Technology: Enhancing Care and Support for Older People

introduction

1st Gerontechnology Symposium: Developments in Technology and Ageing
67th Annual & Scientific Meeting: Innovation, Advances and Excellence in Ageing, 
Cork, 28 Sep. 2019

Developments in Technology and Ageing
President of IGS
Dr Diarmuid O’Shea

Gerontechnology, is a term that includes Assistive Technology (AT), Information Technology (IT) and Digital Technology (DT).   Digital health on the other hand, is about the patient voice and putting patients at the heart of health innovation.    These technologies are playing an increasingly important part in our day to day world and will be a growing support to people and patients in the communities in which we live and work in the decade to come.  All these technologies have vast potentials to engage, inform and empower us. 

There is also an evolving shortfall in health care workers.  It is predicted that by 2035 this shortfall will approach 10 million people.   Thus finding a way of seamlessly integrating technology services with health care professionals and people to improve patient care will be essential.  This challenges all of us - nurse, doctor, health care professional or manager – to reflect on the modes of traditional access to care and the evolving modes of virtual points of access to care.  Integrating technology services into our daily work practices and with health care professionals and people to improve patient care will be essential.  This is not about replacing health care professionals, far from it, it is about empowering health care professionals to do a better job for the patients we look after.  

In September 2019 we held our first “Gerontechology” symposium at the 67th Annual IGS meeting in Cork.

AT has the potential to help people to continue living independently in their communities.  DT is now a requirement for participation in most day to day activities.  These technological advances have the ability to ease, reassure, connect and support all of us, and may even prevent and reduce risk of accidents and harm.  However potential areas of concern remain for all of us.

The pace of research across the spectrum of “Assistive Technology” has and is increasing rapidly in recent years – from “monitoring” to “assisting care” and “smart homes”.  There are a range of different technologies that will suit different people.  It really is a case of “not one size will fit all”.  While AT can be used to connect, entertain and inform us, it is no substitute for personal, social contacts and connections.  We must embrace the future of technology and how it may support us all to live independently for longer in our communities and contribute to health care delivery and gains.  Digital literacy has also become a requirement for participation in most day to day activities.  The practicalities of day to day living should be easier for all of us to navigate.  To achieve this, we must ensure that our online, digital, and iCloud dominated tech-world is accessible to all, not just the young.  This is where technology can really add to the quality of life for older people and support us all to age well at home.  We must however be mindful of the fact that technologies should augment, and should not replace personal, social contact and connections in our lives.  As Shakespeare said “With mirth and laughter let old wrinkles come”.

This evolving concept of “Gerontechnology” and how it can assist and support us as we age has significant potential.  As we progress through the 21st century, and particularly through the next decade, there is little doubt that technology will play an increasingly important part in all our lives and across the generations.

In the report of the symposium that follows over the coming weeks, each of the contributors will give you their view and a synopsis of their talk.

You will read about how technology may enhance care and support for older people, how innovation and technology may assist in our community, the impact that care robots (carebots) are making in nursing homes in Japan, and importantly how technology will impact on the scope of privacy rights for all of us as we age.

We hope this will inform a discussion among you, our members.  With feedback, input and contributions from you we will then set up a small working group to work on a position paper.  Our IGS Spring Symposium - "Gerontechnology - the Future is now!", will be held on April 24th, 2020, from 10am to 4 pm, in the Education and Research Centre, St Vincent’s University Hospital, Elm Park, Dublin 4.  A programme outline will follow in January, but save the date!

 


 

Technology: Enhancing Care and Support for Older People

Sophie Ainscough, ALONE

In 2019, we supported more than 4500 older people, activated more than 2000 volunteers, supported 68 organisations and developed 50 partnerships nationwide. Over the next 5 years we will increase our reach across Ireland to support 45,000 older people, activate 9,000 volunteers and support 100 organisations to adopt best practice in providing services to older people.

Irish Context

Ireland has an ageing population. We are all living longer and healthier lives, which should be celebrated. This demonstrates amazing advancements in medicine and technology as we see Ireland’s average life expectancy increase from 69 for men and 75 for women in 1980 to 78 for men and 83 for women today i. At the moment, 876,423ii people in Ireland are aged 60 and over. In 30 years’ time, that number will almost triple and rise to 1.4 million in 2046iii. This will require a significant re-think and redesign of how we currently deliver care to older people in Ireland. 

