A growing ageing population globally
The world is ageing. A UN report from 2019 says older people account for more than one fifth of the population in 17 countries. That number could well be higher now. People now live longer and mostly healthier lives—a triumph of economic, social, and medical advances of the last century. However, this success has left governments grappling with several challenges, as the older models of social and health care provision are under duress due to the extended demand of these services.
In the UK, 19% of the total population is 65 years-old or above, 60% of whom live alone. The working population of the UK is approximately 32 million, with just under 30 million being salaried. About 12.5 million people are 65 years and above. In other words, there are less than 3 working people for each person above 65 years in the country. The figure was close to a 4:1 ratio between 2000 and 2009. Conversely, retirement ages are going up. In Ireland, the percentage of people aged 65 and above in the workforce is going to increase from one-fifth to one-third of the population by 2030. As a result of this, governments are having to constantly remodel the economics of ageing.
A disjointed eldercare system
The growing numbers and pressure on resources is just one part of the problem. The healthcare and social care system that functions in a disjointed manner adds another layer of complexity to this challenge.
In the UK, an older adult living alone in their home is cared for by multiple entities, including professional caregivers, one or more volunteers, occupational therapists, public nurses, and family members. They contribute a few hours a week to help with household chores, doctor visits, local errands, and monitoring health, but do not systematically capture the needs and health-related information about the elderly persons—that could be useful for medical professionals. Often, this is done through sticky notes, and other informal and transient mechanisms.
In addition, the current systems are designed to be disease management or condition management systems, making them more reactive than preventative. This makes the problem of scarce resources thornier as it is well established that the cost of treatment of any condition is much higher than the cost of preventing it. For example, the money spent on treating people with type II diabetes in the UK is as high as £10 billion a year, which afflicts 3 million people, whereas the estimated number of people at risk of developing type II diabetes stands at 7 million. By investing in preventative programs for those at-risk, billions of pounds spent on avoidable treatments could be saved.
We are, therefore, looking at a multi-pronged problem which leaves us with the question: How will healthcare and social care systems adapt to the provision of more complex extended care for a significantly larger number of people?
The challenge of eldercare is in some ways analogous to the sustainability and climate change challenge—healthy ageing is often paradoxically viewed as everybody’s problem and nobody’s problem.
Designing a digital healthcare platform for the elderly
The use of technology to integrate health and social care could help enable older adults to live independently for longer. TCS has developed a platform called ‘Living with Confidence’ that uses ambient and non-intrusive sensors, wearables devices, and monitoring technologies, that can serve as the foundation on which a population scale ageing solution can be built and delivered across the globe.
The platform—conceived and designed in 2012 in collaboration with Singapore Management University and the Government of Singapore—processes data that it receives from home-based IoT (internet of things) devices to establish patterns of the residents’ daily living. With time, the platform learns about the activities of daily living (ADLs) of these individuals, and if there is a break in the pattern, it sends alerts to family members and caregivers via mobile apps or messages.
TCS ran a 50-home pilot in Singapore with older adults who were living alone in government-provided housing and looked after by a group of caregivers. All the caregivers found this solution to be effective and were keen to use it. Today, the platform continues to support a group of homes and caregivers in Singapore.
The Ireland model—A TCS Pace™ proof of concept
In 2019, TCS Pace™ entered talks with Health Services Executive (HSE), an Irish healthcare provider, to trial this solution with them for older adults in Ireland. The HSE follows a ‘shift left, stay left’ strategy, that states that for the same number of resources spent, many more older adults can be looked after in their homes than in an acute care setting.
This program, Healthy Ageing For A New Digital Society, designed by TCS Pace Port™, London, focuses on going beyond traditional care-based scenarios, to a more comprehensive and multi-sectoral system, bringing together financial services, healthcare, social care, and utilities.
A group of homes managed by a local city council was chosen as the site for the pilot. The program ran for 95 days in 2021 over two households, where family members rather than paid carers were the primary receivers of alerts.
Launching the solution in a European environment for the first time required cultural adaptation and localization of the front-end apps and revalidated user experience. It also required new technology, data, and legal procedures to be enshrined. Many aspects of the solution were revisited and localized to suit the needs and preferences of older adults, family members, and carers within a regional context.
A program such as this also facilitates the creation of an ecosystem which has the potential to deliver personalized, integrated care to older adults, enhance productivity, optimize scarce resources, and engage formal and informal caregivers, ultimately improving care outcomes.
The pilot ecosystem had two parts to it. One was the market ecosystem that included participants and the organization who were directly engaged with the residents and the second part was the product ecosystem that included various organizations working together to deliver the product to participants in the pilot.
In addition to the healthcare provider, the project consortium included a major city council, a university as the academic research partner, and Irish utilities major, Electric Supply Board, as the local electricity provider. TCS was the technology partner in this initiative, while Danish wearables manufacturer Develco supplied the hardware in the program. Vodafone was the pro bono telecom partner that supplied the broadband routers that helped make the program live.
The power of small data
Analysis on the data gathered from the pilot project showed signs of nocturia in one resident and a sedentary lifestyle in another, which could cause downstream health issues. Below are two graphs with weekly data.
The above graphical representations that capture an elderly person’s daily domestic behavior point to how having even small amounts of data from one individual can potentially deliver value in keeping people healthier as they age. Individual patterns uncovered can throw up answers at a larger community level. It points to the benefit and power in collating and deciphering small data.