehealth rollback. Under current CMS guidance, occupational therapists (OT) and speech-language pathologists (SLP) telehealth flexibilities extend only through January 30, 2026; starting January 31, 2026, OTs and SLTs can no longer furnish Medicare telehealth services. This creates meaningful pressure for companies delivering reimbursed cognitive rehab or speech therapy primarily to patients at home under Original Medicare, pushing many toward hybrid delivery models and greater reliance on Medicare Advantage or other risk-based contracts.

Key Innovation Themes

CMS’s GUIDE Model adds momentum by defining a more standardized dementia care-management package and enabling Medicare Part B providers to work with Partner Organizations, creating a clearer path for “plug-in” services to integrate into reimbursed care delivery. Companies like Rippl and Isaac Health have started to take advantage of the GUIDE structure with dedicated offerings, though the program is still early in implementation.

Open Questions

1. Will a breakthrough in AD drug development occur to truly pull early detection forward to change the trajectory of AD?

   A true “pull” from therapeutics requires more than another modestly effective drug that measures efficacy through cognitive tests, which are criticized to have bias and limited real-world implications. It requires a step-change in real-world value: a notable delay in disease onset or a noticeable change in a patient’s functional capabilities. If the next wave of therapies materially improves outcomes and is practical to deliver, early detection becomes an enabling infrastructure investment: routine cognitive monitoring, streamlined biomarker pathways, and earlier specialty engagement start to look cost-effective rather than optional.

   On the other hand if breakthroughs remain incremental, early detection will still expand, but the center of gravity may stay with post-diagnosis care planning, and diagnostics will primarily still be used to reduce uncertainty and guide support, rather than to unlock transformative treatment.

2. Who is the buyer for multi-year dementia risk reduction?

   The buyer question is fundamentally about time horizon and churn: the most natural institutional buyers are risk-bearing organizations with older populations and clear utilization incentives (Medicare Advantage plans, ACO-like primary care groups, integrated delivery systems), but they still need evidence that programs reduce costs through intermediate outcomes they can measure sooner.

   For individuals and families, willingness to pay tends to spike only when risk feels concrete or when symptoms begin, which is why many companies either (a) anchor the business model post-diagnosis (where urgency is high) or (b) bundle “brain health” into prevention categories people already buy for immediate value.

3. As early risk detection becomes easier, will individuals opt in as active operators of their risk, or opt out due to fear, stigma, and the burden of “knowing”?

   As monitoring and biomarker tests get easier to access, people likely won’t all move the same way. Some will opt in, especially if Alzheimer’s feels personal through family history or a strong prevention mindset, because information gives them something concrete to act on. Others will opt out, not because they don’t care, but because “knowing” can feel heavy: fear of what the result might mean, uncertainty about what to do next, privacy concerns, and stigma.

   This stigma already affects behavior today by keeping people from seeking evaluation and diagnosis. In a survey of 1,300 individuals aged 50+, only 7% had used DTC genetic testing for APOE status to understand their risk of developing AD. If opting in is going to become the norm, the experience has to feel safe and useful with supportive counseling, real next steps, and guardrails that reduce the social and practical risks of learning you’re at higher risk.

Closing Thoughts: Who will Win

The next chapter of Alzheimer’s innovation will be defined less by any single technology and more by whether the ecosystem can connect detection to outcomes. Prevention science is clarifying what can be modified, new therapies increase the value of early identification, and care-management pathways are making longitudinal support more scalable.

Together, these forces are pulling Alzheimer’s care toward an operating model that looks more like chronic disease management: continuous measurement, staged escalation to definitive testing, and sustained care navigation that supports both patient function and caregiver resilience.

The companies that matter most will be those that close the loop. It is not enough to predict risk or detect early change; the product must reliably answer “what now?” for clinicians, payers, and families. That means integrating into practical workflows, demonstrating benefits that show up in utilization and quality-of-life metrics, and designing for the human realities of fear, stigma, and uncertainty. If the industry can do that, earlier detection becomes empowering rather than paralyzing, and the Alzheimer’s journey becomes more navigable even before we reach a definitive cure.

Given this, it’s a good time to reflect on the different components of the senior living tech stack, and to take stock in where the technology is in these different areas.

Why now?

As the first baby boomers turn 80 in 2025, many intuitively understand that we will face a surge in senior living demand, but few understand how astounding the demographic shifts described here are.

Between 2025-2030, the 80+ population in the US is projected to see 3-7% annual y/y growth, up from 1-2% growth from the decades prior. That means that the current 80+ population of 15 million is expected to reach 23 million by 2035, a 55%+ growth in just ten years.

Unfortunately, despite these demographic trends, construction of new senior living communities are at historical lows due to rising interest rates and construction costs.

This sets up a persistent senior living supply crunch that we will face over the next couple decades: in order to meet the growing needs of the aging population, the senior living industry must deliver 2x the number of new units annually compared to its historical peak for the next 20 years.

This supply shortage is compounded by the complexity of running a senior living operation today, where facilities face persistent workforce shortages, higher acuity residents, and increasing administrative burden. Technology can play a role in addressing these challenges.

Crash Course: Senior Living 101

Here are the main types of senior living facilities:

• Skilled Nursing Facilities (SNFs - pronounced “sniffs”): Senior living facilities for older adults with complex medical needs. These facilities have 24/7 nurse coverage and physicians on staff. Can be separated between short-term rehab (short stays after inpatient hospital stays) and long-term care for high acuity patients. SNFs are often reimbursable through Medicaid and Medicare and are generally less profitable than other senior living models for this reason. A Department of Health & Human Services report found that Medicaid only reimburses 82 cents per every dollar of cost.

• Assisted Living (AL): Senior living facilities for older adults who need assistance with activities of daily living, but wish to retain some level of independence and autonomy. The model was developed in 1981 by Keren Brown Wilson as an alternative to traditional nursing facilities that felt like hospitals as opposed to homes. Within AL, memory care facilities specifically serve older adults with Alzheimer’s or other dementias.

• Independent Living (IL): Private apartments targeted to older adults with amenities such as dining services, housekeeping, transportation, and activity options on-site. There is no clinical care staff and this is usually paid entirely out-of-pocket.

• Continuing Care Retirement Communities (CCRC): Senior living facilities where IL, AL, and SNF operations are all available on one site. Most require a sizable entrance fee to join ( > $300k), but monthly costs are more predictable on an ongoing basis. Compared to other models, they are more niche.

Senior Living Market Map

Historically, the tech stack in senior living has been fragmented: legacy EHRs, paper workflows, point solutions for emergencies, and ad-hoc tools for staff coordination. The result is duplication, inconsistent data, and limited ability to scale best practices across communities.

A new generation of software is emerging to act as the connective tissue of senior living operations. These tools sit closer to the workflow than to the billing office: they capture real-time activity on the floor, orchestrate staff, and surface insights about risk, wellbeing, and efficiency. As it stands, the senior living ops tech stack has great interoperability, with the proliferation of open API connectivity and cross-company collaborations.

In this market map, we break that landscape into four layers: Core Operations Platforms, Safety/Fall Solutions, Resident Engagement, and Workforce Ops. Together, they form an operating system for senior living, where resident data, staff actions, and building-level signals can flow across systems instead of living in silos.

Core Operations Platforms

Core operations platforms are the backbone of the senior living tech stack. These systems manage resident records, assessments, care plans, billing, and regulatory documentation, forming the system of record for clinical and operational data. Historically, these platforms were designed first for skilled nursing and were primarily electronic health record (EHR) solutions, with senior living layered on as an afterthought. Today’s operators need tools that reflect the realities of private-pay senior living, mixed acuity, and multi-site portfolios.

Next-generation platforms are shifting from passive databases to active operating systems. They support real-time tasking and workflows, integrate with point solutions (from fall detection to engagement tools), and expose analytics that allow operators to measure outcomes like hospitalization rates, length of stay, or staff productivity. For investors, these systems are strategically important: whoever owns the operating layer has a privileged position to orchestrate data and partner with (or absorb) adjacent solutions.

Key innovation themes

Companies in this category are leaning into the role of integration hub. The vast majority of companies in this space allow for free API integration processes, and are open to collaborating with early-stage startups. As an example, PointClickCare and MatrixCare now support hundreds of network partnerships and run independent software vendor marketplaces across a couple dozen solution categories.

Safety/Fall Solutions

Falls, elopements, and undetected health events are among the most costly and dangerous risks in senior living. Falls in particular make up more than 50% of liability costs for senior living providers. Historically, communities relied on staff rounding, pull cords, and basic nurse call systems. These tools are reactive and dependent on resident activation. As acuity rises and staffing ratios tighten, this model breaks down.

Safety and fall solutions use sensing technologies such as computer vision, radar, and other ambient sensors to continuously monitor motion and biometrics without requiring wearables or cameras in every room. These systems detect events like bed exits, unusual gait, or inactivity, allowing staff to intervene before a fall or medical emergency escalates. Beyond incident detection, platforms are beginning to aggregate sensor data over time to identify patterns and predict risk, enabling a shift from reactive to proactive care.

As fall detection sensors get better, senior living liability insurance providers are starting to take note and become natural distribution partners. CareAgents has partnered with Virtusense to develop unique policies that provide senior care operators with Virtusense’s fall prevention and fall detection products.

Key innovation themes

Simple threshold-based radar systems have historically suffered from high false positive rates, triggering “falls” when someone drops an object, sits down quickly, or when environmental noise confuses the signal. Newer players are pushing beyond basic radar by combining richer sensing with machine learning and gait analytics. Pontosense’s Silver Shield is a wall-mounted mmWave radar system designed specifically for aging care that monitors both motion and biometrics (breathing rate, heart rate, HRV) completely contactlessly. Other players have chosen to explore sensors outside of computer vision and radar, including Virtusense (LiDAR) and Blue Oak (Vibration).

Resident Engagement

For residents and families, “how it feels to live here” is as important as clinical care. Yet engagement has historically been analog—paper calendars, bulletin boards, and siloed life enrichment teams. This makes it hard to personalize programming, capture data on participation, or show families the impact of a community’s engagement strategy.

Resident engagement platforms digitize the social layer of senior living. They centralize calendars, communication, and content; support family and resident apps; and increasingly integrate with core platforms to tailor programming based on interests, cognitive status, and care needs. The next wave extends beyond software into immersive experiences and companionship, using robotics and VR/AR to reduce loneliness and support cognitive health.

