How should we address the problem of our ageing society and its impact on the NHS? It’s a question that ministers and health professionals have long been grappling with.
The challenge is enormous. The needs of older people are complex. One in four hospital inpatients has dementia and one in three adults admitted acutely to hospital is in the last year of their life. With life expectancy increasing – by 2030, it will be 88 for men and 91 for women – demand for services won’t slow down. This has created a difficult situation for the NHS, which simply doesn’t have the capacity to cope with the numbers coming through its doors. Indeed, many hospitals are reporting huge pressures from both increased A & E attendance at the front end and delayed transfers of care at the back end, according to a benchmarking report, Older People in Acute Settings, published by the NHS in April this year.
More integrated health and social care provision will help, as will the army of volunteers that Sir Thomas Hughes-Hallett recently suggested we need. The chairman of Chelsea and Westminster Hospital in London believes that a “HealthForce” of volunteers could be trained to help care for elderly and frail individuals before, after and even during their stays in hospital.
However, there is a need to reduce the number of people physically accessing NHS services. Achieving this requires a combination of preventative measures that support healthy living and well-being and self-care initiatives that reduce reliance on hospitals [link to article 3].
Here, technology has an important role to play.
Better health at the push of a button
At their most basic level, websites provide information, support and companionship. Carers UK [http://www.carersuk.org/], for instance, has an online forum on which carers can pose questions and share advice; Cura [curahq.com] offers a simple, secure and shareable online calendar that helps families find respite care for their loved ones; while Grannynet [insert link] supports a community of more than 3,000 grandmothers.
Smartphone apps can also help to optimise personal ageing. There are some 100,000 health apps available today, many of which aim to address health inequity, increase physical activity and healthy diets and empower people to take control of their own health.
Loneliness and isolation have been linked to a range of health problems, from depression to the increased risk of heart attack and stroke. To try to address this, tech companies are developing easy-to-use tools to connect older people to their friends and relatives, such as a Skype-like video-conferencing facility that works through a set-top box and remote control, rather than through a computer. However, with the prevalence of smartphones and tablets these days even among the older community, tools such as SMS, WhatsApp, Snapchat and Instagram are also becoming more commonly used.
Staying independent for longer
“For older people whose illness and disease have been diagnosed, assistive technology has the potential to help them manage their conditions much more easily,” says Alan Davies, director of home health care at Philips. He refers to how telecare, telehealth and telemedicine can all contribute to longer independent living, more cost-effective provision of care and less wasted time.
“Telecare is the provision of remote alerting technology for people often living in their own homes. It doesn’t replace physical care itself but it can reduce the supervisory element of it, encouraging more independence whilst giving the person peace of mind that when they do need help they can still get it,” he says.
Davies uses the example of fall detectors to illustrate the benefits of telecare. Falling is the most common cause of injury-related death in people aged over 75 in the UK. There are around 282,000 reported falls each year, costing the NHS £2.3bn. Fall detectors can be an effective way to combat this problem. The Philips Lifeline AutoAlert is a pendant that people wear around their necks. It uses a series of sensors and algorithms that can detect when someone has fallen and will subsequently notify the carer or health team. This enables the wearer to access medical treatment much more quickly and potentially prevent further complications.
Telehealth involves the remote collection of physiological trend data – for example, by monitoring vital signs, such as blood pressure, heart rate and glucose levels – all from the comfort of the individual’s home. “At its most complex, it uses a range of sensors that would have previously required a trip to hospital. Nowadays, however, it can also simply mean an SMS-based care-plan prompting tool into which the user manually enters data or even a preventative, change-of-behaviour-oriented app linked to an mHealth [mobile health] wearable sensor. Whichever is used, the data is collected for interpretation against goals or thresholds and can be used by both the individual and clinicians to make decisions about actions to improve an individual’s health,” says Davies. “It can also mean individuals can get home earlier from hospital with a complementary programme of step-down recuperative care.”