Although we are living longer, healthier lives, our reliance on health and social care services increases as we age. 65% of people over 50 have at least one chronic disease and over 22% of people over 65 have frailty. More than 1 in 4 people over 60 live alone.

Currently in Ireland, we are overly reliant on acute hospitals when we become unwell and we are underutilising the benefits of technology to live safer and healthier lives. We also have a lack of options of where we would like to live as we grow older if remaining in our current home is not an option. With this in mind, we need to innovate to ensure we can meet the needs of the older people we work with, our relatives and loved ones as they age and our future older selves. ALONE welcomes Government strategies that outline steps to address these issues but we must prioritise implementation, and ensure adequate funding is put in place, to achieve the actions outlined in these documents. It is well recognised that Government policy is to support older people to live at home, but we need to ensure that this policy is also what happens in practice. Initiatives and Strategies such as Sláintecare, National Positive Ageing Strategy and the Joint Housing Policy for Older People all have a focus on keeping people living at home for as long as possible. That is, after all, where the majority of older people want to be. 

ALONE is working collaboratively with the Department, the HSE, and other non-government organisations to realise and implement the aims and objectives of these important strategies for Ireland.

Technology enhancing all of our lives

We believe technology has huge potential to revolutionise how we age at home. It can increase independence, quality of life, physical and mental health and improve overall wellbeing. However, Ireland has been slow to adopt technology into our practices of care and support for older people. This is particularly true in comparison to our neighbours in the UK, who have been providing Telecare and Telehealth since 2004, when the Government introduced a Preventative Technology Grantiv  encouraging its adoption.

Almost eight years ago, ALONE started our technology journey.  In 2016, we created a department dedicated to providing technology to our organisations, other community and voluntary organisations and to older people. ALONE’s BConnect service provides technology and community supports to create connections between older people and the support organisations they need. We provide smart technology, knowledge-sharing, and training opportunities to offer peace of mind and security to older people and ensure sustainability and efficiency of the services that support them. As well as the older people who have benefitted from our technology, to date we have also supported 68 community and voluntary organisations through training, knowledge sharing and computerisation. We have over 60 staff and 2,000 volunteers who are equipped with digital tools to carry out their role. From our Case Management System for our Support Coordinators to our BFriend application for our volunteers, we record each interaction and intervention we provide to older people allowing us to better measure outcomes and impacts.

Technology is playing an increasingly important role in both our professional and personal lives. Take a moment to think about it – would you have been able to get through your day without even the basics of technology? Your alarm clock, your phone or your computer? Or what about the advanced technology we have become accustomed to? Your smart watch, your Alexa or your real-time Dublin bus app! The reality is, technology enhances all of our lives each and every day. Yet a recent CSO survey shows 52% of people aged between 60 and 74 do not use the internet regularlyv.  So why are these benefits not reaching so many of the older people in Ireland?

What is a challenge for us as professionals working with older people, is to keep up with the rate at which technology is changing. As the technology changes and improves, we must change with it. The internet was invented and commercialised in our lifetime but now we are talking about machine learning and assistant robots which is incredible. 
But what are the challenges for older people? Based on our experience, this is what we have learned.

Barriers to Participation

We believe there are four main barriers to participation in technology.

Firstly, is affordability. Technology, particularly an internet connection, can be too expensive for people who are budgeting on a restricted income. State pensions are the most important source of income among older people in Ireland and make up around two-thirds of gross income for those aged 65 and over. Around 26% depend on state transfers as their sole source of incomevi.

The second barrier to participation is experience. People who have not come from a workforce that used computers and technology may not feel they have enough experience to use it and benefit from it in later life. 

Thirdly, our confidence can decrease as we get older and we can start to doubt our abilitiesvii  – particularly for something that may seem so complicated and so far removed from what we are used to. However, this may be the best time to learn a new skill.

Lastly is access to the right support and training. This is key. Without adequate supports and without one-to-one training, people don’t build up the confidence they need to learn independently. Our experience has seen older people transform from never using technology before to regular daily users. Other programmes for older people such as Age Action’s Getting Started has shown similar excellent results supporting older people to get online.

