Innovation and the future of aging, with Zayna Khayat

In this episode of Innovation Capital

In this episode, we look at the innovation opportunities for the future of aging.

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Episode transcript

Ray Chohan: Zayna, Welcome to innovation capital, I’m really excited about today’s conversation. Longevity is front of mind in the public eye and also, internally with a lot of the clients we serve here at PatSnap. So we’d love to kick off with learning a little bit about your story and how you got into the wonderful world of longevity and healthcare.

Zayna Khayat: Hi, thanks for having me. I love that you’re focusing on this topic. Now, I can’t say as I kid I knew one day I’d be a future strategist in the aging space. But I guess I backed into it. In hindsight, it’s because I love working on really messy, complex, wicked, intractable challenges and opportunities in an area that’s important to society. And that’s definitely the future of aging space. Now, for context I want to give you a bit of background about me. I’m a scientist by training, and I did a PhD in biochemistry and diabetes research. But I pivoted to the business world with Boston Consulting Group for 10 years. So that’s how I learned my business chops and how to work on solving complex problems, particularly in healthcare. And then, I worked in tech space in healthcare with MaRs Discovery District here in Toronto, which is kind of Canada’s global address for tech innovation. After that I spent some time in Europe, and came back in in 2018, to be the future strategist with an organization called SE Health, which was formerly St. Elizabeth Healthcare. We’re a social enterprise and for the past 112 years, we’ve been visiting older adults in their homes, to deliver care. And that’s really our living lab to now create the future of aging instead of just the future senior care. That’s what I do.

Ray: Now, with the future of aging, what’s the background context because for us here at PatSnap, we’ve started seeing more and more organizations deploying more capital when early-stage businesses focus on longevity. When did this kind of movement really start with longevity being top-of-mind and there’s more research dollars, and more early-stage investment dollars going in this category? Well, what’s the backstory?

Zayna: I mean, the simplest [backstory] would be that the baby boomers (of which one was born every 10 seconds) in most Western economies, just started turning 70 a few years ago. As they bulldoze through every age category, from being infants which resulted in a demand for pediatricians, to teenagers which led to everything from McDonald’s to the suburbs, and fridges and malls. They’ve created every category like Toys R Us, and now they’re in this segment, and no categories have been really created for this population. And they will not age the same way their parents did. And so that’s really, I think, the trigger that led to a lot the writing and research and, tech innovation. For example, like Procter and Gamble just as a proxy, right — they are the case study of every business school. It takes a lot for them to create a new category. They’ve got diapers and feminine products, and aging is their new category. So that’s a big sign. Walmart, Best Buy, Samsung — every company has created a category for this space. So, I think that’s the tipping point. And in terms of macroeconomics, by about 2035, in most economies, one in every five people will be over 65. And there is nothing in our history as a species that has prepared us for that proportion of the population to be that age. And so pretty much every social construct and norm, policy, product and service is up for grabs to meet this market where its needs and expectations are. And that’s really the promise and why we wanted to capture all that in a book.

Ray: Now, from a science level, are there particular paradigms, which are enabling fundamental research, which has a route to commercialization, with key epiphany points within the scientific community that are enabling the longevity players?

Zayna: Yes — but let’s be clear what longevity is. There’s one stream, which is the longevity science. We’ve quadrupled life expectancy in the better part of a century, which is unheard of for our species. For a long time, the average life expectancy was about 18 years. Now, longevity science will continue. But, we’re not actually that interested in that — instead, we’ll assume based on the science that we are not yet done in life extension. Aubrey de Grey who is a top expert in aging longevity science, believes by 2036 we’ll hit what we call longevity escape velocity. So, like a rocket ship, there’s a point where the pull of gravity is overcome because the Rocket Power offsets it, and you enter an escape velocity where you keep going, and nothing pulls you down. Well, we will get to a point for every year you and I are alive where science can keep us alive for 1.1 years, right? So, if that’s the case, and we’re going to live much longer than we ever did before, then what are the products, services and policies that need to be created? So, I don’t think it boils down to science — it’s just good design that’s needed. And the incumbents are not going to be the ones create [these products, services and policies]. Instead, we hypothesize it will be a bunch of new players.

Ray: You mentioned year 2036 is when we are expected to reach escape velocity. Now, human beings by nature, we’re not great at understanding or anticipating exponential curves. What’s the background behind that? Because I’m quite shocked hearing that year as the inflection point. Is there a background wave of technology or fundamental research?