Communication solutions, including those with an AI companion element, build on top of resident engagement platforms to deepen engagement. Companies are also bringing VR / AR technology into senior living to improve the wellbeing of residents.

Key innovation themes

AI is increasingly becoming the “front door” to resident engagement rather than just a back-end feature. Conversational agents, virtual companions, and social robots can meet residents where they are, whether this be voice, text, or touchscreens, and guide them to activities, answering everyday questions, and even initiating check-ins when behavior deviates from normal patterns. For residents who are anxious, cognitively impaired, or simply lonely, AI can function as a low-friction first interaction that nudges them toward human connection.

Workforce Ops

The senior living workforce is the critical bottleneck in the system. Communities are facing record turnover, wage pressure, and expensive reliance on agency staffing. Meanwhile, training and compliance requirements are increasing, and staff expectations are shaped by consumer mobile experiences rather than legacy LMS portals and paper schedules.

Workforce operations tools focus on two jobs: building and managing a high-performing workforce, and giving operators flexibility in how they source labor. Training and compliance platforms deliver bite-sized, role-specific education and track credentials at scale. Recruitment and staffing marketplaces connect communities to pools of W-2 or 1099 workers, often layering on dynamic pricing, ratings, and shift-matching algorithms. The most compelling solutions integrate directly with core operations platforms, pulling in acuity and occupancy data to inform staffing decisions.

Key innovation themes

To address staffing shortages, technology is enabling flexible labor models. These models provide more attractive arrangements for senior living staff (more schedule control and pay transparency) and allow operators to leverage on-demand workers while preserving quality and continuity.

Open Questions

1. Will tech actually solve the staffing crisis, or just make a smaller workforce more efficient?

There will be an estimated 8.9 million total job openings in US direct care workers from 2022 to 2032, and it is not yet clear that technology will meaningfully change that trajectory. Remote sensing tools have helped communities respond more effectively to falls, but they have not changed the underlying staffing ratios in buildings that already operate at or near minimum coverage. Workforce operations platforms can help senior living providers navigate labor shortfalls more intelligently, through on-demand labor, flexible scheduling, and better matching, but they still operate within a system where the core constraint is the number of people willing and able to do this work.

2. What is the right balance between AI vs. human engagement?

As AI technology advances and labor shortages become more acute, senior living communities are under pressure to lean more heavily on automation, virtual companions, and conversational agents to fill gaps in social and emotional support. The promise is compelling: AI can provide 24/7 coverage, proactive check-ins, personalized prompts, and low-friction engagement for residents who might otherwise withdraw. But many older adults experience these tools as a compromise rather than a benefit and feel uneasy about being “talked to” by machines. The open question is how far operators can lean on AI without eroding residents’ sense of dignity, autonomy, and genuine human connection.

3. Who will own the “operating system” layer and the data that flows through it?

There are many different players in the ecosystem, all looking to become a more comprehensive suite as opposed to point solutions. PointClickCare and MatrixCare are building marketplaces with hundreds of partnerships and open APIs; engagement platforms like TSOLife and Cubigo integrate deeply into EMRs, sales operations, dining, and maintenance; and safety vendors increasingly plug into core systems rather than remain standalone.

External work on senior housing innovation suggests that integrated, data-rich platforms will underpin future person-centered models. The open question is whether one or two core platforms become the de facto operating system for senior living operations, or whether a more federated model emerges, where data is portable, ownership is clearly defined, and operators can swap components without losing their history and analytics.

Closing Thoughts

Senior living is entering a decade defined by constraint and possibility: historically low construction, a rapidly growing 80+ population, and a workforce that is already stretched thin. Technology will not magically solve the supply gap or the staffing crisis, but it can meaningfully expand the effective capacity of the system by streamlining operations, reducing preventable risk, and deepening resident engagement.

The operators, investors, and founders who will matter most in this next chapter are those who treat tech less as a collection of point solutions and more as an integrated operating system, one where data can move, partners can plug in, and continuous experimentation is possible at the portfolio level. The open questions around staffing, safety ROI, and data ownership are not reasons to wait; they are the agenda for the next wave of innovation.

For builders, investors, and anyone who wants to feel better in 30 years (and tomorrow morning), here are five ideas that actually matter now.

1) Most people don’t think slowing aging is “worth it.” That’s a problem.

One of the most striking ideas for me wasn’t scientific at all. Carolyn Baker Ringel highlighted polling that showed that more than half of Americans believe medical treatments that slow aging and extend life by decades would be bad for society.

The basis for objection can be clustered into three buckets:

• Justice & resources: “Only the wealthy would benefit from such a technology, and extended human lives would only strain the planet and our systems.”

• Social structures: “Our institutions (retirement, labor markets, family dynamics) aren’t designed for 100-year health spans.”

• Existential meaning: “Finitude gives life purpose and longer lives dilute that.”

Carolyn elegantly went one by one to highlight the inherent pessimism of these objections. Social structures have always evolved with changing health and economic realities (see the evolution of age of first childbirth), and we should be confident that we will be able to adapt to a society where we all live healthier longer. Researchers have shown that the corresponding value for a 10-year increase in life expectancy is $366.8 trillion, translating to 33.6% of the 2019 GDP. Humans use technology to improve life across the board; aging shouldn’t be the exception.

2) We are decades away from “solving aging.”

Multiple speakers drew a bright line between modifying our trajectory of aging versus reversing it. Yes, we can shift risk trajectories and improve late-life function. But the bolder claims—“aging reversal achieved!”—are not where consensus science sits today and unfortunately we are still decades away.

Matt Kaeberlein pointed out the humbling fact that in animal models, interventions like caloric restriction (that were researched in 1986) are still outperforming headline-grabbing interventions like rapamycin today. Despite the hype, a sober read of the data is needed to keep our expectations grounded.

3) Don’t “solve aging.” Don’t even “cure cancer.” Start with your heart and your mouth.

If you want a near-term longevity stack, look across your key organs:

• Cardiovascular health is table stakes, as it’s one of the strongest predictors of life expectancy. Amit Bhatt shared that if you can only fix one thing about your cardiovascular health, fix blood pressure. Roughly half of adults have hypertension and many don’t know it, so be sure to check on your blood pressure, even if you don’t feel symptoms. Until there’s a validated, scalable “longevity drug,” keeping arteries healthy is the highest-leverage move.

• Dental/oral health is a systems problem, not a cosmetic one. Mariya Filipova shared that periodontitis is one of the most common treatable diseases and oral health is linked to or contributes to 8 of the top 10 causes of death. Saliva is emerging as a rich screening medium, and dentists, whom many people see more regularly than their doctors, could become front-door stewards of whole-person health. Stephen Thorne from PDS Health shared how the company is enabling the use of saliva as a means to detect disease and unlock dental-medical integration. If we want affordable longevity, integrating oral health into primary prevention is low-hanging fruit.

4) For simple interventions that change your life today, fix your circadian clock.

Satchin Panda is a world expert on the circadian rhythm, and turns out circadian strength touches immunity, cellular repair, cognition, metabolism, even how you respond to chemo (chronomedicine is coming to the clinic).

For your daily life, here are three levers to learn the circadian rhythm:

• Light: Aim for >1 hour of daylight exposure every day. Light timing is medicine, especially for older adults with fragmented sleep or dementia symptoms.

• Feeding window: Consistent with time-restricted eating, eating within a 10-12 hour window can nudge metabolic pathways toward repair and act in similar ways caloric restriction can.

• Exercise timing: Late-afternoon exercise tends to produce better performance and lower injury risk.

To help you implement these changes today, Satchin has developed an app myCircadianClock to help users adopt these habits through simple nudges on the app.

5) There is still reason to dream: every one of us has already been through a “de-aging event.”

Surprising fact from David Sinclair: at the embryo stage, around day 7 of our lives, the developing organism resets its age to zero, likely via epigenetic reprogramming. That’s not sci-fi; it’s developmental biology. This means that we all have experienced a “de-aging” event to be born.

Building on that insight, Sinclair’s lab is testing OSK-based partial reprogramming that reverses age in specific tissues (retina, liver, kidney, peripheral nerves) in animals, with first human data expected in 2026. Teams are also using AI to search for small molecules that could induce OSK-like effects—potentially compressing timelines from years to weeks-scale tissue rejuvenation, if safety/precision pan out. This is high-risk, high-reward, and it’s exactly the kind of moonshot society should support alongside near-term prevention.

In the US, the “Aging Network” of over 600 local agencies helps to make this possible. The group collectively supports one in six older adults by providing critical services outside the context of institutionalized care, ranging from meal services and in-home assistance to caregiver support.

Unfortunately, the Aging Network runs on local government, Medicaid and Older Americans Act (OAA) funding, all of which are frequently subject to review and have not kept pace with the growth of older populations in recent years.

As demand surges and budgets tighten, agencies within the Aging Network are being forced to do more with less. This is accelerating a quiet transformation: many are looking to adopt new technologies that can boost efficiency and seeking new partnerships (particularly with healthcare) to diversify revenue as well.

For AgeTech founders and investors, this shift opens a rare window to modernize a trusted but under-resourced public system, and to scale solutions that directly support the future of aging in place.

Aging Network 101

Created by the 1965 Older Americans Act (OAA), the Aging Network is a three‑tier public system:

1. Federal – The Administration for Community Living (ACL) allocates funds across seven program areas known as “Titles.” Two important ones to know are:

   1. Title III includes funding for supportive services (transportation, case management, information access points), nutrition services (congregate and home-delivered meals), disease prevention and health promotion, and caregiver support

   2. Title IV has discretionary and competitive grants to fund research and demonstration projects for innovation in aging services

2. State – 56 State Units on Aging draft multi‑year plans and decide each state’s intrastate funding formula to determine how federal funds are distributed within their state.

3. Local – 618 Area Agencies on Aging (AAAs) plus 250 Tribal programs deliver or subcontract the services, which range from meals, transportation, caregiver support, home modifications, and more.

AAAs are a diverse group of organizations designated by states to coordinate and deliver services that help older adults age-in-place. They can be either government, nonprofit or tribal organizations. For a start-up, AAAs are typically the groups that they would first sell into within the Aging network.