ALONE is working hard to address these barriers by sourcing cost-effective technology, offering financing if needed, providing support for set up, and ongoing one-to-one training. We believe the benefits for the person far outweigh the barriers. We think it is time to discuss how technology can enhance our care now. We want to maximise outcomes for older people and to support health professionals in their roles. Technology has the power to:

•    Support with timely discharges
•    Prevent admissions to the ED
•    Support with health and wellbeing management at home
•    And to prevent early or unnecessary admissions to LTC

We want to prove these outcomes through our Slaintecare project; ALONE BConnect which links healthcare, social care and community care together. We are supportive of the vision to shift the care of older persons from the hospitals and long term care settings into the community. Here is just one example of how technology can help with that:

Technology transforming care for older people – an example of hospital discharge:

Let’s look at a scenario with Mary aged 78. Mary lives alone. She has a family that lives quite close by, however due to work, school and busy schedules they can’t visit as often as they would like. Mary had a fall last year and was admitted to hospital. Mary stayed for over 3 weeks and was in respite for another month or so. She spent a total of 2 months away from home. Mary worries about falling every day. She worries so much she rarely goes out.

Let’s reverse this story and add in technology and support services. When in hospital, the doctor referred Mary to ALONE. ALONE’s Support Coordinator met Mary in the hospital to assess how we could support. Rather than going to respite, the Support Coordinator worked with Mary and the team in the hospital to support her to come home. Mary went home with a volunteer calling to her each week and a daily telephone call. Mary also went home with an emergency response alarm smart home sensors. She decided to share her information from the sensors with her daughter so she can see how well Mary is moving around the house, if she is getting out, what temperature it is and she also set up a no movement alert in case something happens. Lastly, Mary has been going out for a walk with her volunteer. This has helped build back up her confidence. Now Mary goes out for a walk on her own every day. Before she does she checks the weather and she puts her emergency response device in her bag in case she needs it. This is the idea of technology enabled care in action

There are plenty more examples of how technology and services can support people to live happier and more independent lives at home. ALONE’s Support Coordinators provide one point of contact for the older person, supporting them to access the services and supports that they need. We can provide technology that supports people with health management, access to information, mental health, and safety and security. Alerts can be set up as needed to prompt people to check in on people more proactively. That is what is powerful about our system. It is not just stand alone devices. It is backed up by a human response either through our staff, family, other professionals or emergency response services. 

We aim to support an additional 350 people through technology in 2020, 12,500 older people nationwide and activate 4500 volunteers in local communities. We will continue to partner with other Non-Governmental Organisations and community and voluntary groups as well as statutory services such as, HSE and Local Authorities.

We need to work collaboratively together, we need to link healthcare, social care and community care to deliver better outcomes for older people. We see a future where technology plays a central role in support and care for older people to enable them to stay well at home. Our vision is that every older person can age happily and securely in their own homes for as long as possible. That is where they want to be.

Níl aon tintean mar dó thitean feinviii 

i Central Statistics Office -  https://www.cso.ie/en/releasesandpublications/er/ilt/irishlifetablesno162010-2012/

ii Central Statistics Office – 2016 Census - https://statbank.cso.ie/px/pxeirestat/Statire/SelectVarVal/saveselections.asp

iii  Housing Options for Older people report - http://alone.ie/wp-content/uploads/2018/07/Housing-Choices-for-Older-People-in-Ireland-Time-for-Action-1.pdf

iv https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-telehealth-telecare.pdf

v https://www.cso.ie/en/releasesandpublications/er/isshh/informationsocietystatistics-households2018/

vi https://tilda.tcd.ie/publications/reports/pdf/w1-key-findings-report/Chapter9.pdf

vii https://www.health.harvard.edu/staying-healthy/regain-your-confidence

viii Irish Proverb meaning ‘there is no home like your own’


About ALONE
ALONE is a national organisation that supports and empowers older people to age happily and securely at home. We support individuals and their families, work with other organisations, and campaign nationwide to improve the lives of older people. We work with all older people, including those who are lonely, isolated, homeless, living in poverty, or are facing other difficulties. We support them through these challenges to help them find long term solutions.
ALONE provide Support and Befriending, Coordinated Support, Age-friendly Housing, and BConnect technology and community services. We use individualised support plans and provide one point of contact for older people to access health, social care, housing and other services to improve physical, emotional and mental wellbeing. ALONE enables outcomes including improved quality of life, community activation, and implementation of national strategies.