Telemedicine, in which consultations are delivered remotely through video and audio, also reduces the need for patients to travel to hospital or the GP surgery.
“Telecare, telehealth and telemedicine enable patients to remain at home and give them back some measure of control. For example, for a COPD [chronic obstructive pulmonary disease] patient, if they are feeling anxious, they could review their recent trend data against the clinically defined thresholds set for them to get a sense of how the aggregate information collected measures up. If the equipment is showing that they are within acceptable boundaries, then that can reassure them and reduce the need for calling an ambulance,” says Davies. “Meanwhile, this same information is being received by a clinical multidisciplinary team (MDT) member, who, on a different week, seeing the trend moving in a concerning direction, might be in touch with the individual to help them take corrective action well in advance of the situation becoming more serious. It’s technology like this that can play a useful role in freeing up capacity within the NHS and better leveraging the available resources.”
For all the benefits that technology can bring, there are challenges, too – especially around adoption.
In May 2014, Philips and the Global Social Enterprise Initiative (GSEI) at Georgetown University’s McDonough School of Business, Washington, DC, held an event titled “Ageing Well Working Session: Creating Connected Communities for Ageing Well” [https://www.usa.philips.com/b-dam/b2bhc/us/innovation/thought-leadership… to try to identify some of the attitudinal barriers that need to be overcome if smart home technologies are to be more widely adopted. Some 91 per cent of older Americans say that they want to live in their own homes as they age; however, most do not plan to take the necessary steps, such as remodelling their home or adopting smart technologies.
One way to tackle this, the event report suggests, is to focus on developing and promoting tools that involve technology they are familiar with. “Ageing Americans are willing to invest in new tech for things that they are comfortable with and use regularly and in which benefits are tangible,” argues the report, which also suggests that people will “age into tech”. “Product strategies are needed to expose boomers to smart apps now to ensure a seamless transition to more assistive, smart technologies later on,” it says.
Older people are becoming more familiar with new technologies. The number of people aged 65 and over accessing the internet rose by more than a quarter in the space of a year, driven by a threefold increase in the use of tablet computers to go online, Ofcom revealed in 2014. The proportion of those aged over 65 who are accessing the web reached 42 per cent in 2013.
Despite this, older people can also have very complex needs that can make the provision of appropriate technology more costly and complicated to deliver. For example, a study by the Blackpool Teaching Hospitals found that the average 65-year-old with diabetes will have several other morbid conditions. Making sure that the telehealth provision meets all of those needs and is delivered in a way the individual understands can be challenging.
Telehealth-supported remote care is not suitable for every patient. “If you have a history of self-harm or alcohol abuse, it can be difficult to provide remote technology that can improve the quality of life. In these cases, a different approach to developing a goal of wellness must be taken but, once stabilised, this technology can then be introduced to support,” says Davies.
Support for carers, too
It isn’t just older people who can benefit from technology. It also helps their carers. Of the 6.5 million unpaid carers in the UK today, some 40 per cent look after their parents or parents-in-law. Technology can help reduce or remove some of the many duties they have. For instance, tablet dispensers [link to Philips Medido] help them manage medicine, while remote consultation facilities and online services allow them to connect with service providers. It is even possible to place GPS trackers in shoes to help care for patients with dementia who are prone to wandering off by themselves and getting lost (assuming a “best interests” test has been undertaken or consent provided, in accordance with the Mental Health Act).
Again, there can be barriers to adoption. A study by Georgetown University, also as part of the Ageing Well hub that is supported by Philips, showed how some caregivers are unconsciously disregarding enrichment as a goal in their care recipient’s life, instead focusing on the functional and practical duties of each day. For this to change, the report suggests, much more support and training for carers is needed.
Technology provides us with the opportunity to reimagine ageing and to find creative ways to address the challenges that our health service currently faces. Increased use of the facilities mentioned here and more can help maintain independent living and encourage cost savings. A win-win for everyone.