Why the Aging Network is Under Threat

Despite their reach, the Aging Network operates under chronic funding pressure. Practically every AAA out there will say that funding is their #1 concern.

Federal OAA grants are discretionary and have not kept pace with rising demand. Recent reauthorization efforts have also struggled to advance, leaving agencies without certainty for future OAA funding.

And while Medicaid funding contributes as an alternative, it rarely aligns perfectly with the Aging Network’s scope and is often fragmented across programs, states, and eligibility rules. Additionally, the newly passed 2025 federal budget reconciliation bill will put more pressure on states cut costs in its Medicaid programs as their capacity to raise revenue is constrained.

New Revenue Avenues Needed

New partnerships present important alternative sources of funding for AAAs seeking to diversify in these challenging times. But tapping into these opportunities increasingly requires stronger data systems and the ability to demonstrate measurable outcomes.

Historically, it had been less common for the Network to articulate its value through standardized data. A 2018 poll by the National Association of Area Agencies on Aging found that only 28% of AAAs measured the financial value of their services while the remainder did not. This can make outcomes harder to quantify and funding feel more discretionary.

Today, pioneering AAAs are working to change that. By aligning with new stakeholders, they are adopting more rigorous data practices to secure sustainable, performance-based funding.

Medicare Advantage

To offset constrained federal dollars, AAAs are increasingly partnering with Medicare Advantage (MA) plans. Nearly 45 % of AAAs now report at least one healthcare contract, but this has historically been within Medicaid as opposed to MA. As of 2023, only 24% of AAAs contract with MA plans.

Entry often starts with care‑transition coaching programs that cut 30‑day readmissions—exactly the metric MA plans reimburse. Anecdotally the impact of combining clinical and social teams for care transition programs can be very significant as hospital readmissions represent significant costs for MA plans.

Housing Partnerships

Developers of senior and mixed‑income housing are realizing that AAAs can lower tenant turnover and improve property values. A Michigan AAA secured service funding from a HUD‑supported developer by embedding a full-time care coordinator in a 45‑unit project. Federal initiatives like the Housing & Services Partnership Accelerator are scaling such cross‑sector models between housing and aging services.

Start-up Landscape

While historically slow to adopt new tools, AAAs are increasingly turning to technology out of necessity. The convergence of labor shortages, growing demand, and a heightened need for data-driven documentation is pushing even the most cautious organizations to seek innovative solutions that 1) improve efficiency and 2) relieve documentation burden.

While start-ups may face challenges working with resource-constrained groups like AAAs, there are important reasons why this space should not be overlooked:

• High-need, low-tech infrastructure. The Aging Network already supports millions, but with outdated tools and limited tech capacity.

• System under pressure. Rising demand, workforce shortages, and flat federal funding are driving urgency to modernize.

• New payer pathways mean new capabilities needed. AAAs are opening contracts with new partners, notably MA plans, requiring them to build up new capabilities quickly.

Given the opportunity, below are two of the start-ups leading the way in creating tech solutions to serve the Aging Network:

• Mon Ami – Volunteer‑coordination and case‑management software used by 80+ AAAs across 27 states. Helps streamline I&A workflows and friendly visitor coordination.

• Blooming Health – Multilingual communication platform (SMS, voice, email) that improves outreach and engagement

Closing Thoughts

The U.S. already has the scaffolding to support aging in place. What it lacks is modern tooling and sustainable funding. Technology has a critical role to play in bridging this gap: improving service delivery, tracking outcomes, and unlocking partnerships that make the system more resilient.

For AgeTech founders and investors, this is an opportunity to build the operating system for “Aging-in-Place” on top of a trusted infrastructure that already serves millions.

Loneliness is far more than just a bad feeling—it harms both individual and societal health. It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity.

Dr. Vivek H. Murthy 19th and 21st Surgeon General of the United States

Unfortunately, older adults are on the front lines of this issue:

• One in three older adults report infrequent contact (once a week or less) with people outside of their homes

• Loneliness has been shown to correspond to a 45% greater risk of death, and a 40% increased risk of dementia

• These health consequences translate to a large financial impact. According to a 2017 study by AARP, lack of social contact is associated with an additional $6.7B of Medicare spending annually

Given the scale of the problem, might technology play a role in providing part of the solution?

We live in an exciting time where large language models (LLMs) have advanced conversational AI capabilities by leaps and bounds. Today, everyone can access human-like, contextually relevant responses to any imaginable prompt through technologies like ChatGPT and Google Gemini. Though social companion technology has historically seen low adoption—particularly among the elderly—these recent developments raise the question of whether it’s finally ready to deliver scalable social support.

PARO: The First Robot Social Companion for Older Adults

Technologists have pursued digital remedies to combat loneliness for decades. PARO, a baby harp seal invented in 2001 by Dr. Takanori Shibata, is one of the earliest examples of social companion tech for older adults.

PARO has many design features to make it more sociable. PARO weighs about 6 lbs (3 kg), mimicking the weight of a baby. It responds to light, noise, and touch like a living being. The baby harp seal also gets sleepy at night and is more active during the day.

Because PARO has been around for 25 years, there are more than 60 academic papers written on its impact. Among users with dementia, PARO has been shown to alleviate negative emotions and improve social engagement. Multiple studies have also found that PARO leads to improvements in positive emotions and perceived quality of life.

Despite its rich history, however, PARO’s adoption remains limited, and only a few thousand units are active today.

Empirical research suggests that PARO faces multiple barriers to adoption:

• Relationship with human caregiving: Caregivers, staff, and researchers flagged concerns that PARO dehumanized care. There are concerns that PARO could be seen as a replacement for human interaction as opposed to a complement to it.

• Variation of long-term outcomes: Not everyone adjusted to PARO in the same way. In some cases, older adults became reliant on PARO and experienced negative impacts upon PARO’s removal. In other cases, PARO would lose effect over time.

• Costs: The cost of PARO is high (each unit sells at around $6000). This makes the solution cost-prohibitive for most older adults and their families. Oftentimes, PARO would be purchased by healthcare organizations where government support for assistive technologies is sometimes available.

• Stigma: Some older adults, particularly men, felt like they were being infantilized and treated like children when asked to interact with PARO, particularly given that PARO was seen as “toy-like”. Individuals reported being embarrassed about interacting with the robot.

While PARO is designed for people with dementia, these hurdles highlight the broader adoption challenges of social companion technologies: what do our AI-mediated interactions reveal about our human relationships and connectivity? How might long-term “relationships” with AI affect our mental health and well-being?

These questions remain open, and rapid technological progress is bringing us ever closer to answering them.

ChatGPT: A New World for Conversational AI?

ChatGPT’s release on Nov 2022 marked a turning point in the role of technology in social companionship. Armed by large language models (LLMs), developers were now able to facilitate more natural, organic, and complex human-computer interactions. This has ushered in a new era of social companion tech, where AI companions are good enough to achieve almost mainstream adoption.

A recent study by Brigham Young University found that up to 1 in 5 adults in the United States (19%) reported that they had chatted with an AI system meant to simulate a romantic partner. And although one might expect LLM adoption to be the exclusive prerogative of younger adults, the same study found that 15% of men and 10% of adult women reported that they have chatted with a virtual romantic companion.

This trend is reflected in a growing cohort of companies that specifically use technology to target the social companion needs of older populations, and here we will cover what some of them are.1

Social Companion Tech Market Map

As I did research on the space, I noticed that the form factor of the product would determine the features it would have.

The form factor of a technology is the physical characteristics the product has (or lack thereof, in the case of pure software solutions). In this case, some companies chose to go with robotics solutions with sensors and actuators that would move based on the environment and the user’s behavior. Other companies developed virtual chatbots that would live either on proprietary hardware with screens (e.g., tablets) OR on any device as a (device-agnostic) pure-software solution.

In my market map, I chose to include recently folded companies in the space as well to reflect the challenging nature of the space, particularly for hardware companies.

Virtual Chatbots

Broadly speaking, virtual chatbot solutions have the following functionality:

• Everyday personalized conversation, enabled by the latest LLM technology

• Health coaching (e.g., medication and health reminders)

• Real-time alerts to the circle of care (e.g., family members, caregivers) if something is wrong

There is a clear bifurcation in the space between proprietary hardware (“HW”) solution providers that have been around since the 2010s and software-only ("SW-only”) entrants that were founded after the recent advancement of LLMs.

Given that most consumer electronics are not built with the older adult in mind, proprietary HW allows developers to have more control over the user experience and incorporate more design features with the older user in mind.

However, this custom design comes with a higher price tag. As an example, GrandPad sells senior-friendly tablets at $65/month, and includes a blue owl Grandie as its virtual companion offering within it.

This is more than twice as much as the $20-30/month price tag of SW-only AI solutions.

Despite their lower price point and access to cutting-edge LLM capabilities, software-only entrants have yet to demonstrate meaningful traction in the category. All the players appear relatively nascent and none of the SW-only entrants have raised venture-backed rounds.

Robotic Solutions

Moving beyond the virtual chatbot interface allows companies to add additional functionality based on the hardware capabilities of the robot.

ElliQ (from Intuition Robotics) has a screen, a camera, and a little robot on the side. Because ElliQ is always on, users can interact with ElliQ throughout the day with minimal effort. ElliQ will also prompt conversation based on the body language of the user. Users can also use ElliQ to video chat and connect with friends.

ElliQ is the most well-funded start-up in the social companion tech market map, with a total of $81M of funding from Seed - Series C. In 2023, NY Office of Aging partnered with Intuition Robotics to roll out ElliQ to 800 New Yorkers.

Despite significant funding, ElliQ is only deployed in thousands of homes, so adoption is still relatively early.

While ElliQ is a primarily direct-to-consumer/direct-to-government solution, Andromeda’s Abi sells to aged care providers to provide both 1:1 companionship and group activity facilitation.

As a mobile robot, Abi can engage with groups of people with a wide range of physical and mental abilities at the same time. Abi’s bright color is not only meant to spark joy but also allows the robot to be easily identified by older adults with vision problems.

Robotic Solutions - Animatronic

Most products on our market map target cognitively healthy older adults, leaving those with dementia underserved. PARO blazed the trail in targeting this group; Joy for All and Tombot have since followed with similar animatronic companions.

