Hearing aids fail four out of every five people with partial hearing loss. That’s not to say they aren’t perfectly functional as pieces of electronics. They are—and they’re becoming more so every year. But according to the National Institutes of Health, only 20 percent of Americans who could benefit from hearing aids seek them out, a disturbingly low proportion that doesn’t even account for the many who own but choose not to wear them. That means that, in a way, hearing aids are as broken as if they spewed black smoke from people’s ears.

That is just one symptom of a much broader problem with how businesses innovate for older adults. In most of the consumer-facing economy, a product with such low uptake would likely have been unseated by something cheaper, cooler, simpler, or more useful. Incremental improvements aside, the fact that this has never happened with hearing aids is telling. It suggests that when it comes to designing and marketing products for older people, the normal rules don’t apply.

As I describe in my recent book The Longevity Economy, there’s a simple reason why: A counterfactual narrative of old age has developed over the course of more than a century, and it’s become so ingrained that very few people—and perhaps even fewer businesses—think to question it. When most people picture “the old,” a specific impression usually comes to mind. It varies by country, but this group is often seen as a singular, homogenous population that depends on the largesse of others to survive because it can’t pro­vide for itself. Older people are assumed to live apart, quietly sequestered away in retirement communities, assisted-living facilities, and nursing homes, surfacing to shop and dine only when everyone else is at work.

Most important, it’s assumed that they like it that way. Because retirement is usually regarded as a state of idyllic contentment, many people suppose that to be not working and separate from other age groups is wonderful. In this all-too-common reading of age, older people are somehow simultaneously needy (because they’re con­sidered constitutionally unable to provide for themselves) and leisure-oriented (because, in the absence of work, they are at their most visible while out buying things and having fun).

Taken together, these ideas add up to a picture of the older consumer that feels deceptively complete: Leisure products must be all older adults want, while medical and accessibility-oriented products must be all they need. With both needs and wants covered, businesses need perform no additional mental legwork to under­stand the desires of the older population.

Watching these biases worm their way into tech products—even ones made by companies with the best of intentions—is dispiriting. On the rare occasion when they see fit to direct their attention toward older adults, most tech innovators instinctively reduce their target users down to their medical issues. Consumed with the obvious problems of old age—issues like hearing, mobility, medication management—they fail to consider the other things someone of any age would want. Concerns about self-image or style, crucial considerations for every other age group, are frequently seen as frivolous, and come only as an afterthought. Meanwhile, for many older adults, the higher-level desire to look and feel a certain way can overpower base-level physiological needs such as the ability to hear clearly. And so for every older adult who has hearing aids, an emergency-response necklace, or one of those cell phones with the huge rubber buttons, there are legions avoiding these potentially lifesaving devices.

But that may be changing, gradually. An early glimmer of hope arrived this past August, when a bill was signed into law that created a new category of hearing aids that don’t require a prescription and can be purchased over the counter. The law could free up companies to experiment with a technology that has long been associated with medical needs and oldness. Eyeglasses, a functional item that clarifies fuzzy images, can be high-fashion accessories. Why can’t hearing aids, which clarify fuzzy sounds, move in that direction?

The most intriguing such movement is the rise of “hearables”—wearable technology for the ears that blur the line between hearing aids, earplugs, and headphones. There have been some promising early entrants in the field: Since 2014, the Starkey Halo brand of hearing aids can double as earbuds, letting users pipe music and telephone audio directly into their hearing aids. The codec that made that possible over a low-energy Bluetooth connection now resides in Apple’s own wireless earbuds.

As Apple, Google, and others continue to enter the hearables field, perhaps the most exciting aspect of the technology is its potential to turn up or down certain frequencies of environmental sounds—something that could be useful to younger and older users alike. In addition to listening to music through their earbuds, young people might soon begin to use them as augmented-hearing devices that can filter out background noise in a crowded coffee shop or office, or provide real-time language translation. Hearing aids with a similar appearance and functionality could then lose their stigma. They would also be significantly cheaper than today’s traditional hearing aids, which cost users an average of nearly $2,400 per ear, plus mandatory fitting costs. (There has been, however, one major disappointment in the realm of hearables: Doppler Labs, the maker of the promising Here One earbuds, has shut down, apparently due to the capriciousness of Silicon Valley funding and the vicissitudes that come with manufacturing hardware as a small start-up.)

Another example of an age-old old-age technology with an uncertain but potentially promising future is Personal Emergency Response Systems (PERS) devices, which often take the form of an emergency-call necklace that can summon help in the event of a fall. Just 2 percent of the U.S.’s 65-plus population subscribe to such services. Part of the issue may be cost, but in the United Kingdom, where the National Health Service foots the bill for consumers, the adoption rate is still a lackluster 16 percent. If the main problem isn’t cost, it may have to do with self-image. As Pew reported in 2009, only 35 percent of people 75 and up say they feel old; 100 percent, though, it’s safe to assume, recognize that PERS are for older adults. People are dying as a result of this disconnect—because they fail to obtain a much-needed PERS device or else, if they have one, because they refuse to use it.

Disturbingly, in one small 2010 German study, 83 percent of PERS wearers who laid on the floor for at least 5 minutes after taking a fall failed to press the button to summon help. It wasn’t because they couldn’t physically press it, many later explained—it was that they simply wanted to manage the situation themselves, with no help from emergency services. That revealed preference suggests a product concept that is every bit as broken as hearing aids: something few want to own, and even fewer want to use.

Happily, however, an answer may once again be on the way, in the form of genre-bending technologies. The smartphone is one early PERS challenger. Even though a PERS device is perhaps the easiest product to use in the event of an emergency, a cellphone is arguably a better emergency technology for the simple reason that people actually go out of their way to own them, carry them on their person, and use them. It’s easy to see why: Whereas a PERS device signifies a decline into isolated dependency, a cellphone represents a healthy social network at one’s fingertips. As of 2014, 77 percent of Americans 65 and older own cellphones, making smartphone fall-detection apps that much more promising.

But a perhaps even bigger improvement on PERS is still on its way. Dina Katabi, a colleague of mine at MIT, has developed a fall-detection system that relies on wifi-like radio signals to determine—through walls—whether someone is upright and breathing in their home. Currently, Emerald, as it’s known, is a standalone technology that is not yet on the market, but it’s easy to imagine it or something like it finding its way into smart-home hubs like the Amazon Echo or Google Home. Soon, such devices could alert emergency services if users take a nasty spill, experience a stroke, or choke on an olive pit while home alone (something that can happen at any age), obviating traditional PERS setups.

These developments are just the first signs of change in the future of consumer products for older people—a future in which companies that treat older adults solely as needy and leisure-hungry will fare poorly. The most important changes, though, will manifest not in corporate boardrooms but in the lived experience of old age. With technological innovation applied to older consumers’ actual wants, needs, and goals, older adults may soon find themselves living not just longer lives, but better lives, defined by independence and connectedness. For an early preview, watch the transformations coming to assistive audio devices. As hearing aids go, so goes the world.


This article has been adapted from Joseph F. Coughlin's book, The Longevity Economy: Unlocking the World’s Fastest-Growing, Most Misunderstood Market.