Can technology fill the elderly care gap? - Telegraph
'Because of my hips and knees, all my spring has gone. Once I am on the floor, I can't get up, at all. I can't raise myself. So I have to have my panic button. They come and unroll this big square thing, and push it under my seat, switch on the machine and it very gently lifts me. Once I'm up I can stand, but I can't get up from ground level at all. I just have to have help, and they have been wonderful for me.'
I am sitting with Edith Garside in her neat Peak District bungalow. The room is colourful and warm, particularly so in contrast to the cold day outside. Mrs Garside is 90 years old and untouched by any mental deterioration. As we wait for one of her regular wardens to arrive, she is telling me about the care service, which she often uses. The button hangs around her neck like a piece of functional jewellery, and in the case of a fall or any other emergency, it can alert a warden within minutes. In itself it is not a complicated piece of equipment and has been around for some time, but it marked the beginning of the use of technology to prolong independent living.
In recent years there has been an explosion in technological innovation in the field of elderly care. Mrs Garside and her warden are, in their different ways, at the coalface of the looming crisis of how we are going to care for the elderly in our ageing society. We are facing a future where a shrinking workforce is going to have to support a growing population of older people. The number of over-65s in Britain stood at 15 per cent in 1985. By 2010 this had risen to 17 per cent – an increase of 1.7 million. It is projected that by 2035 those over 65 will make up 23 per cent of the population. A cursory glance at numbers like these explains why the race is on to find technological solutions to elderly care, motivated by a need both to improve services and to save costs.
Much of the technology in development can be broadly broken down into two camps. One is monitoring and surveillance, whereby electronic devices keep track of a person's medical condition and automatically alert health care staff when intervention is required. Sensors can also be fitted into the home that will alert staff if, for example, someone is not in bed when they should be, a sign that something may have gone wrong.
The other main area of active research is assistive technologies, which can range from a simple device to help an arthritic hand turn on a tap, to a robotic machine that is able to spoon-feed an older person without the need for health care staff attention.
Much of this technology is designed to be fitted into the home to allow independent living for as long as possible. According to Prof James Goodwin, the head of research for Age UK, 'We are not far from the day when people routinely have their health monitored from home.'
On the face of it, prolonging independent living is a laudable aim, but some argue that it has the potential for abuse. Health care provision is a delicate balancing act between service levels and cost, and while many of these technologies can be used to improve the quality of older people's lives, it can also be much cheaper to keep people in their homes rather than occupying hospital beds. Like the criticism once levelled at care in the community, some are concerned that it may be the right policy for the wrong reasons.
Dr Christine Brown Wilson, the programme director at the University of Manchester's School of Nursing, Midwifery and Social Work, has an optimistic view of how these new technologies will be applied. She sees a future where technology will be used to perform the routine tasks, leaving staff more 'quality time' to spend with those in their care. 'I think we have to realise that we are in charge of the technology,' Brown Wilson, who has a background in practical nursing, says. 'The technology doesn't have to guide us; we have to guide the technology.'
Others though, such as Prof Noel Sharkey, an expert in the field of robotics at the University of Sheffield, warn of the potential for a future where cutting corners and costs leads to the elderly becoming little more than prisoners in their own homes, socially isolated and tended to largely by machines. 'People will say, "Oh, that's science fiction,"' Sharkey says, 'but it is not.' He estimates that the technology will be there to allow such fiction to become a reality within a decade.
Where there are problems there are opportunities and developing technologies that will help in the care of the elderly is becoming big business. The University of Manchester actively encourages an interdisciplinary approach to research into ageing. For example, one collaboration between the university's schools of nursing and engineering has produced a prototype of a pressure-sensitive carpet underlay that can measure people's gait. The concept of the carpet, if not the technology that lies behind it, is simple. A fibre-optic mid-layer detects the pressure of each footstep and sends data to a computer where they can be analysed. Falls can obviously be detected, but it is more subtle than that. It can pick up changes in a person's gait over time, and so act as a predictor of a likelihood of falling, allowing a health care professional to be alerted if required. The hope is that a fall (and a potentially expensive hospital stay) can be averted.