Zayna: I’m not the expert, but as faculty at Singularity, this is a big area. For people like Aubrey de Grey, and many others, this is their life’s work. There are whole societies dedicated to this. From my stance, I’m just going to assume it’s right. A lot of it is dementia, most of the musculoskeletal diseases, most of the cancers — these are diseases of the ages, right? It’s your accumulated stuff in your life, where your body stops working and degenerating. These things will start to go away. Many futurists predict that the number one causes of morbidity and mortality [illness and death] will not be physical disease like they are today. Instead, it’ll be geopolitical. It’ll be crime, it’ll be accidents, whatever it is. And you could argue these aging in place technologies, which frankly, is where most of the tech market is in terms of the startup economy and investment capital, remote monitoring and so forth, are helping. For example, life extension technologies, robots and digital companions. But the needle really moves from reversing aging through biological manipulation.

Ray: A lot of our team members have enjoyed the piece called Lifespan by David Sinclair, which I’m sure you’re familiar with. In the piece, he talks about how a cell is either in growth mode, or repair mode. And we’ve identified certain genes and lifestyle habits which can activate that repair mode. So, with that specific stream, where are some of the low hanging fruit opportunities within the next three to four years? What are some of the big exciting developments, which enabled that gene activation?

Zayna: I have to say, it’s not my area of expertise. This stuff is big science, right? There are many factors that come into play, whether it be accumulated toxicity in our environment, or our age. For example, the Wnt signaling pathways (these pathways comprise a group of signal transduction pathways that allow proteins to pass signals into a cell through cell receptors) — these pathways can be turned off. Some of that is just biology, much like the way the mRNA vaccines work. You go in and manipulate and, like Moderna and other vaccines that are anti-aging etc. On a broader note, in the wellness space of things, you can make changes to reduce the toxicity in your cellular environment. Reducing exposure to free radicals, bad food, stress, and aligning the circadian clock — that’s all good stuff to do. But the real push will be when you can eliminate disease, just like we’ve eliminated polio and other diseases we don’t talk about such as tuberculosis because you can now have a therapy to turn those pathways on. So again, I don’t want to go too deep because it’s not my area of focus, and we’re more interested in all the innovation which will actually move the markets. For example, when all these people are staying alive for a long time because diseases aren’t killing them, and they’re retiring at 60, but living until 90 – what is available to them? What happens during those 30 to 35 years? Everything needs to be redone for them, and that’s what we’ve been focusing on.

Ray: That’s fascinating. So even the design of a city to adopt, right? And what are some of the key pillars you’re trying to knock down initially?

Zayna: We let the data speak to us in the book. We partnered with Idea Couture, an innovation firm that’s based in Canada, the UK, Singapore and California and spent a year researching the signals around the future of aging. Specifically, what are some signs and interesting things emerging? Then we let those 350 or so signals that we tracked tell us the story of the themes, and how they’re clustering together. That data because the driving force of the five chapters in the book. The five big areas, one of which you alluded to earlier — housing and community — and all things around the built and non-built environment of how and where you live, that’s chapter one. The second chapter focuses on healthcare. Earlier you mentioned lifespan, and this book speaks to how the new job of healthcare will not be to keep you alive at all costs and cure disease. Instead, the job of healthcare will be to match your health span to your lifespan. We don’t do that today. And that will have massive implications for the $14 trillion dollar healthcare sector. Then in chapter three, we discuss gerontechnology. So, technology and aging — not just life extension. This chapter provides tools to help you live with agency, and independence, and on your terms. Chapter four is about the economy of aging. So, everything about how you make money, save money, spend money, and pass on a legacy. Pretty much every assumption about that is up for grabs, and there are very few financial products that are ready for this. And then chapter five is all about the identity of aging. So that’s ageism, and to put this into context, think of racism going through its moment. Think of feminism, and sexism. Ageism is the next one that’s going to have a major shift of social constructs. And, COVID just accelerated that. Those were the big themes, and then within each there’s a lot more to unpack.

Ray: So, redesigning that $14 trillion economy, that sounds insane because that’s going to unbundle everything. And everything potentially has to be redesigned to match your health plan to your actual lifespan. So, it’s interesting, you mentioned that and I love the way you put that. Now, what are the big scary challenges initially in terms of redesigning our healthcare system to match this potential new paradigm?

