Independence Day for the elderly

Assistive technologies are helping healthcare systems under intolerable pressure relieve the strain.

Next time you're sitting in your doctor's waiting room, look around at your fellow patients. Notice anything? Chances are that most of them will be older people if not elderly.

This is something you can see anywhere around the world these days - the phenomenon of ageing populations. According to the United Nations, currently about 10 per cent of the world's population is aged 60 or over; by 2050 it will be 20 per cent. It has already reached that level in Japan and much of western Europe.

Yet, whilst we're living longer, we're not doing so in full health, meaning that nearly a billion people worldwide are suffering from chronic long-term diseases, and account for up to 85 per cent of healthcare spending as a result.

At the same time, birth rates are falling - in some cases below those needed to maintain existing population levels - leading to a shrinking workforce and falls in economic output and business productivity. This further inflates the proportion of older people.

Against this backdrop it shouldn't be hard to see that healthcare systems around the world are coming under intolerable strain, creating a pressing need to come up with a different approach to caring for our fast-growing elderly and increasingly unhealthy populations. This is where assistive technology (AT) is coming to the fore.

A common definition of AT is "any product or service designed to enable independence for disabled and older people". As such, it covers a huge range of technologies, but the operative word is "independence".

As Ian Rhodes, technology and innovation consultant at PA Consulting, and a member of its management group, explains, "In the UK, it costs health authorities about £600 a day to keep a patient in hospital; nurse-led home care costs about £100 a day. So AT is all about keeping people who would otherwise be in hospital, in their homes."

Personal control

Assistive technologies are therefore control systems in the most personal sense, giving their users control over their daily lives again and offering at least some measure of freedom. And an AT product or system doesn't have to be some Terminator-style cyborg outfit like HAL (see 'Out on a hybrid assisted limb' p42); it can be as simple as a handrail or a pair of crutches. It's all about meeting the needs of the individual.

And yet, with such a pressing need for AT around the world, recent research shows that, in the UK at least, only a tiny minority of R&D projects actually lead to commercial products. Keren Down, director of the Federation for Assistive Technology (FAST), which carried out the research, points to number of reasons for this.

"Many of the problems stem from the fact that most of the R&D is done in academia, as commercial companies just don't have the budget," she says. "So, first there's the issue of genuine need - academics get too excited about the technology and lose sight of what the consumer actually needs.

"Then there's the lack of commercial expertise in academia, and the fact that the commercialisation or enterprise arms of universities aren't always set up for this type of commercialisation process - sometimes they're more geared towards licensing the technology for someone else to commercialise it.

"We have to accept though that the market is also under-developed, and that it lacks assertive and informed consumers," Down says.

Rhodes and his fellow PA consultants Bob Damms and Peter Farenden echo these points, adding that they're often approached with an idea for a complicated (and therefore expensive) product or system when something simpler and cheaper would do just as well, and that sometimes the idea can't be patented, raising the issue of the inventor's intellectual property.

Funding issues

Funding is an issue too, with Damms pointing the finger at too few government initiatives bedded in commercial reality, while Down says there are too many funding gaps at early stages of research.

Farenden highlights the area of telehealth - delivery of services to the home via telecoms links - with a person's mobile phone acting as comms hub. "At that point," he says, "the mobile starts to look very much like a medical device, so it suddenly has to meet strict standards - as does any other technology in the home adapted for health-related purposes." 

But there are some general features that AT experts have on their wish-lists. The technology needs to be DOTS - dependable off-the-shelf - and come with a simple, preferably familiar user-interface. Hence the interest in mobile phone technology.

But, says Rhodes, there's the issue of failsafe here, particularly with respect to mobile phones. "Say granny at home forgets to take a drug. You need some way to alert carers of that, but you can't use SMS texting, for example, in case the text message goes missing, as it can do. So SMS is not failsafe."

And Damms says that whatever technology is used, there needs to be as little change as possible to the user's regular pattern of behaviour, so the AT device or system needs to fit in here. This point is echoed by FAST's Down, who says there needs to be some creative thinking about user interfaces -the idea of 'age-friendly' technology.

Integrated technologies

The next logical step is to begin integrating the various technologies into a home-wide system, and, as with the technologies themselves, there are many strands here.

Farenden, for example, cites the Digital Access Provision (DAP) forum and its Assisted Living Innovation Platform (ALIP) project. This aims to develop an open access health 'home hub', accommodating a series of plug-and-play-style devices and services, which can be scaled to meet future independent living provisions for people suffering from chronic conditions as well as other needs. Under development by a consortium including BT, Cisco and Microsoft, it's being rolled out by building research consultancy the BRE.

Clearly, key to this project is an open system architecture - to any such project, in fact, argues Damms. "Open systems are fundamentally important here, as no one company could ever hope to dominate," he says. "In fact, a proprietary platform would actually cut a company off from the rest of the industry."

This inevitably brings with it the issue of standards, an issue made all the more complex because of the need to know about regulations on the medical side as well as the industrial standards governing many of the technologies. And, as Farenden points out, "assistive living is such a broad area that setting regulations will be a very tough nut to crack, although I can see new standards emerging." There's a clear parallel here with sector-specific standards governing any other sector in which control and automation technologies are used.

But while efforts in this arena are across a broad front, both PA and FAST agree that there are areas where products and systems are most urgently needed, even if they do cite different examples. The PA group points to patients suffering from diabetes, chronic obstructive pulmonary disorder and heart and post-stroke conditions - all commonly acknowledged large groups around the world.

Incontinence technology

FAST's Down, however, highlights a group whose condition is rarely the subject of public discussion: people suffering from incontinence. She says, "Incontinence is one of the major reasons why people go in to care homes - second only to suffering a fall. You won't hear the issue being debated in Parliament, but everyone needs to go to the toilet."

To meet this need in older or disabled people, Down gives the example of work by Brunel University's Institute for Bioengineering to develop a wheelchair with a self-contained toilet - self-contained in that it includes a cleaning and drying facility.

Another area Down sees as offering promise, and one which picks up PA's point on integration in the home, is so-called prompting technology, for dementia sufferers. A recent study predicts that more than 115 million people worldwide will suffer from dementia by 2050, up 10 per cent on previous estimates.

The example she cites is the Ambient Kitchen, a lab-based replica of a real kitchen developed at Newcastle University to test different technologies to support people with memory loss while they're cooking. The ability to prepare their own meals is an important factor for sufferers in maintaining their independence.

The kitchen uses standard kitchen units with built-in RFID readers, and has cameras set into the walls, a wireless network of accelerometers attached to kitchen objects, cupboard doors and utensils, and RFID tags attached to storage jars. Projectors and speakers embedded in the environment display visual and auditory cues.

The different technologies act in concert to provide prompts or assistance if someone with dementia forgets how to perform a particular task. For example, the university team has developed a cookbook with an RFID tag embedded in each page, allowing the kitchen's sensors to detect the page at which the book is open and to respond by presenting relevant food information for that recipe.

Initiatives like this are very much test-beds; it's still early days for the AT sector, and much still needs to be done. For example, says Down, "Central government needs to open up the marketplace - it's not supporting industry. We also need massive investment in enabling older people to feel confident in using the technology."

Rhodes at PA says, "We need to find a platform that brings all the technologies together. This is not a cottage industry, but it works and runs like one. We also need standards of clinical best-practice that can be translated into a technological solution, and make that solution economically viable."

Rhodes and his colleagues concede though that there are too many variables at play here. While it's impossible to nail everything down, they say, what can be nailed down must be done with sympathy and understanding. And just because we can't nail everything down doesn't mean we shouldn't do any of it.

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