By Professor W J McG Tegart AM FTSE
Prepared by the Australian Academy of Technological Sciences and Engineering (ATSE)
A national policy is required for the research, demonstration, commercialisation and wide-scale deployment of smart technology for ageing-in-place to ensure: a healthy, safe, secure and fulfilling future for the increasing aged population in Australia by enabling them to remain at home longer, by easing the strain on the national healthcare system and providing cost effective solutions to meet the needs of the growing number of elderly Australians.
The mounting challenges of population growth and demographic ageing will place a considerable strain on Australia’s national healthcare system, leading to increased healthcare costs and a risk of lowering the standards, not only for older Australians, but all Australians. To address these challenges, Australia will need an increased national focus on the R&D, commercialisation and deployment of smart technology to enable the elderly to remain in their homes longer and provide cost-effective solutions to meet the needs of an ageing population. New health funding models to support the widescale deployment of these technologies will be required to achieve the potential savings and benefits.
The Academy of Technological Sciences and Engineering’s (ATSE) landmark report, Smart Technology for Healthy Longevity, reviews the state of aged care technology in Australia and in Europe, looking ahead to the future of ageing-in-place, where elderly individuals are empowered to remain in their own homes and, crucially, explores how technology can be utilised to realise this vision. This document is a short-guide document is based on the ATSE report, which can be downloaded at https://www.atse.org.au/
Population pressures: the challenge of an ageing society in Australia
Australia’s population is projected to grow to 36 million by 2050, comprising 7.8 million people aged over 65 and 1.8 million over 85. Population growth poses immense challenges for energy, transport, education and water, as current urban habitats are likely to be enlisted to accommodate the largest increases of this growth. Furthermore, demographic ageing1 will lead to significantly increased healthcare costs which will be further accentuated by a reduction in the healthcare workforce. Technology offers cost-effective solutions to enable ageing-in-place (whereby people can remain at home safely and securely, for longer) and provide medical support and treatment; technology can be deployed to relieve the pressure on the service provider hubs of the national healthcare system, offering the potential for substantial saving in both residential aged care and in overall healthcare for the elderly.
Demographic ageing is taking place in all developed countries and an increasing number of developing countries, due to longer life spans and declining birth rates. Although Australia’s continued high immigration rate has buffered the process, slowing the rate below that in Europe or Asia where demographic ageing is happening substantially faster; demographic ageing in Australia is inducing a population change (Figure 1). The number of people of working age (20 to 64) relative to older people, currently stands at 5:1. By 2050, population ageing will have driven this ‘demographic support ratio’ down to 2.7:1, indicative of a smaller proportion of people of working age to support retirees. This will eventuate in a shortage of healthcare professionals to attend to the increased number of older persons and is symptomatic of a significant economic challenge that will demand improved productivity to be overcome.
Older people have higher healthcare demands, as they proportionally incur higher levels of chronic illness, disability and degenerative diseases. They need increased resources to be invested in the development of new drugs and medical procedures related to age, inducing higher costs to governments. The Australian Government, in the 2010 Intergenerational Report2, forecast a sevenfold increase in health spending on people aged over 65. Government urgently needs to consider how technology, in a range of areas, can be adapted, developed and deployed to reduce costs and improve the quality of life for the elderly. Technology not only can provide solutions to overcome barriers of safety and security, diagnosis and treatment, but assistive technologies offer significant potential to reduce costs.
A larger number of older people may have a very positive impact on society, especially if healthy years can be extended. In addition to new models of healthcare and training to accommodate the increased demand for health services by older people, a radical change of mindset is required to overcome the current stereotype of older people as unable or unwilling to deal with new technology.
Ageing-in-place: responding to the challenge through technology
There is a suite of emerging innovative technologies that offer the prospect of enhanced security, safety, diagnosis, treatment and physical assistance to improve the quality of life for older people and to empower them to remain safely at home. The numerous smart technologies currently available support ageing-in-place in a number of ways, for example, by providing early alerts to changing health patterns or by minimising falls and other accidents in the home. This also enables substantial financial savings in residential aged care, medical treatment and through reduced admissions to hospitals.