Zayna: Well, I pretty much have concluded that the current health care systems, whether that’s the NHS in the UK, what we do here in Canada, the US etc., they’re not going to redesign themselves. They’ll work on the margins; they’ll slowly migrate and meet people where their needs are. But, in terms of redesign, I think it’s going to be a whole set of new players that come in and bring better policies, products, services, and experiences. And there’s so much to do. So, it’s not like anyone stealing market share from anyone. As I mentioned earlier, and I’ll specifically site Canadian data, but it’s relevant everywhere — today 17% of our population is over 65. By 2035, that percentage will increase to around 25%. And that 25% will consume about 45% of all the resources. This is typically what you’d expect to see, and then within that there’s a massive micro segmentation. To put this in perspective, let’s say half of the total healthcare industry delivers services specifically for older populations today. All that is up for grabs in terms of personalization, hyper segmentation, and most importantly, there is no more medical model. The aging process is all about how you relate to all the different things that are around you, not just your formal medical services. So, if you think you’re going to solve what people want to increase to match their health span to their lifespan purely through medical means, it isn’t going to work. And that’s where the opportunity lies — it’s all about who can play on all of the variables to address social needs, functional needs and so forth. And so that’s a lot of what we explored, and then we unpack certain parts of that in a little bit more detail based on the data.

Ray: In terms of unpacking, what would you say are the key pillars surrounding this challenge our audience should keep in mind?

Zayna: I’d say four big things. One is the shift in perspective from treating aging like a disease that you are trying to avoid. So many people view aging as a bad thing. And rather than seeing aging as a negative experience, this shift [and the companies and people creating products and services for this segment] encourages people to age affirmatively. The idea is to help them get through it, as opposed to trying to avoid it or once you hit a certain point when you can’t function well, then that’s it, you’re going off to get warehoused in an institution and, and we’re going to move on so. So affirmative aging, let’s call it aging with agency, over your health experience, that’s one. Two is, like I said, is shifting from curing disease, to adapting that lifestyle to maximize health span. And so, the name of the game if you’re in healthcare is “How do I let people adapt and manage in the face of medical or physical challenge instead of this kind of cure all approach?” And if you start there, you get a vastly different organization of services. The third is a very physical model of health, because it’s actually easy to measure things like heart rate, blood pressure, and things in your bloodstream, for example. In the past, we’ve had a very medical model, and then a lot more of at least a balanced leg of a stool of the emotional determinants of your health and your healing. And, of course, COVID really showed that in terms of social access. And the final area we dig deeper on specifically surrounds cognitive decline and dementia. For example, in my world, I’d say about 30% of our clients experience these aliments. Therefore, this shift from trying to just treat Alzheimer’s and cognitive decline, to perhaps reframing the entire experience — this is where startups will be huge — and looking at how neuroplasticity and brain training can shift the paradigm. So how do you recognize the path of biology, and then work to overcome it? Neuroplasticity research and commercialization is still very, very early stage.

Ray: You mentioned another key — one I can’t get out of my mind. The idea of ageism and its shifting paradigm. Could you go into more detail about that because I’d love to get a better understanding of that forecast.

Zayna: Let’s start with the identity of aging. For the longest time, we as a species have decided that around 65, because that’s what the science and data showed, that’s when the major decline happens. Once you reached 65, you were really only alive for four or five more years. And so that’s how you planned everything. And, that framework was a deficit framework. Think of the pictures you see of an old person for like a street sign, what’s the image you would imagine?

Ray: Normally, it’s kind of a hunched over poor posture person.

Zayna: Yeah, with a cane, right?

Ray: Exactly!

Zayna: And then language like ‘gray tsunami,’ and there were even ridiculous COVID-related hashtags such as ‘Boomer remover.’ Not only is that wrong, but it’s ageist. Think of racism — not that it’s gone away — but in the peak of it in North America before 1965, or sexism before some of the women’s movements at that time, it was just normal to be that way. Right now, that’s how we are with ageism. I think that’s what we unpack in many ways. The big one is around the shift in how we respond to crisis. For example, if you’ve fallen down, or gotten cancer, you should still have agency in your life rather than having everything decided for you. And that’s what this does — it creates a fifth stage of life that didn’t exist before. It’s about reinventing and recreating, and living with purpose. Think of the world wisdom. We’ve had it in our East Asian societies for centuries, and in our indigenous populations, and that wisdom now become a massive asset to society. What’s more, when we dig deep into our ageism chapter around sexuality, because that’s a whole market waiting to be designed for, we talk about being able to authentically enact one’s gender and sexuality. And then, there’s a whole bunch around that about incontinence. There are so many ways men and women in this category are not looked after at all. And then the last area of this ageism shift is around the idea of avoiding mortality, and end of life. Today, death is a fairly standard process. You get put in a box, you go to some building, there’s a ceremony held in your honor, and you get put in the ground or cremated. This is going to change. In the future, you will have control over how you die, when you die, where you die, how you’re memorialized. And what’s done with your remains. And those markets don’t really exist today.