Both companies have created pet-shaped robots that forego speech; instead, they respond to touch and gentle voices with lifelike movements and sounds, delivering the familiar comfort of a beloved household animal.

It’s worth nothing that Joy for All, a Hasbro spin-off, has achieved something important in this space: Medicare and Medicaid reimbursement based on demonstrated health benefits. Its success shows that a company rooted in social companion tech can clear clinical and regulatory hurdles to reimbursement, hinting at a viable path that other companies might follow to reach insurance-backed adoption.

Closing Thoughts: What it Takes to Win

After surveying the companies in the space, it appears that the winning solution for AI companions for older adults has yet to emerge.

There are two key questions that a start-up will need to address to have the right-to-win in this space.

1. Moat

Conversational AI capabilities are no longer a moat. As frontier models proliferate and mainstream platforms (Alexa, Siri, et al.) handle smooth dialogue, conversation data are easy to come by and technical barriers have collapsed. The winners will have to differentiate through go-to-market execution and crisp product positioning. Distribution, brand, and ecosystem integration will count for more than the tech itself.

2. GTM angle

Loneliness is omnipresent, but most people are reluctant to identify themselves as “lonely,” forcing social-companion products to anchor demand in a more nuanced way. Character AI tapped fan-fiction fans; Replika targets seekers of virtual romance. Many offerings aimed at older adults cast too wide a net. On this dimension, I am more bullish on Andromeda (targeting aged care providers) and Joy for All (patients with dementia) as I feel like they benefit from a narrow GTM wedges that lend themselves to clearer proof of impact.

A common benchmark for success in the startup world is achieving “unicorn” status, or a valuation of over $1 billion. The emergence of unicorns signals that a space has attracted significant venture capital and innovator interest. Conversely, the absence of unicorns suggests that the market is still in its early stages of development or has yet to capture the interest of top innovators and investors.

In this post, I take a closer look at the AgeTech unicorns that exist today with the goal to understand the evolution of the space tomorrow.

Here are my 3 main takeaways from this exercise:

• Healthcare dominates the AgeTech space today: Even though I explicitly included AgeTech investment themes that were not healthcare, 91% of the companies and 91% of the unicorns in the AgeTech universe were related to healthcare. This reflects the relatively mature and well-capitalized healthcare VC ecosystem compared to the nascent state of AgeTech more broadly.

• Non-healthcare AgeTech has been largely overlooked: The scarcity of AgeTech unicorns outside of healthcare is mirrored by a general lack of startups entering those segments. As an optimist, one may interpret this as an under-explored opportunity, but practically this may also speak to the challenges of building in non-healthcare Agetech.

• Market creation has yet to happen among non-healthcare AgeTech categories in a meaningful way: Estate / retirement planning was the only bright spot in the non-healthcare AgeTech universe, with 8 unicorns from the space. Estate / retirement planning companies benefit from existing, well-defined pools of spending that can be reallocated from incumbents to new entrants, with little need for market creation. This is different from most of the other areas of non-healthcare AgeTech, like home robotics for example (i.e., few people spend money on robotics for the home).

Defining the Universe

To start off, I mapped out the companies in the Agetech universe. Pitchbook does not have such a universe pre-defined, so I created my own taxonomy.

To do this, I used the AgeTech framework that I had developed in an earlier post as a basis (link). This anchored my search into the five categories of value props that AgeTech companies had to deliver on — Ikigai (“reason for being”), Autonomy, Health, Safety, and Caretaker Cost Efficiency. From these five broader categories, I refined my universe into 17 different themes that were sufficiently narrow to act as a filter for companies.

I chose to disaggregate wearables and preventative health solutions from general “Healthcare” companies as these sat outside of the traditional medical model of healthcare focused on the diagnosis and treatment of illnesses. I labeled this category of companies as “Non-traditional Healthcare” or “Wellness”.

As I looked through the data, I quickly discovered that healthcare (traditional and wellness/non-traditional) absolutely dominated the AgeTech universe, both by the number of companies and number of unicorns produced.1 Even though I had explicitly included non-healthcare AgeTech themes, 91% of the companies and 91% of the unicorns in the AgeTech universe were in healthcare.

The following three themes accounted for the greatest number of unicorns in the AgeTech universe:

• Healthcare AI (35 unicorns): There are many applications of AI in healthcare, including improved efficiency through enhanced diagnostic accuracy, streamlined administrative processes, personalized treatment plans, and others. Even though 2021-2024 was clearly a boon for the AI space, all but one of the 35 unicorns I found were founded before 2020. This suggests that applications of AI in healthcare take longer to scale than in other categories. The one exception? Hippocratic AI founded in 2023.

• Chronic Disease Management (24 unicorns): Even though chronic disease is not an issue that exclusively applies to older populations, nearly 95% of older people have at least one chronic condition, and nearly 80% have two or more (link). Innovators in the space have developed a varied range of solutions for the diagnosis, monitoring and management of chronic conditions.

• Healthcare at Home (23 unicorns): Nearly 2 million adults over 65 are completely or mostly homebound in the US, while an additional 5.5 million seniors can get out only with significant difficulty (link). The largest company in this space was Signify Health, focused on bringing clinicians into the home to identify and address chronic conditions and social determinants of health. Signify Health was acquired by CVS in 2023 for $8B (link).

Healthcare and AgeTech

I am not surprised that healthcare dominates the Agetech universe.

First, many aging problems are healthcare problems. This is why, once we get older, our wallet share spend on healthcare increases. In 2022, nearly 3 in 10 Medicare households spent 20% or more of their total household spending on health-related expenses, compared to 7% of non-Medicare households (link).

Additionally, the healthcare innovation ecosystem is a much more active than non-healthcare AgeTech. The healthcare VC ecosystem has tens of billions of capital raised each year and an established addressable market (link). There are enough success stories in healthcare that there is playbook of success to follow, and metrics and milestones to go alongside it.

This is a much friendlier space for entrepreneurs and investors compared to the relatively uncharted territory of AgeTech.

Just because healthcare is the lion share of AgeTech today doesn’t indicate that all of AgeTech should be healthcare.

Through the data, we observe that the lack of unicorns in non-healthcare pockets of AgeTech are also reflected by the lack of companies in the space.

The AgeTech ecosystem is significantly less mature than healthcare. It’s unfair to say non-healthcare AgeTech is a bad opportunity as opposed to one that has yet to be fully explored.

Most importantly, there is a strong need for solutions to the social consequences of aging, not just the health-related ones. In 2024, John A. Hartford partnered with Age Wave and the Harris Poll and asked adults age 65+ what they were most concerned about (link). The top four issues were: 1) losing the ability to think clearly, 2) becoming frail, 3) becoming a burden on family, and 4) becoming financially insecure.

While these issues are at least in part rooted in healthcare issues — for example, the cognitive impairment associated with Alzheimer’s — they can be ameliorated through solutions that do not directly address the disease. Accurate and affordable fall detection solutions, for example, can help to reduce the worry that families have for older adults aging-in-place.

This is especially important given that there is currently no medical “silver bullet” for aging. In some areas, scientific breakthroughs remain elusive; in others, existing medical interventions merely delay the onset of symptoms. As a result, many older adults are left grappling with the same challenges—just a few years later.

AgeTech (non-Healthcare) Unicorn Map

To better understand why there are not that many non-healthcare AgeTech companies, I looked more carefully at those that did exist. I quickly found that the distribution of unicorns in my AgeTech universe was still quite skewed. Estate/retirement planning (8 unicorns) accounted for the majority of unicorns, while other non-Healthcare AgeTech themes had at most a couple of unicorns within each category.

1. Unicorns in Estate and Retirement Planning

There were 8 unicorns in estate/retirement planning. Every single one of them were digital platforms that worked on one aspect of the space, whether this was 401(k) for small to medium-sized businesses (Human Interest and Guideline), Crypto IRA retirement solutions (iTrustCapital), or online legal services (LegalZoom).

I think the main reason that estate / retirement planning have multiple unicorns compared to the rest of non-healthcare AgeTech is because the category benefits from existing, well-defined pools of spending that can be reallocated from incumbents to new entrants. This means that there is little need for market creation. For example, 401(k) plans in the US already hold $4.9T of assets, so when new digital platforms come around, they are simply taking market share on the existing assets under management in 401(k) plans (link).

2. Unicorns in Senior Care

It is interesting to me that there are 3 unicorns that work in the senior care space— IntelyCare, Honor, and Papa. In my opinion, the shortage of caregivers is one of the most pressing themes in the AgeTech space. To illustrate this point, it’s worth understanding more about the caregiver support ratio. The caregiver support ratio is defined as the number of potential caregivers aged 45–64 years, the most common caregiving age range, for each person aged 80+. In 2010, more than seven potential caregivers were available for every person in the high-risk years of age 80. By 2030, the ratio is projected to decline dramatically to 4:1, and by 2050, it is projected to further decline to less than 3:1 (link).

IntelyCare, Honor, and Papa each have slightly different approaches, but all three essentially displace traditional home care services to connect families to caretakers with a certain level of tech enablement.

To take IntelyCare for example: ​IntelyCare is a healthcare talent platform that connects nursing professionals with job opportunities. The company reached unicorn status after its $115M Series C raise that valued the company at $1.1B in April 2022. The round was led by Janus Henderson, with participation from Longitude Capital, Leeds Illuminate, Endeavour Vision, Revelation Partners and Kaiser Permanente Ventures (link).

It’s hard not to think that COVID-19 may have provided a great tailwind to IntelyCare’s business. IntelyCare’s unicorn status was achieved on the back of impressive growth during this time: according to Pulse 2.0, IntelyCare’s annual revenue had grown by over 850% between 2020-2022. IntelyCare’s nursing professionals, known as IntelyPros, had more than doubled in 2021, while client demand for IntelyPros had almost tripled from the previous year (link).

Honor and Papa also reached unicorn status in 2021-2022.

3. Unicorn in Remote Monitoring

There is only one unicorn in remote monitoring — Cera.

Cera is a London-based tech-enabled home health care provider. The company reached unicorn status in Jan 2025 when it raised $150M led by BDT & MSD Partners and Schroders Capital.

Cera is a leading provider of home care and live-in care services in the UK, and has a network of professional caregivers. Cera has also developed an app that allows nurses and carers to collect, monitor and react to a range of vital health signs in their clients in real-time. This translates to up to 70% reduction in hospitalizations and cost savings for the payer (link).