To enable successful ageing-in-place, technology must provide solutions to issues such as personal health monitoring, telehealth, shopping, cognitive training and education. Information communication technology (ICT), particularly wireless communication, can be used to address these challenges in the context of housing for older people and, crucially, is a key enabler of social communication. These smart enabling technologies can be deployed and implemented into existing homes; however, future homes will need to be designed especially in order to incorporate the required systems and to provide for the life-long needs of the occupants. This will demand modification to the Building Code of Australia.
Although there is already a substantial investment in R&D capacity in this area in Australia, particularly in the field of telehealth (Figure 2), more needs to be done to strengthen and coordinate this activity and to ensure that public and private aged care authorities and organisations can effectively utilise the outcomes. Many technological solutions already exist but are not being utilised to their full potential, for example, individual devices are not compatible for linking to a common control system. Other barriers include poor design for ease of use and maintenance, a lack of consultation with users about their needs, high cost and a lack of policy on financing. To overcome these barriers, there is a need for: national and international protocols for the connection of wireless devices; improved awareness in industry and business of the potential markets for technology for the aged population; and national policies for funding elderly-friendly homes.
There are numerous opportunities for Australian business and industry to capitalise on the projected expanded markets, both in Australia and abroad, which will be opened up with the increased development and application of smart technologies for coping with ageing and the development of a national broadband system (NBN) that will facilitate the mobilisation of e-health and enable greater integration of the elderly into society by assisting enhanced social communication.
Technological opportunities in aged care for Australia
Delivering solutions to the complexities and challenges inherent in the deployment of technology to the aged will demand a broad combination of technologies, specifically: nanotechnology, biotechnology, ICT and cognitive science. In accordance with the objectives of the Australian Government’s National Enabling Technologies Strategy (which marks the convergence of the aforementioned technologies to focus on areas of social, economic and technical importance and emphasises the importance of potential for development by business and industry) several technological opportunities for Australia have been identified, in three categories (see Opportunities for Australia).
Gerontechnology3: lessons from overseas and opportunities for Australia
The concept of applying these smart enabling technologies to the medical aspects of ageing (gerontology) to assist in daily living is termed ‘gerontechnology’. Worldwide, the concept of gerontechnology is well established in national agendas as illustrated by significant activity in the development of technologies for the aged population in the US, Japan and in particular in Europe, where there are well-organised and well-funded national and multi-national programs including elderly-friendly housing. This is particularly crucial for accommodating the needs of dementia sufferers, which is a key area for action in Australia given the increasing frequency of dementia and the growing shortage of carers. Large-scale developments of elderly-friendly housing in Australia linked to studies of aged people in these environments are required to fully understand the potential of these technologies to improve quality of life and deliver financial savings in Australia.
It is imperative that the concept of gerontechnology is established in Australia, in education, research, industry and business. It is important that it is applied as a means to coordinate R&D activity in this area. Despite having numerous formal centres of activity on health and ageing in a number of universities across the country, Australia, unlike Europe and North America, does not have any centres for gerontechnology and there is a lack of overall coordination on a national scale. Given that research on gerontechnology in Australia is dispersed through a number of different areas, expenditure is difficult to estimate. An audit of activity and funding on gerontechnology is urgently required.
Opportunities for Australia
- Security and safety – elderly-friendly homes, prevention of falls, communication and social interaction.
- Diagnosis and treatment – telehealth, coping with degenerative diseases, nanomedicine.
- Assistive technologies – biorobotics, brain/ machine interaction, mobility systems.
Current funding models focus on institutional care as opposed to keeping individuals in their own homes. The Productivity Commission (2011) in Caring for Older Australians4 recently identified the need for new funding models to accommodate the increased demands on the healthcare system as a result of demographic ageing and for elderly people to remain and receive care at home.
This echoes the findings of the ATSE report that there is clear need for a new funding model to facilitate the wide-scale deployment of technologies to enable ageing-in-place.
Social and ethical issues
Although there are clearly a multitude of benefits that may arise from the use of smart technologies in the home environment, there are also threats and vulnerabilities which must be addressed; particular issues surround privacy, autonomy, informed consent, identity and dignity.