Given that between 30 and 40 per cent of community-dwelling old people fall each year, and that falls in the home account for 50 per cent of hospital admissions in the over-65 age group, there is scope for such technology to save the NHS a great deal of money. Brown Wilson, whose research interest is early illness detection in the elderly and dementia sufferers, worked on the 'underlay' project. 'I started out by asking, "What can we do with this technology?"' she explains. From this, collaboratively, they defined an application. 'The engineers are interested in coming up with novel technology, I'm interested in actually dealing with health care issues.'
The collaborative process was not without its difficulties. Dr Patricia Scully, a senior scientist at the School of Chemical Engineering and Analytical Science at the University of Manchester, says, 'Initially there was a mismatch there. They want a technology that is easy to use so they can get their statistics right, and we want a technology that is of social benefit. But as engineers we might want to sell it and make money for a company. That interface between us was quite difficult to bridge.'
But they bridged it sufficiently well to produce a working prototype currently residing in the corner of the university's photo-optics laboratory in the Photon Science Institute. Bench scientist Dr John Vaughan, 62, appropriately enough came out of retirement to build the mat. He shows me a sample of the carpet with the backing pulled away, in between which the fibre optics are inserted. The carpet was an offcut from a local shop, and for a moment his face lights up with the childlike delight all scientists seem to show when they have managed to incorporate a complex design into an everyday object. It is a reminder of the fundamental creativity that is at the heart of science.
The team see applications in care homes, and the 'smart carpet' could be easily fitted into an older person's own home to assist in independent living. They are now looking for a commercial partner with which to develop the project, and have a number of companies showing interest.
Some might consider these technologies to be intrusive. But Brown Wilson is keen to draw a distinction between monitoring for preventative purposes and surveillance. 'The early-illness detection that we are proposing is actually only alerting somebody if something out of the ordinary happens,' she tells me. 'The health care professional is only alerted when something goes wrong, but before something goes catastrophically wrong.' Monitoring technologies are always operating and collecting data. 'If somebody goes out of a door, we know that they have gone out of the door,' she says. 'But we are not watching you all the time.'
'Telehealth' and 'telecare' technologies are seen as key to enabling independent living for older people. The terms cover a multitude of applications, from sensors placed in the home that can transmit information about whether the person is in bed, sitting in a chair or indeed on the floor having fallen, to the monitoring of blood pressure and blood sugar levels. The information is gathered in the home prior to analysis at a central data centre, allowing health care staff to be alerted as appropriate.
Goodwin sees three main issues associated with telehealth: are the readings valid and reliable? Will older people accept the intrusion and loss of control that such devices may confer? And from a health provider's point of view, will the provision of such care lead to real savings for the NHS?
A piece of technology that has recently caught his eye came out of the award panel of the Royal College of Art, on which he sits. It is a small Gore-Tex patch that is placed on the upper arm along with a subdermal probe that monitors blood sugar levels. There is also a chip, which transmits data back to a mobile phone and displays a warning on a traffic light system of red, amber or green. 'This solves one of the main problems of diabetes control,' Goodwin says, 'which is compliance, or adherence.' Usually, people have to actively remember to test their own blood sugar levels, which can easily be forgotten, particularly by the elderly. 'Self-monitoring is not as reliable as you might think.'
In December 2011 the Government published the results of the largest trial in the world for telecare and telehealth. Launched in May 2008, the study involved 6,191 patients for a minimum of 12 months in east London, Kent and Cornwall (of these, 3,030 had one of three conditions – diabetes, heart failure or chronic obstructive pulmonary disease). The study showed that there was a reduction in hospital bed days of 14 per cent, emergency admissions were down 20 per cent, and mortality rates were reduced by 45 per cent. The scope then for these technologies to save the NHS money is considerable.
Other technology in development, though still very much a work in progress, is pervasive computing, which means that a computer is always working in the background at home. A combination of sensors, trackers and software analysis 'learns' to identify a person performing simple tasks. The system is being developed to assist early-stage dementia sufferers, who can often forget the next step when doing something as simple as making a cup of tea. The computer can 'sense' what task is being performed, and provide an audible prompt for the next step.
Technology, though, no matter how clever it may be, is not in itself enough. It still requires the human touch. According to Goodwin, in too many cases, there has been too much reliance on technically driven solutions, and not enough on collaboratively developed products. 'I come across multiple examples where products are developed, then they ask users if they are acceptable, rather than having older people involved right from the start, so that the conversation irons out some of the problems before they get there.'