Ray: I see a really bright future where, for many people, life will begin at 60. The career can carry on, they can still play the sports they love and grew up with, and potentially meet a new partner. They’ll have an additional 30 to 40 years of a career, personal life, maybe even conceived by them with the way technology is developing. So we’re kind of building a metaverse in a way a metaverse which doesn’t exist. And this new future of aging opens up a brand new metaverse.

Zayna: You’ve summarized their book better than I could! That’s exactly it. And just to give you an example of what that means, adolescence as an era or age stage didn’t have a definition until the boomers got into it. Exactly as you described, that’s now coming in what we call the fifth stage. And they’ve estimated now that as you turn 65, on average, you’re alive for another 8000 days. That’s 21 years. If you think you’re going to go retire to Florida, or be in a home for 21 years, are you kidding me? So that’s what we’re saying — what is society for those 21 years? What are the products, services, policies? I think it’s just a massive opportunity to meet people where they’re going.

Ray: This is amazing. This resonates with something I was watching this weekend, and the number actually surprised me, Zenya. So, I think in 2020, and 2019, the average age of a tech founder was 42!

Zayna: I was going to say 39.

Ray: Yeah, that numbers threw me off for hours, and made me smile.

Zayna: I’ll give you a category. So, for PatSnap, there’s a whole segment called elderprenuers or seniorpreneurs. And there are startup incubators just for the 60 plus entrepreneur.

Ray: This is such a positive outlook, Zenya — for the world. Especially for certain folks who may be missed opportunities when they were younger due to socio-economic reasons, personal random reasons or whatever the case may be, they get a second chance where if they are taking care of themselves and taking advantage of the therapies and the lifestyle habits, aging doesn’t have to be a negative experience — it can be highly positive. Starting a business at 48, or taking on a new hobby, or meeting a new life partner. All these scenarios are possible.

Zayna: Absolutely. But I want to be careful with language here because I can’t stand toxic positivity. When I see a lot of cliché content out there like, “Oh, aging is an amazing time of your life!” or “Oh, It’s so great!” That’s not what we’re doing here. We’re saying this segment needs to be different. The population is ready, and we need to meet them where they are. Now, there are going to be many people in this segment who want to go to a nursing home, or have someone else take care of them. They don’t want to reinvent their career at 80. Fine. So, it’s really a micro segmentation. I don’t want to generalize because we’re not saying everybody’s going to become an Estee Lauder model, in their 80s and join a dance troupe or something like that. It’s just that these channels are opening, and people are going through them. And so, who’s going to help them get there at scale.

Ray: It’s hard looking at the bright side of all these amazing entrepreneurs walking around a certain age thinking the game’s not over. And it’s actually probably great for innovation because you’ve got more players in the arena. Plus, age gives you wisdom and experience. It’s a fascinating space. And, in terms of the Singularity University, I know you’re also part of that organization as a faulty member. What are some of the big 100,000-foot views of this category? Are there some really exciting things which are up-and-coming on the design side or technology side which we should keep our eyes on in the next four to five years?

Zayna: A lot of what I know is because of my role with Singularity. Part of that is because I have to be trained and go educate the masses about the future of health care, which again, half of that is aging. Some of the things we talked about with these emerging vaccines that will exploit the pathways in your cells to reverse aging, and some of the wearables and so forth, that’s from there. We haven’t taken on aging at Singularity as its own stream. There’s healthcare, manufacturing, and FinTech as the big areas, but maybe we will one day. But as I mentioned there are elderprenuers and seniorpreneurs, and I keep a little lexicon of new language in the tech space around aging. Do you want me to drop a few word bombs on you?

Ray: Sure, go for it.

Zayna: Going back to earlier when I said the end of life, and everything about death will be reimagined, that’s called NecroTech. Maybe that’s a category you start tracking — tech innovation around dying and death. Reminiscence therapy, that’s another emerging category. The idea is to tap into the brain’s most formative memories, and activate the senses. Whether it’s smells from the past, or the music you listened to, the Happy Days TV show you watched, this therapy jogs the brain’s ability to recall memories. Nana technologies instead of nano technologies. Of course, I said gerontechnology. There’s also biogerontology which is a category of biologics and bio science. There’s also IoT, or as Canadians would say, IoOT, which is the internet of older things. So those are your sensors and wearables which are designed for this population. I have many more [terms], but those give you a flavour of some of the new language.

