Who really makes choices?

I was speaking at the Ambient Assisted Living Forum in Bucharest recently and was wondering how add an extra 10 or so minutes to the Epidemiology of Innovation talk that I had been invited to present to fill my allotted time slot. A quick conversation with my 87-year-old Mother gave me all the information I needed, but I had to reach back to one of my first encounters I had with the dark arts of marketing to give her story a framework. The challenge as I understand it was of layered customers and choice editing.

I can remember the first time anyone tried to get me to understand layered customers. The example they chose was so simple and unambiguous that it has stayed with me for over 20 years and proved (I believe) as effective in my (unskilled) hands in Bucharest. It is about the purchase of a water pistol. The end-user of a water pistol is usually a child between the ages of 5-10. Their needs are simple. They want range – so that they can soak their opponents without getting wet themselves – and they want capacity – so they can soak more of their opponents (or one a great deal!) Invariably, children do not have the purchasing power to buy a water pistol and one of their parents acts for them in this respect. Being responsible, what the adult looks for in the water pistol is safety – so the child will not be harmed by it – and durability – so the purchase has longer-term value than one afternoons play. The two parties do not look for the same things in the water pistol as they choose. The parent makes the actual purchase decision and so, inevitably, the water pistol is safe and durable. This would infer that they are the important person in the economics of water pistol commerce. But if the purchased water pistol does not also have range and capacity, the child will reject it, lose it or just move onto another activity and the purchase will be wasted – so perhaps they do actually have the final economic power?

Most health and care markets have a similar dynamic. Choices are made by professional carers, nurses and doctors (or the administrative functions associated with their activities) and they do tend to treat older adults (in particular, but also most people in care) as incapable of making an informed choice. Food is a good example. By the time a person is over 80, they will have eaten about 85000 meals. In that time they will have sampled most foodstuffs and decided what they like. Being told that something is good for them, or to “be reasonable” is a form of customer service that would destroy most retail industries! Similarly, older adults will have met a very large number of people in their lives and worked out what type of person they get on with and what type they do not like. Yet the various state systems (allegedly) designed to provide them with support give them no real choice in who they have to allow into their homes. What tends to happen is that, like the child with the water pistol, they exercise control over the repeat choice and regain the economic power – by not eating the food or not answering the door. The problem is that this results in waste and an inefficient support system – in an area where we desperately need to improve efficiency and effectiveness.

What we need is a better way to engage older adults as consumers and design products and services that address their needs – and complement those of their providers. Each individual older adult is an experienced and sophisticated consumer and we ignore their potential input into the design of better products and services at our peril – if we want a sustainable industry to support the older ranges of our society – a range we are all destined to become part of, so getting this right is surely in our own interests?