According to Times, the majority of Cera’s revenues, which stood at £225 million in the year to December 2023, come from contracts to deliver care to elderly patients on behalf of NHS organizations and local authorities (link).

4. Unicorn in Home Robotics

When we think about home robots in the US, we think iRobot, but from a global perspective, we really should be thinking about Roborock, a Chinese company that specializes in robot vacuums and other smart home appliances. In 2024, Roborock recorded USD $1.65 billion of revenues, a 38% increase compared to the prior year (link). In contrast, iRobot recorded USD $680 million of revenues in 2024, a 23% decrease compared to the prior year (link).

This difference in growth trajectory is reflected in the valuations of the companies. While Roborock is worth more than $6 billion as of April 1, 2025, iRobot is only worth $80 million. In March 2025, iRobot issued a "going concern" warning, indicating substantial doubt about its ability to continue operations over the next 12 months (link).

iRobot’s valuation today is in stark contrast to the $1.7 billion price tag that Amazon was willing to pay in Aug 2022 (link). The company’s deep decline in value can be attributed to poor execution on growth efforts and increased competition in the space. This goes to reflect how difficult it is to build a great consumer home robotics business.

The need to fix Medicare might be one of the few issues that both sides of the political spectrum can agree on. With DOGE taking over news headlines, scrutiny over Medicaid and Medicare spending has come to the forefront of public attention. Previously, the Biden administration initiated a broad investigation by the DOJ into UnitedHealth that culminated in an investigation into the company’s Medicare billing practices recently (link).

Despite this, there is some disagreement about exactly how Medicare should be fixed, and I think this may be due to philosophical differences in what people think Medicare should achieve.

I could have called this post Medicare: Is it working? or perhaps even more precisely the real question that people have: Is the $1T+ that the US government spends on Medicare each year providing adequate health insurance to the older populations efficiently, whatever “adequate” and “efficiently” may mean.

In this post, I’ll break down the real question into a couple of more digestible sub-questions for us to walk through:

1. What is the trend of government spending on Medicare?

2. Why is enrollment in Medicare Advantage growing as a proportion of all Medicare enrollment?

3. What are the implications of increasing Medicare Advantage adoption?

The goal here is to go through some of the research or data that reflect how Medicare is working to provide more context to interested innovators and investors looking into AgeTech. I won’t be making any policy recommendations and hopefully this doesn’t read like an opinion piece.

Here, we will try to stick to the facts:

1. What is the trend of government spending on Medicare?

Apart from a small blip in the late 1990s (due to the Balanced Budget Act and efforts to curb fraud and abuse), government spending on Medicare has grown unabated.

The primary drivers of this are healthcare inflation and demographic trends, as baby boomers enter Medicare enrollment age between 2010 - 2029.

Interestingly, Medicare spending growth rates, particularly on a per capita basis, slowed down in 2010 - 2019.

This appears to be driven by a few reasons:

• Younger baby boomers entering the program lowered the average age of Medicare beneficiaries. Medicare spending increases with age, with the average Medicare spending for people aged 70 at $11.5k while the average Medicare spending for people aged 90 almost double that (link). As more baby boomers enroll in Medicare, the average spending per enrollee declines.

• Lower than expected introduction of new brand name drugs and technology. In a letter to the Senate Budget Committee in 2023, the CBO described the main source of lower than expected Medicare spending in 2010s to be due to lower than expected spending in Part D (associated with prescription drugs), as existing brand-name drugs lost their patent protection and fewer introductions of new brand-name drugs were realized. CBO also cited a NBER working paper that suggested that there was less adoption of highly beneficial but more expensive technologies during this time as the focus shifted more towards cost-cutting technologies.

• Better management of cardiovascular diseases through medication of risk factors was also cited by CBO as a reason for lower Medicare spending in 2010s. In 2015, direct medical costs associated with heart disease totaled $281B in the US, and 42% of Medicare beneficiaries aged 65 and over have at least one heart condition (link).

Regardless of this slowdown, Medicare spending has re-accelerated in the early 2020s, because:

• COVID: The pandemic itself had mixed impacts on Medicare spending. On one hand, many patients delayed elective procedures and non-routine visits during the pandemic, which led to a slowdown of Medicare spending growth in 2020 (link). On the other hand, costs associated with vaccine administration and treatments, along with payment policy adjustments by Congress from 2020-2023, led to some upward pressure in Medicare spending. By 2023, healthcare services use had rebounded to utilization levels higher than pre-pandemic as people made up for missed visits and procedures from prior years. Medicare per enrollee spending grew 7.1% in 2023 compared to the previous year (link).

• Rebound in growth in spending on retail prescription drugs: From 2020 to 2023, retail prescription drugs experienced the fastest growth in spending at 8.6%, following 3.3% average annual growth from 2010 to 2020 (link). Drivers likely include higher utilization, pricing, and the introduction of newly approved drugs (link). In 2020-2023, the FDA approved on average 48 drugs per year while in 2010-2019, the FDA approved only 37 drugs per year (link).

Another potential driver of increased Medicare spending is increased enrollment in MA plans. There is some debate as to whether or not MA is more or less expensive for the government, and there are studies that argue for each position. One study by Medicare Payment Advisory Commission (“MedPAC”), for example, argued that MA payments were 22% above that of Original Medicare once risk coding and favorable selection were taken into account (link).

What can not be disputed is that 2020-2023 was a high-growth period for Medicare Advantage, with total government spending in Medicare Advantage increasing from $361B in 2021 to $462B in 2023. This of course cannot solely be attributed to larger per capita spending, as there was an increase in percentage of enrollees that chose Medicare Advantage over Original Medicare during this time:

2. Why is enrollment in Medicare Advantage growing as a proportion of all Medicare enrollment?

Apart from the annual growth of Medicare spending, another noticeable trend of the Medicare program is the increasing enrollment into Medicare Advantage programs as opposed to Original Medicare. 2023 marked the first year that Medicare spending surpassed that of Original Medicare, and this trend is only expected to continue.

Why choose Medicare Advantage: the enrollee perspective

To put it simply, Medicare Advantage appears to be a much better deal than Original Medicare, covering more at a cheaper price:

• For Original Medicare: Enrollees pay at least a monthly premium of $185/month for Part B and $37/month for Part D (prescription drug coverage).

• For Medicare Advantage: In 2024, three quarters (75%) of enrollees in MA plans with prescription drug coverage paid no premium other than the Medicare Part B premium, essentially getting Part D coverage for free (link). Additionally:

  • Most MA plans also offer supplemental benefits not covered by Original Medicare, such as vision, hearing and dental.

  • MA plans tend to have an out-of-pocket limit, which Original Medicare does not have absent a separate Medigap policy. This translated to 18-24% lower out-of-pocket spending in MA than Original Medicare in 2014-2019 (link).

What’s not accounted for in the description above are prior authorization practices and limited provider networks in MA plans which can negatively impact the enrollee experience (more on this later).

Why expand Medicare Advantage: the insurer perspective

Increasing adoption of Medicare Advantage is not simply because it appears to be a better deal for enrollees, but also because health insurers want to make it a better deal for enrollees.

Navigating through Medicare and MA plan selection can be challenging, and nearly one-third of beneficiaries age 65 and older say they turn to an insurance broker and agent. Brokers and agents are usually paid more in commissions by insurers to enroll people in MA plans compared to Medigap supplemental plans for Original Medicare (link).

This can only mean that MA plans are great business for insurers. And, they are, particularly for the big insurers. Annual earnings per MA member reached $562 in 2022, about double the earnings in Medicaid and 45% higher than in risk-based commercial plans. MA insurers with larger footprints, notably UnitedHealth, Humana, and CVS Health-owned Aetna, are particularly well-positioned to achieve good profitability due to scale from customer acquisition, pricing and benefits administration (link).

3. What are the implications of increasing Medicare Advantage adoption?

From an AgeTech innovator’s perspective, MA plans are generally a good thing as they are better early adopters of new tech. Due to clear cost savings objectives and less bureaucratic structures, MA plans can be more active and nimble in testing and incorporating in technological solutions compared to Original Medicare.

MA plans are also incentivized to stand out in a competitive market of MA plan providers and so are more willing to test innovative solutions to differentiate from competitors, whereas Original Medicare does not have that same incentives. In 2024, the average Medicare beneficiary had access to 43 MA plans (link).

Finally, because MA plans offer supplemental benefits that are not covered by Original Medicare, there is more room for partnerships for innovative companies working on supplementary services such as dental, vision, wellness programs, etc.

Despite these benefits to the innovation ecosystem, MA plans have been under scrutiny that a) they do not provide equivalent or better enrollee experience compared to Original Medicare and b) they are not more cost efficient from the perspective of the government and tax payers. This has historically led to political scrutiny and at times policy action to revamp the program.

a) Medicare Advantage and Beneficiary Experience

There are two key unique features of MA plans that can lead to a negative impact on patient experience:

• Prior Authorization: MA insurers frequently require patients and providers to obtain prior authorization before receiving care. Nearly all Medicare Advantage enrollees (99%) are in plans that require prior authorization for some services, which is generally not used in Original Medicare. Prior authorization is most often required for relatively expensive services, such as skilled nursing facility stays (99%), Part B drugs (98%), inpatient hospital stays (acute: 98%; psychiatric: 93%) and outpatient psychiatric services (82%) and is rarely required for preventive services (6%) (link). This practice was criticized by a Senate report, which said:

  “This Majority staff report reveals how Medicare Advantage insurers are intentionally using prior authorization to boost profits by targeting costly yet critical stays in post-acute care facilities. Insurer denials at these facilities, which help people recover from injuries and illnesses, can force seniors to make difficult choices about their health and finances in the vulnerable days after exiting a hospital.”

• Network accessibility: MA enrollees can only access more limited provider networks, whereas virtually all (98%) of non-pediatric physicians participate in the Medicare program. This gap is expected to widen — according to a 2024 survey of 135 health systems CFOs, 16% were planning to stop accepting one or more Medicare Advantage plan in the next two years due to payment delays and prior authorization practices. 45% were considering the same but had not yet made a final decision (link).

Apart from these two differences in program design, from an outcomes perspective it’s difficult to comprehensively assess how Medicare Advantage impacts beneficiary experience and health outcomes as there are limited high-quality data sources to compare the two. While Medicare claims data are considered the gold standard of administration data, Medicare Advantage plans publish much less (link).