Ray: That reminisce tech just hit a chord with me. I just saw something posted this weekend showcasing a night out after lockdown restrictions ease, and we’re back to some commonality. And it literally was remnant marketing. I actually got really excited when I saw the ad. So it’s interesting smells, maybe VR capabilities, which takes you back to a certain time and era.

Zayna: Exactly! Could be video, doesn’t even have to be VR, by the way, just an old school TV screen. There’s a great company at a Norway called Motiview, check them out. Motitech, I think, is the parent company. Anyways, they take recorded video from the village you grew up in, in Italy. And they go really slow so it’s as if you’re biking through the streets and the landscapes. If you put that in front of a person who’s now 80. And they will continue biking for hours because they’re locked into this old village that they grew up in, or even the City of London, it doesn’t matter, and you should see the clinical results. Everything from smells, to music and then a built environment. VR will explode too. There’s also a great company in the US called Town Square, and it’s an adult daycare program for adults with Alzheimer’s. They use empty malls and real estate, and convert these buildings into 1950’s and 60’s themed diners, houses, schools and so forth. The results of the calmness, the engagement, and the therapy for these people with dementia far exceed what you’d get in a Bayesian burgundy institutional model. And that’s reminiscence therapy.

Ray: In terms of obviously we’re seeing in the marketplace with a whole bunch of capital being deployed in longevity, obviously now we understand that wider ecosystem of players that will contribute to this new marketplace. For our audience, are there any cool startups or emerging businesses, which we should watch out for? Or keep top-of-mind?

Zayna: Yeah, a couple. So again, I’m not that excited about the high science stuff, like true longevity science, although that’s awesome. But I’m more excited about the new products and experiences for people, because they are going to be alive until they’re 120. A few to keep top-of-mind are Motitech in Norway (as I mentioned earlier), which is reminiscence therapy that gets you biking. There’s also Papa in the US, so think of Uber for grandkids. If I’m an older adult, I’m isolated, especially during COVID, and I need a little bit of help around the house or someone to hang out with, I can Uber them up, and I get grandkids on demand. The value exchange is bartered between the two parties, and that’s mediated by the pop-up platform. Papa just did a $7 million series A funding a few weeks ago. I kind of like those guys. Memory Well is another one that allows you to capture story and narrative. And again, photos and artifacts of your life become really vital for reminiscence, but also creating a better experience around aging and end of life. So, I think they just raised another round. And a few more in the VR sector come to mind such as MindVR, In the VR context you’re overcoming receptors in the brain that would have normally had another input to tell your body what to do, like feel pain, and you can replace those receptors. It’s like a drug in many ways. And so really neat stuff around pain management, and even like letting people visualize. So, imagine if you had a parent or a loved one who was at the end of life — that’s extremely shocking. Because it’s not seen often, maybe once or twice with your parents if you’re lucky, and there are certain smells, the skin, the way the body is ending, and it’s hard for people to see. It’s traumatic. But there’s a VR training that can prepare you for what to expect at end of life so that when it happens, you’re focused on the person and not on dealing with the trauma. There’s so much going on there, I could go on and on. There are lots of good summaries now of the ageing tech space in the different categories. And I think it’s going to continue that way.

Ray: Just so our audience knows, let’s do a quickfire round because I’ve really enjoyed this exchange. What are the top two books you gift the most or highly recommend?

Zayna: Well, my book! I mean, we just wrote The Future of Aging. It’s on Amazon. I think that just gives you a holistic view about aging. And then on this topic, I’d absolutely have to recommend The Longevity Economy by Joseph Kauflin. He’s at the MIT aging lab he’s really quantified the size of this economy, purchasing power, and shown some amazing examples of major market opportunities in this space. I love the work that his team is doing over in Boston.

Ray: And, alien life form believer or non-believer, and why?

Zayna: Non-believer because I understand the biology too much to think it’s possible.

Ray: Also, if our audience wants to find you online, what’s the easiest way to find you?

Zayna: Twitter, so first name, last name, Zayna Khayat, LinkedIn, and I’ve just started getting a little mild obsession with Clubhouse. I’m part of a club we’re running called “The future of health”. I know dabble in a few other clubs because I think it’s a fascinating platform.

Ray: Brilliant. Awesome. Well, Zayna, it’s been brilliant having you on Innovation Capital, and hopefully we can get together for part two!

Zayna: My friend, I look forward to it!