To realise the potential of smart enabling technologies to achieve reduced healthcare costs and enable older Australians to enjoy a high quality of life and to remain safely in their homes for longer will demand national coordination to make optimum use of the available resources and sustained commitment to R&D support. There is a need for universities to synthesise a range of skills in Centres of Excellence in Gerontechnology to provide research and training in the application of smart technologies for healthy longevity. Meanwhile, awareness should be raised amongst healthcare authorities, the insurance industry and the public as to the potential of smart technologies to assist in providing healthy, secure and happy futures for the aged population. Furthermore, Australian business and industry should be alerted to opportunities for commercialisation of outputs from gerontechnology R&D. The ATSE study identified three key gerontechnology opportunity areas for Australia: security and safety; diagnosis and treatment; assistive technologies. The report makes nine recommendations for the development and deployment of these technologies to improve quality of life for elderly Australians by enabling ageing-in-place.
Summary of recommendations for using technologies to enable ageing-in-place in Australia
1 - Support gerontechnology from research to deployment
The Australian Government Departments of Health and Ageing (DOHA) and Industry, Innovation, Science and Research (DIISR) should develop a National Research and Development Agenda on Technology and Ageing to ensure national coordination of existing programs relevant to gerontechnology; identifying priority areas and ensuring sufficient funding for their research, demonstration, commercialisation and wide-scale deployment. This would complement the National Strategy for an Ageing Australia and the National Enabling Technologies Strategy and be in line with the Australian National Research Priorities.
Where clusters of expertise exist, universities and research institutes should be encouraged through joint Australian Research Council (ARC)/National Health and Medical Research Council (NHMRC) support to set up Centres of Excellence in Gerontechnology.
The Department of Health and Ageing should be tasked to develop a new funding model to support ageing-in-place and to capture the economic benefits.
2 - Understand the potential economic and societal benefits of ageing-in-place
The Productivity Commission should be tasked to carry out a study of the potential savings arising from maintaining seniors safely, securely and happily in their own homes by using technologies that are available or under development in Australia. The Productivity Commission should also be tasked to advise on a new funding model for wide-scale deployment of technology for the ageing population.
Medicare and the health insurance industry need to assess the potential of new technologies to reduce serious accidents and other events which can lead to hospitalisation of elderly people, and to implement mechanisms that encourage the application of new technologies.
3 - Deploy gerontechnology solutions to successfully deliver the benefits of ageing-in-place
The Australian Government Department of Education, Employment and Workplace Relations (DEEWR) should establish a Taskforce drawn from relevant Skills Councils to identify the training and accreditation needs of a future gerontechnology workforce operating in the home environment. This should be seen as a component of the National Health Workforce Strategic Framework.
The Privacy Commissioner should be tasked to examine the issue of privacy in the application of technologies to the aged population.
4 - Recognise the concept of ageingin- place to enable independent living for the aged population
Ageing-in-place should be an essential component of the National Strategy for an Ageing Australia. DIISR should actively seek to ensure Australian participation in international programs and projects on gerontechnology to amplify our limited resources and gain access to new findings.
|“ Older Australians generally want to remain independent and in control of how and where they live their lives.” – Mike Woods, Deputy Chairman, Productivity Commission (2011)5
The ATSE report Smart Technology for Healthy Longevity, authored by Professor Greg Tegart AM FTSE, was launched by Professor Margaret Shiel FTSE, Chief Executive Officer of the Australian Research Council, in July 2010 in Melbourne.
The Academy of Technological Sciences and Engineering (ATSE) is an independent, not-for-profit organisation. Our Fellowship, composed of more than 800 outstanding scientists, technologists and engineers, drives our mission: to foster excellence in technological sciences and engineering to enhance Australia’s competitiveness, economic and social wellbeing and environmental sustainability. As an independent, science and technology evidencebased policy think-tank, ATSE provides robust, independent policy advice to government, industry and the community and a forum for debate and policy formulation on major national issues. Further information can be found at https://www.atse.org.au/.
The full report and accompanying presentations can be downloaded from the ATSE website (at https://www.atse.org.au/). Limited hard copies are available from Harriet Harden-Davies, 03 9864 0926, [email protected]
- Demographic ageing is the process by which an increased population triggers a change in the population balance between old and young people.
- Australian Government (2010) Intergenerational Report
- Gerontechnology is the linking of medical aspects of ageing to advanced technologies.
- Productivity Commission (2011) Caring for older Australians
- ‘Major overhaul proposed for Aged Care’, Media Release, https://www.pc.gov.au/