That being said, multiple studies do compare a subset of Medicare Advantage and Medicare outcomes across various dimensions. The results are mixed and generally suggest that MA and Original Medicare lead to generally similar outcomes though differ in some dimensions. Here are a few examples:

• MA beneficiaries are shown to have higher rates of primary care visits, more access to preventative services (link) and receive fewer low-value services (link), which speak to improved efficiency.

• However, MA beneficiaries are found to be less likely to receive treatment from high-quality home health agencies (link) and surgical cancer care (link).

b) Medicare Advantage and Cost Efficiency

As previewed earlier, the government may be paying more on a per capita basis to MA plans than Original Medicare. According to the Congressional Budget Office, this could be driven by the mechanics of how MA plans are compensated (link) (Note: I recommend reading Medicare: how it works for a refresher if the following doesn’t make sense)

First, about half of the people enrolled in Medicare Advantage plans reside in counties in which benchmarks, by design, are constructed to exceed estimated FFS (another name for Original Medicare) costs by 7.5 percent or by 15 percent.

Second, beneficiaries in Medicare Advantage have higher estimated risk scores, on average, than similar beneficiaries in Medicare FFS, in part because Medicare Advantage plans have an incentive to record more health conditions. That incentive exists because a plan's payment increases when the risk scores of its enrollees increase…

Third, quality bonuses apply only to Medicare Advantage plans—creating an additional cost that does not apply to Medicare FFS enrollees

Conclusion

Medicare and Medicare Advantage can be a powerful pathway to reimbursement for AgeTech innovators. Given this, it’s important that AgeTech Innovators are aware of the context that result in the dynamic environment these policies are situated in. Hopefully this intro post provides a good overview of the relevant research and data, and I’m sure we will revisit this topic at a future date.

1. It is the main health insurance program for anyone above 65 years old in the United States, and about 89% of this age group participates. This translates to about 68 million enrollees today (link).

2. Due to #1 being true, Medicare is the main path to reimbursement for anyone working on a medical/health-related solution targeted to an older population (in other words, Medicare is the main way that you can avoid having the consumer pay for your product, and have the solution paid for by Medicare instead).

3. Due to #1 being true, the federal government spends a lot of money on Medicare each year. In 2023, the Medicare program cost $839B, about 14% of total federal government spending and over one-fifth of all health spending (link).

Despite its importance, Medicare is a labyrinth to decode. In this post, I will attempt to walk through the basic mechanics of the Medicare program. I will go light on the research and statistics of how Medicare is performing and leave that for my next post. Instead, here I’ll focus purely on the nuts and bolts of how it all works.

This is not meant to be a comprehensive guide, nor a resource for those actually looking to select their Medicare program (I recommend Medicare.gov for this), but more for someone who is doing research on the space and wants a cheat sheet or launching pad to dig deeper.

The Two Sides of Medicare: Original Medicare vs. Medicare Advantage

To make things easy, there are two very different ways that Medicare is offered — Original Medicare and Medicare Advantage. We will walk through each program individually, but the two programs are fundamentally different in how they are administered and the mechanics that govern each.

For now, you can just note that:

1. Original Medicare (also known as Traditional Medicare or just “Medicare”) is administered directly by government, specifically by the Centers for Medicare and Medicaid Services (CMS), a branch of the US Department of Health and Human Services (HHS). Some aspects of Original Medicare are also outsourced to private companies and we will point out how later.

2. Medicare Advantage (or “MA”) is a Medicare-approved plan that is administered completely by private companies. This is an alternative for consumers to Original Medicare’s coverage.

In 2024, enrollment in MA plans slightly exceed that of Original Medicare, and about 54% of enrollees are enrolled in MA plans as opposed to Original Medicare (link). The distribution varies slightly state-by-state.

How Original Medicare works

Coverage

Original Medicare consists of three parts: Part A, B, and D. In case you are wondering, Part C corresponds to Medicare Advantage, originally called "Medicare+Choice”.

The table below gives a high-level view of how coverage works in each of these categories, but there is a lot of subtlety that is not captured for the purposes of brevity in this post. If you wish to dig deeper, I recommend the following resources: Medicare Interactive and Medicare.gov.

Out-of-pocket expenses

Unlike most health insurance policies, Part A & Part B of Original Medicare has no limit on out-of-pocket spending. To limit the risk of catastrophic medical costs, enrollees can buy Medigap. Medigap is extra insurance that you can buy from a private company that can help pay the helps you pay your share of costs in Original Medicare’s Part A and Part B. Medigap kicks in after you have met your deductible and typically has an additional premium associated with it. The average monthly premium among current Medigap policyholders was $217 in 2023, or $2,604/year (link).

Participating Healthcare providers

Virtually all (98%) of non-pediatric physicians participate in the Medicare program. Psychiatrists account for the largest share (39.0%) of all non-pediatric physicians who have opted out of Medicare in 2024, followed by family medicine physicians (21.5%) and internal medicine physicians (13.0%) (link).

How Original Medicare works with Health Care Providers

Enrollees can receive care at any Medicare-certified group. The facility or provider then submits a report of their costs to Medicare Administrative Contractors (“MACs”) for processing and reimbursement determination. This auditing process occurs after the service has been conducted. MACs are private health insurers that receive contracts from CMS to process Medicare claims.

Original Medicare is also sometimes called fee-for-service (“FFS”) Medicare because the government pays providers directly based on a predetermined fee schedule or system (also know as the Medicare-approved amount). Medicare-approved amounts are lower, on average, than payments from private insurers (link).

How Medicare Advantage works

Coverage

MA plans are required to provide all medically necessary services that Original Medicare provides. An exception is hospice care, which would still be covered by Original Medicare even if you are enrolled in a MA plan.

While Original Medicare requires enrollees to select a separate plan to cover prescription drugs (Part D), MA plans typically include them.

MA plans may also offer supplemental benefits that are not covered in Original Medicare, such as dental care, gym memberships, and hearing aids.

Types of MA programs

There are multiple different flavors of MA programs, but there are two main types that most people are enrolled in:

• Health Maintenance Organizations (HMOs): Enrollees are limited to the providers in the plan’s network. When they get health care outside of the plan’s network, they may have to pay full cost.

• Preferred Provider Organizations (PPOs): Enrollees pay less if they go to providers and facilities that belong to the plan’s network, but can also go to out-of-network providers for covered services, though they may have to pay more. PPOs can be either local (serves one or more counties) or regional (serves one or more states).

Aside from these two, there are other types of MA programs as well. One example is Special Needs Plans (SNPs) that provide benefits and services to people with specific severe and chronic diseases. All SNPs use a care coordinator to develop a care plan for the patient.

Out-of-pocket expenses

Since 2011, MA plans are required to provide out-of-pocket limits for services covered under Part A and Part B. In 2024, the out-of-pocket limit for Part A and B services for MA plans may not exceed $8,850 for in-network services for (HMOs, and for PPOs if only in-network services are used) and $13,300 for in-network and out-of-network services combined (for only PPOs, when out-of-network services are used) (link). Like Original Medicare, out-of-pocket costs for prescription drugs are capped at $2,000/year starting from ‘25 (link).

How private companies are paid for running MA programs

On a basic level, the government pays MA plans a set rate per person per year that is assumed to cover the full cost of providing coverage for the individual for that year (these are called capitation payments).

However, there is a lot of nuance on how much the government actually pays:

• Benchmark and Bidding: Every county has a slightly different plan benchmark, which is the maximum amount the federal government will pay a MA plan (this ranges from 95%-115% of average Original Medicare spending). Each MA plan submits a bid for how much the plan thinks it would take to cover Plan A & B benefits for a person of average health in that county.

  • If the bid is below the local benchmark (which is the case for the majority of the plans), the plan keeps part of that difference as a rebate. Plans are required to use the rebate to lower patient cost sharing, lower premiums, or provide some coverage for benefits not included in Original Medicare. Rebate dollars can also be used to pay for administrative expenses and profits associated with providing additional benefits.

  • If the bid is above the local benchmark, the plan can charge a premium for coverage of Part A & B benefits.

  • Even if a plan bids below the local benchmark and receives rebates, it can still charge premiums for supplemental benefits and Part D coverage.

• Risk Adjustment: Rebates, along with the bid amount, are adjusted for the enrollee’s health status. Patients with certain diagnosed conditions cost more to treat and hence MA plans will receive higher rebates for enrolling them.

• Quality Adjustment: Quality is calculated under the Quality Rating System ran by CMS, and impacts the rate calculation in two ways: 1) Higher quality plans benefit from increased plan benchmarks by 5-10%, and 2) lower quality plans receive a smaller portion of the difference between the bid and the benchmark as rebate compared to higher quality plans (this ranges from 50-70% of the difference).

• Medical loss ratios: Medicare Advantage and Part D prescription drug plans are required to have a medical loss ratio of no lower than 85 percent. This means that plans’ administrative expenses and profits, or margins, can be no higher than 15 percent of the total revenues that plans receive from the federal government and enrollees. Plans that do not meet this requirement must remit payments to CMS.

How MA works with Health Care Providers

Unlike Original Medicare, MA insurers frequently require patients and providers to obtain prior authorization before receiving care for some treatments and services. Prior authorization is essentially a process that health insurance companies use to determine if they will cover a medical treatment, prescription, or service. A denial often forces a patient to pay for the service out-of-pocket, or forgo it entirely if they can’t afford it. Patients have the right to appeal denials but in 2022 less than 10% of denials were appealed (link).

Also unlike Original Medicare, MA plans don’t pay the Medicare-approved amount and instead negotiate price with clinicians independently (link).

Conclusion

With all this information in hand, hopefully you feel more confident about your understanding of Medicare and Medicare Advantage!

Despite this post is already a bit too long, we have only just scratched the surface. In my next post, we will look at some of the statistics and research on the program to better understand how Medicare and Medicare Advantage are functioning in practice.

Let me know if you have any questions or feedback and stay tuned for Medicare Part II: How it’s working.

Sources:

• U.S. Senate Committee on Homeland Security & Governmental Affairs. 2024. Majority Staff Report on Medicare Advantage. October 17, 2024. https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf.