Goodwin chaired last year's Royal College of Engineering (RCE) conference, which considered the role of technology in providing cost-effective care for the elderly. Keeping people out of hospitals and helping them live safely and comfortably in their own homes for as long as possible are challenges where engineers see themselves as having a crucial role. There was much talk and excitement about developments in the field of robotics. Goodwin considers the RCE conference to have been a good and constructive day, but this hasn't always been his experience when dealing with scientists and technologists who are developing products for the elderly. 'For them the technology is everything, and you really have to fight your corner to get them to acknowledge that there is an ethical issue, then discuss it,' Goodwin explains. 'It's the last thing they want to hear.'
For many, the human face of robotics is Prof Sharkey of the University of Sheffield. He was a judge on the television show Robot Wars, which aired from 1998 to 2004, and became that strange, hybrid creature, the celebrity academic. Now there is something of the poacher turned gamekeeper about Sharkey. He has gone from gleefully presiding over robotic machines bashing seven bells out of each other, to leaving the laboratory behind and concentrating his research purely on Human Robot Interaction, and ethical issues arising from the way that society is likely to employ this technology.
When people talk about robots, we often think of upright, metallic, humanoid creatures strutting about the place, but as Sharkey explains, most robotic applications in health care will look much more like machines. He outlines some that are available now and in use in Japan, a country farther down the road when it comes to meeting the challenges of an ageing population.
There is a robot that can wash people's hair, for example. It sprays water, shampoo and conditioner on to the head, then 24 robotic fingers 'knead' the scalp. It is claimed to be a more relaxing experience than a wash from another human. Another machine sits on an elderly patient's lap like a tray while a robotic arm clutching a spoon feeds the patient, unattended by health care staff.
Others are designed to act as companions to dementia sufferers and combat the loneliness that so often afflicts the elderly. Paro is a small, robotic seal that is in use in Japan and responds to the human voice and to movement. One company in America estimates that by 2020 the personal assistant robot will be as ubiquitous as the PC is today.
Sharkey is more aware than most that the technology can have a vital role, providing that its application is person-driven and empowers the older patient in their goal of independent living. 'The worst scenario is that people are just left in the hands of machines,' he says. Sharkey is keen for us to be aware of the ethical issues involved in robotics care. He cites the example of a dementia sufferer living in a house with a door leading out on to a busy road. Should the robot be empowered to prevent the person from walking out of the door? 'If so, you have to think, is that machine keeping them prisoner now?' Sharkey asks. 'There are always two edges to these things. If it were your own mother, you might well think, "Well yes, I don't want her walking out on the road."
'If people are fully monitored,' he adds, 'if they fall over you can be in there in a second; that sounds great. But if you set up an alerting system so that if anything happens at all you can get medics in there very quickly, there is no reason for seeing them the rest of the time. What I am worried about losing is the element of care.'
Sharkey thinks that Britain and Europe in general have the advantage in that we will see the introduction of robotic care happen elsewhere first. Japan, the USA and China are a long way ahead when it comes to developing and implementing these kinds of technology.
Goodwin is also concerned that these technologies, designed to prolong independent living, may actually end up increasing the level of isolation experienced by older people. 'The paradox about living in your own home and being in a care home, is that in the care home, you are not in the environment that you want but you are surrounded by people. In your own home, you're in the environment that you want but you have no social contact, or less social contact.'
But for Mrs Garside, there can be no replacing her human carers, and no replacing her own home. Sharkey thinks some older people would prefer to have a machine to conduct some tasks, personal care for instance, as they would be embarrassed to have another human do it for them. 'I suppose there must be some people who think like that,' Mrs Garside says, tactfully. 'But I am not one of them. I love humanity, and I am glad to be a part of it.'
As she leads me from the warmth of her bungalow, she tells me that she is sorry she could not be more enthusiastic about my robots. I ask her to sum up how she would feel about being constantly monitored, in the way that some of the technologies I have been describing to her would propose to do. 'I would hate it,' she says, emphatically.
But Mrs Garside is 90. As Sharkey points out, it is not really today's elderly we should be asking about technology, but those of us who have grown up surrounded by computers and smart phones, to whom gadgets are an everyday part of our lives. If Sharkey's dystopian vision should ever come to pass, then a caricature of human compassion etched on to the face of a robot 'carer' may be, for some of us, the last act of kindness we ever see.
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