• Commonwealth Fund. 2024. Medicare Advantage Policy Primer. January 2024. https://www.commonwealthfund.org/publications/explainer/2024/jan/medicare-advantage-policy-primer.

• Medicare.gov. Your Health Plan Options.

  https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options.

• Commonwealth Fund. 2024. Medicare Advantage Policy Primer. January 2024. https://www.commonwealthfund.org/publications/explainer/2024/jan/medicare-advantage-policy-primer.

• JAMA Internal Medicine. 2017. Original Medicare vs. Medicare Advantage: Key Differences. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2643349.

• Medicare Interactive. Original Medicare Coverage Overview. https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/original-medicare.

• Medicare.gov. Medicare Costs Overview. https://www.medicare.gov/basics/costs/medicare-costs.

For many, longevity is the first thing that comes to mind when they think about aging. Longevity medicine, or the science of interventions that can help people live longer and healthier lives, is relevant to everyone, regardless of age and health.

I think it’s important to highlight that longevity is meant to address both longer and healthier lives, as we all want to improve not just our lifespan, but more importantly, our healthspan. In Greek mythology, Zeus granted Tithonus the gift of immortality, but not the gift of eternal youth. This led to immense suffering as Tithonus continued to age and decay, unable to die.

In the burgeoning field of longevity, the two issues go hand in hand — longevity science is not only concerned with making you live longer as measured by your chronological age, but more importantly, making you feel younger by your biological age.

Interested in learning more? Professors Alex Zhavoronkov, Evelyne Bischof, and Alexey Moskalev have made it easier to learn about the field of longevity through their online course Longevity Medicine 101. Though the course is targeted for medical professionals, it is also approachable for the general audience.

Here are my key learnings from the course:

Terminology

Fields of Study

Gerontology: An umbrella term for the study of aging processes and older adults from physical, mental, and social perspectives.

Biogerontology: A subfield of gerontology that focuses on biological aging processes, their evolutionary origins, and associated interventions to slow down or reverse biological aging.

Longevity Medicine: Biogerontology applied to clinical practice, typically involving personalized precision therapeutics, where multiple aging clocks are monitored, and systematic interventions are offered for the prevention and treatment of chronic diseases. This is not yet formally recognized as a medical discipline.

Geriatric Medicine: Diagnostics and therapeutics in the elderly, including palliative care.

Geroscience: A scientific field that explores the genetic, molecular, and cellular mechanisms that render aging a major driver of age-related diseases and chronic conditions.

Symptoms of Aging

Homeostasis: The ability of an organism to maintain constant internal conditions (e.g., blood acidity, oxygen saturation) under external disturbances. One symptom of aging is the decline in homeostatic capabilities, leading to an increased risk of age-related diseases and death.

Senescence: The process of growing old, particularly at the cellular level. In biology, senescence refers to cells that have aged and permanently stopped dividing but do not die. Over time, large numbers of senescent cells can accumulate in tissues throughout the body.

Inflammaging: Chronic, aseptic, low-grade inflammation that develops with aging and contributes to the pathogenesis of age-related diseases.

Interventions of Aging

Aging Biomarkers: Measurable parameters that qualitatively and quantitatively reflect the rate of human aging.

Geroprotectors: Substances that can reduce the aging rate and increase the healthy lifespan.

Subscribe now

The Key Questions of Longevity (Unresolved)

1. Should aging be treated as a disease?

At first glance, the statement seems preposterous—why should aging be treated as a disease when it is a natural part of the human condition?

However, since modern medicine is based on the evidence-based treatment of symptoms and diseases, advocates argue that this classification is critical for developing therapeutic interventions and preventative strategies targeting aging and age-related diseases.

In 2021, the World Health Organization proposed this change in its International Classification of Diseases (ICD), a catalog used to standardize disease diagnosis worldwide. The plan was to replace the diagnosis of “senility” with the more expansive term of “old age”, and to define the extension code for “aging related” diseased as those “caused by pathological process“, implying that old age could be a disease in itself.

This revision was retracted when the 11th version of the ICD was formally released without references to “old age.” “Aging-related” diseases were categorized as those “caused by biological processes,” removing implications that aging itself could be classified as a disease.

The primary concern about classifying aging as a disease is that it could further ageism and lead to misuse by physicians. Instead of determining exactly what is wrong with a patient, a physician might simply attribute a problem to “old age.”

Regardless of the classification, scientists and researchers continue their quest to address aging.

2. What is aging?

To complicate matters, scientists do not agree on a universal definition of aging.

At a high level, aging is commonly described as the gradual accumulation of intracellular and extracellular damage or errors that impair the body's functioning at various organizational levels.

Some researchers argue that this accumulation results from the cell's reparative systems being unable to eliminate certain types of damage.

Proponents of programmed aging suggest that aging is driven by evolutionary mechanisms activated at specific stages of development to make room for the next generation. However, no gene, hormone, or body structure has yet been identified as initiating aging in humans.

Another perspective views aging as a quasi-program—a byproduct of the hyperactivation of compensatory mechanisms in response to accumulated damage and errors.

3. How do we measure aging?

Currently, there are no universal biomarkers of aging besides chronological age. However, we know that there are significant variations in populations with the same chronological age.

This has led to the field of developing aging biomarkers, or metrics that can be used to measure aging in people. An aging biomarker needs to satisfy the following criteria:

• High correlation with chronological age in healthy individuals

• Can be used to predict mortality better than chronological age

• Indicative of the risk of onset for age-relate diseases

• Minimally invasive sample collection procedures

• Sensitive to early signs of aging, as opposed to mortality and frailty

• Low analytic variability, robust and reproducible results

Biomarkers can be measured through three different types of testing:

• Clinical and functional: links biological age to specific biological processes

• Aging mechanism-based analysis: measures hallmarks of aging through theoretically known mechanisms of aging (e.g., cellular senescence)

Omics: the objective of omics is to identify, characterize, and quantify all biological molecules that are involved in the structure, function, and dynamics of a cell, tissue, or organism. Scientists use data-based approaches train predictors of chronological age with omics data.

Most longevity physicians operate under the assumption that there are multiple aging biomarkers that should be measured and monitored together. This is because each biomarker has its own advantages and limitations.

Areas of Innovation

In addition to the continued search for more aging biomarkers, there is also potential to use neural networks to combine different individual biomarkers together.

4. How do we study geroprotectors and other interventions of aging?

Aging biomarkers are crucial for establishing standardized methods to measure the effectiveness of anti-aging therapies, or longevity medicine.

Many longevity interventions overlap with general health advice: regular exercise, adequate sleep, and dietary optimization. The most well-known intervention is caloric restriction—reducing calorie intake without compromising overall health.

The more exploratory aspect of longevity medicine is the search for geroprotectors, or substances that aim to reduce the aging rate and prevent the onset of aging-related diseases.

As mentioned before, developing geroprotectors is challenging due to the lack of universally accepted biomarker panels to measure their efficacy. Additionally, most geroprotectors under investigation are gerosuppressors, meaning they may slow aging but cannot reverse it. This makes clinical trials more challenging as it is harder to statistically prove the effectiveness of a substance in slowing a symptom as opposed to reversing it, particularly when the symptom in question is something as complicated as aging.

Areas of Innovation

Scientists have identified hundreds of compounds that could extend lifespan across various organisms. Some geroprotectors have advanced from academic research to clinical trials, including metformin, everolimus, and urolithin.

Unlike geroprotectors, cell therapy offers the potential for true rejuvenation. Induced pluripotent stem cell (iPSC) technology, pioneered by Shinya Yamanaka, has been in clinical trials since 2008 for age-related diseases like macular degeneration, Alzheimer’s, and cancer.

Gene therapy is poised to be the next breakthrough in anti-aging therapeutics. In the future, the concept of a “healthy genome” may emerge, with on-demand allele editing becoming a common approach to achieving it.

Conclusion

Based on this elementary exploration into longevity medicine, it seems to me that the field is still in the early innings of its evolution. The key challenges to this field are not just scientific, but institutional, rooted in how our health care systems develop drugs and therapies. Despite this, investors have shown appetite to pour billions of dollars into this space (link, link). Though I wouldn’t expect longevity medicine to be a reason to negate the need to invest in other areas of AgeTech today, this remains a space worth watching.

For this reason, I thought it would be worth putting pen to paper to describe how I conceptualize the category based on my learnings from the research community today.

I have experience as a climate tech investor, and within climate tech significant effort has been made to define the different technologies and pathways to take society to net zero. Might we similarly think of agetech as technologies that are needed to help us realize a goal of healthy aging in society?

A lot of resources out there define agetech through the underlying technologies (IoT, wearables, robots, etc). I will not pursue that approach in this post as I think the problem here is that the goal of healthy aging in society is not well-defined. I think that technologies are a means to the end. In climate tech, the end is clear — to help society reduce GHG emissions and and adapt to climate change. Agetech does not have this clarity today. Here I will make an attempt to resolve that issue.

Target Market

So let’s start with the most obvious answer to the definition of agetech: isn’t agetech just technologies for “older populations”? Typically this is defined by an arbitrary threshold, usually 65+.

This definition obscures the remarkable variation between people within this cohort, based on on factors including:

• Physical dexterity (e.g., mobility)

• Sensory acuity (e.g., visual and auditory) 

• Cognitive capability

• Comfort with technology 

The reality is just because someone is a certain age certainly does not mean that they face the same age-related issues. Additionally, each individual’s profile changes over time. In some cases, the key may be technologies with evolutionary capabilities as opposed to technologies that are suitable for one theoretically proposed age group.  

To add to the complexity, not all agetech start-ups sell to older populations directly. Other payers of agetech solutions are those that are tasked with the care and responsibility for older populations, which include professional caretakers, health care providers, family members, and govt. The target market for certain agetech solutions could also be entirely compose of younger populations who are interested in improving health and nutrition so that they can stay healthier as they grow older.

For this reason, I think agetech should not be defined as technologies for older populations, but instead technologies that address common aging-related needs for both individuals and their caregivers. Below I will define the different dimensions of age-related needs that agetech can target. 

This framing can also help to reduce the stigma of agetech by re-framing “technologies for older people” to “technologies that address aging-related issues”. This acknowledges that aging-related issues like Alzheimer’s or mobility loss are just aspects of a person, not what defines them.

Value Prop of Agetech

When I look at a start-up, the fundamental question that I always ask myself is, what is the value prop that the companies offers? This is true regardless of the industry of the company in question.

So, every agetech solution must address a perceived age-related need. Here I propose five value props to help people deal with age-related issues. The proposed value props also address my view of what healthy aging in society looks like.

AgeTech Value #1: Ikigai (meaning of life): This is the first value prop listed as I think this is the dimension of agetech that is least discussed. Ikigai is a term that originates from Japanese, and it means the “reason to live”. All of us are driven by Ikigai, the for-the-sake-of-which that is key to a happy and healthy life. Post-retirement, older adults need to redefine where in society they fit and how they are connected with everyone else. Technologies can help to enable this and become the basis for new communities and relationships to form.

Communication and entertainment technologies can be parts of the puzzle. Another approach is to keep older adults active through work, whether this be through continued regular employment or through other lower intensity engagements like volunteering or consulting. Working at an old age may sound depressing to some, but may be necessary for ikigai to others. Additionally, countries like Japan, Germany, and Italy are considered “super-aged”, with over 25% of their population over 65. For these super-aged countries, engagement of older populations into the economy may be a necessity. 

AgeTech Value #2: Autonomy: For older Americans living outside of a nursing home, 25% of those aged 65 to 74 and 50% of those aged 75 and older have reported some kind of disability, such as problems with vision, hearing, or mobility (link). Assistive technologies can mitigate the impacts of decline of physical ability so that individuals can continue on with previous activities despite the changes (e.g., hearing aid addresses hearing problems). Even without addressing specific physical limitations, there are many technologies that can make the lives of older people more convenient, whether this be delivery apps, ride shares, etc. 

One way to think about independence and autonomy is the ability of individuals to conduct activities of daily living (ADLs) and instrumental activities of daily living (IADL) (link). These are defined as:

• ADL: eating, bathing, dressing, toileting, transferring, walking, and managing continence

• IADL: cooking, driving, using the telephone or computer, shopping, keeping track of finances, managing medication, doing laundry, and housekeeping

The first post on agetech ventures on personal mobility (link) tackles just one aspect of these activities but clearly there is much more to it to cover in the future!

AgeTech Value #3: Improved Health Outcomes: The diagram below provides a great overview of representative health problems faced by older populations. Technologies can help to mitigate the impacts of these conditions as they occur.

Unfortunately, many older adults have multiple chronic conditions, which means increasing complexity of care needed, often from multiple providers and multiple care settings. These older adults are also more likely to experience poly pharmacy (taking between 2-7 medications daily), which increases the risks of medication errors and adverse events. 

Given the wide-ranging consequences of age-related health impacts, there is significant interest in preventative health measures that can delay the onset of conditions and add time to lifespans. This pertains to different aspects of health, including nutrition, hygiene, and physical exercise. This is also relevant for younger consumers who do not fit into the “older population” bucket, but are interested in longevity.

One challenge here is that agetech healthcare innovations are challenging to test in clinical trial settings. Aging related health conditions have many concurrent complexity that can be difficult to control for in an artificial lab setting. 

AgeTech Value #4: Safety: Older populations are more susceptible to fraud and exploitation as they experience cognitive changes. Scams targeting individuals aged 60 and older caused over $3.4B in losses in 2023 in the US (link).

The consequences of fraud vicitimization are more severe for older adults than younger adults as older adults usually lose more money, are less likely to report the incidents, and lack the earning capacity to recuperate from the loss (link). Technologies can offer a piece of mind to both the individual and the individual’s relatives and caretakers.

AgeTech Value #5: Cost savings:  Given we are in a capitalist society, cost efficiency is a viable value prop for every target market and agetech is no exception. The cost savings benefit not only the older individuals but also their caregivers.

There are at least 17.7 million individuals caring for someone aged 65 and older with an impairment in the US (link). Given that by 2035 there will be 78 million individuals older than 65 (outnumbering those under 18 for the first time), solutions are dearly needed to make caretaking more efficient (link).

For example, increasing adoption of telehealth and robotics has the potential to reduce the stress and demands on caregivers. However, many older adults may prefer the personal contact with people and will resist against this approach…

Tensions between conflicting value props

I would be remiss to not identify some critical tensions between the different value props that I listed above. Here are just a couple that come to mind that an innovator in the space will likely face. 

Autonomy vs. Safety 

There is a risk in allowing older populations to maintain independence while they may not be aware of the physical/cognitive declines that put them at risk from a safety perspective. For example, many older people prefer to continue driving but that may be at the detriment to their own and others safety. 

Improved health outcomes vs. Autonomy 

A lot of the technologies available to improve health outcomes are based on more extensive and potentially invasive monitoring technologies. How do we think about the trade-off between foregoing privacy for improved health> Additionally, as we age, we have more complex care needs from a health perspective that also make it harder for us to take care of ourselves. 

Cost Savings vs. the rest

Older populations have limited financial resources as the majority live off of savings and fixed incomes, and hence are unlikely to invest in agetech unless there is a clear perceived need. Caretaking facilities are also profit-driven organizations that are not incentivized to invest in agetech unless there are clear outcomes and efficiency improvements. 

There are many reasons why loss of mobility can occur with increasing age. Similarly, there are many technological approaches to promote personal mobility. Here we touch on a few dimensions of the solution and walk through examples of venture-backed companies in each space:

• Mobility aid

• Personal conditioning

• Fall prevention

• Environmental interventions

• Exoskeletons.

I found the companies by searching online and using the PitchBook Similar Companies tool to map out the universe. High-level, outside of pockets of innovation (fall prevention sensors and age-targeted fitness apps), the space is still nascent and companies are either early stage or not venture-backed. Of this map, only Whill and IFIT have raised more than $50M in venture dollars. Both Whill and IFIT are not agetech pureplays and sell to a broader end market.

Personal Conditioning

Staying active starts with strengthening the body. Research shows that even moderate physical activity can decrease the rate of physical limitations by 20%. Experts recommend than an older person should be physically active for about 30 min per day adding up to 150 min per week of moderate physical activity (link). There are four reasons why aging can be challenging for personal mobility and exercise can help to target these areas:

Some fitness apps are targeted to an older population and have exercise programs that are specific to strength training, flexibility, and balance as mentioned above. These app are more accessible to folks of all fitness levels (e.g., some have programs that allow people to exercise both seated and standing up). Most of these age-targeted apps are are covered by Medicare and commercial plans for at least parts of the population. Lindera is worth noting in that it is a personal conditioning platform targeted specifically for fall prevention amongst older populations.

This is a buzzy space and both Bold and Nymbl have attracted more than $20M+ in venture capital investment. Bold features high-profile investors including a16z and Khosla Ventures.

Mobility Aids

About 2 million powered wheelchairs were sold in 2020 (link), and start-ups tackling the space include Whill, Lifehub, and Abby Chair. Whill, founded by ex-Nissan car designer Satoshi Sugie in 2012, has attracted more than $150M of venture capital investment to-date. Traditionally Whill has not sold DTC (Direct-to-consumer) but sells B2B (Business-to-business) to dealers instead. In March 2024, Whill launched Model Ri, an urban mobility scooter designed specifically for seniors, available at $3,999. Unfortunately Whill’s products are not covered by Medicare or Medicaid today.

Other start-ups to mention include Nuvio which has developed a walker that continuously collects mobility data and generates insights to prevent falls and improve care. Walk with Path has developed a shoe specifically for those who live with Parkinson’s disease that experience difficulties walking through freezing of gait.

Environmental Interventions

Home modification can make living spaces more accessible. There are many companies that sell ramps and rails that can be used, but I did not find any the companies to be particularly technologically differentiated (let me know if you’ve seen anything). There are also many builders/contractors that can are certified-aging-in-place specialists (CAPS) who has completed professional training on aging in place.

Fall Prevention

Loss of mobility goes hand in hand with fall prevention, because falls both lead to reduced mobility, and preventing falls should be a priority in encouraging mobility. Falls are pervasive — about a third of community-dwelling people over 65 years old fall every year (link). Falls are not only common but consequential — the World Health Organization estimates that around 684,000 fatal falls occur globally each year and another 37.3 million falls are severe enough to require medical attention (link). Among individuals with a recent fall, up to 70% report fears of falling. Of these individuals, 50% may limit or exclude physical or social activity because of this fear (link).

To address this problem, fall prevention sensor companies produce solutions that are able to detect when people are standing up and when people have fallen. The products then are able to alert caregivers for faster response times. The data is collected from wearables (e.g., OK2StandUp), visual detection (e.g., bide), or radar systems (e.g., QUMEA). Target customers could either be individual households (DTC) or caregiving institutions (B2B).

BONUS: Exoskeletons

Exoskeletons are wearable structures that support the movement of a human operator. Exoskeletons can be used for rehabilitation and/or performance augmentation in contexts varying from consumer, industrial, military or medical applications.

Though this may sound straight out of science fiction, exoskeletons are already a reality. Ekso Bionics has a personal exoskeleton called Ekso Indego Personal that is only 29 lb (13 kg). The device enables people with mobility impairments to walk independently. Today the target market is individuals with spinal cord injuries, as this is a more high-powered exoskeleton (link).

WiRobitcs has also developed a consumer/commercial powered exoskeleton for hiking and exercise that is more applicable to people with less severe mobility challenges. Seismic has similarly developed a consumer/commercial device to provide support as needed for older populations.

As a VC, I've dedicated much of my career to Climate Investing, witnessing firsthand how technology and dedicated effort can drive societal progress.

However, throughout my life, what I've really been fascinated by is the concept of aging. How can we ensure that people age with dignity and continue to live fulfilling lives through all stages? While this issue may seem abstract and philosophical, I firmly believe that technology will play a crucial role in addressing it.

This challenge is of immense societal importance. Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%.

2. What to Expect?

In this substack, I will write different kinds of articles, including:

• Macro/Thematic Background on Aging

• Market maps of specific technologies

• Policy Analysis relevant to AgeTech

• Philosophical Musings on Aging

• And more…

3. Please Reach Out!

If you have innovative ideas or know of technologies making a difference in this area, let’s connect! Feel free to reach out to me directly or share your thoughts in the comments.

If you enjoyed this post and want to stay updated on future articles, don't forget to subscribe to the substack. Together, we can explore solutions and make a difference in how we approach aging.