It’s not just about living for longer, it’s about living with quality of life. It’s a huge challenge, and a challenge we must face, says Joan Cornet Prat, ECHAlliance Board Member and Director of the Digital Health Observatory.
Humanity is facing one of the most complex challenges in our history. The progressive and rapid increase the population 65 years and above is a reality. It is happening now. There are many different terms to describe this population, elderly, old, retired, senior, third age, silver economy. All these descriptors are various attempts to try to define this stage of life.
There is no homogeneity in people of this age, there is mass of elders. Each person is different, an individual, singular human being.
From the evolutionary perspective, we are the sole mammal that has broken the programming of our life cycle. Orangutans, elephants, horses, dolphins and dogs have a life cycle that rarely exceeds a certain number of years by the law of life, there are exceptions, but they are rare.
Numerous demographic studies show the dimension of this phenomenon that in different ways is global. The following graphics illustrate and explain the widely known and understood facts.
A new demographic paradigm
This paradigm cannot be addressed in a simple way. One way or another we need to find solutions. There are many studies and numerous projects promoted by the European Commission that add knowledge and propose concrete solutions to specific challenges. But, and it’s a big buy, the problem is that the solutions are often technological and applied to very specific areas relating to elderly people.
The ageing of the population is not only a social problem. It’s a challenge to our society
Ageing is one of the biggest social challenges of our time. In western societies old age is often considered as a social and economic problem that needs to be resolved, on the one hand, by the decision-makers, but increasingly also by the elderly themselves. Desirable ageing is mainly pictured as active, healthy and independent. However, ageing adults live their everyday lives in many different kinds of communities, multiple socio-material relations and diverse bodies.
There are important differences in the ageing process across social groups and cultures.
The economic situation directly affects quality of life and the number and the quality of services that an elderly person can have access to. Additionally, the cultures of each society have an impact on how the elderly are integrated in society.
Ageing is often seen as a health issue. Being old doesn’t mean you are sick (although there are often more chances of suffering from illness.)
Advances in life expectancy are so often celebrated as a triumph of modern medicine, but this must surely be tempered by an exploration of the impact on the quality of the lives being sustained, as well as the ways in which the two might be in conflict.
How are pensions being addressed for people who come to their retirement?
In the past with a shorter life expectancy and a large majority of productive citizens this was not a major issue. The Population and Employment development in this chart from a demographic perspective tells us otherwise.
Healthy ageing and digital technologies
Really, It’s not just about living longer, it’s also about living with quality of life. And it’s a huge challenge. It is a multifactorial issue that takes in many variables from:
- genetics,
- the social and economic situation,
- Access to health services,
- Educational level,
- Lifestyle,
- Personal health history,
- Even attitude towards life.
This complexity is illustrated in the attached diagram by A.M. Davis on Determinants of Health Ageing.
Silvia Stringhini of the University of Lausanne has further explored this area and the below extract illustrates the impact of social differences on the aging process.
The Physical impact of social difference in ageing
Human and animal studies have identified several interrelated processes through which the social environment could be embedded, including dysregulation of the hypothalamic-pituitary-adrenal axis (HPA), inflammatory processes, neural function and structure, and, ultimately, epigenetic mechanisms.
In humans, low socioeconomic status across the life course has been associated with greater diurnal cortisol production, increased inflammatory activity, higher circulating antibodies for several pathogens (suggesting dampened cell-mediated immune response), reduction in prefrontal cortical grey matter, and greater amygdala reactivity to threats.
Evidence is accumulating for a crucial role of epigenetic modifications induced by the experience of social adversity in initiating these physiological dysregulations. More specifically, human and animal studies have shown that social factors influence DNA methylation and gene expression, in particular across genomic regions regulating the immune function.
Explaining social differences in ageing Silvia Stringhinia a IUMSP, Université de Lausanne, Switzerland
For centuries, ‘senior-citizens’ have been taken care routinely. Take a doctor (to diagnose and maintain medical needs), and add a caregiver (a family member or a group of nurses who look(s) after daily needs). The senior citizen may then require assistance due to a variety of issues, including:
- Lack of mobility
- Memory loss (due to ageing or diseases like Alzheimer’s or Parkinson’s)
- Loss of vision or hearing
- Loneliness
Rise of the smartphone
Over the last 10 to 15 years, with the increasing development of smartphones and advanced GPS, senior care has vastly improved thanks to the technology associated with these innovations. At times, seniors can be taken care of without a human even present.
One of the most important aspects of health in the elderly is that which is related to cognitive deterioration, which affects the ageing process with different degrees.
Over recent years, thanks to research in neuropsychology, as well as the availability of high-resolution brain scans, progress has been made in our knowledge of cerebral degenerative processes. Without a doubt we are just at the beginning, we have managed to identify the problems and their causes, but there is still some distance to go in order to stop or avoid conditions such as Alzheimer’s disease or vascular dementia.
Thanks to the scientific advances and the development of digital platforms ‘cognitive’ training has developed. The good news is that research has shown that cognitive training is very positive.
Cognitive training for ageing people
Cognitive training improves cognitive abilities in the health of elderly people. The approach includes specific stimulation regarding concrete processes such as memory or language, and more general tasks based on broad constructs such as attention or speed of processing.
As a principle, cognitive stimulation must be adapted to the cognitive abilities of each person, which means that the level of difficulty must be in accordance with capability: difficult enough to be a challenge for the elderly, but not so difficult to become frustrating.
Specialized software and commercial devices including the possibility of cognitive gaming are now available; with most of them being based on neuropsychological models of cognitive aging.
Example of Aging cognition and cognitive training structure of related games. (1)
Computer based cognitive programs
Although critical arguments can raise doubts concerning the efficacy of computer-based cognitive training, there is ongoing work to develop computer-based cognitive programs for older people. Clinical studies have indicated that this training may generate transfer effects, specifically near-transfer effects, both in healthy older individuals and older people with Mild Cognitive Impairment (MCI). (2)
A cognitive game with a serious outcome
The growth of access to technology in people’s homes across the world allows researchers to carefully develop game-based interventions for older adults that can address serious need, including physical rehabilitation, social connectedness, and education/training.
Cognitive games, and other beneficial interventions, can be pushed, updated, and delivered using existing technology (computers, phones, tablets, smart TVs) and can overcome barriers of access, as well as providing compelling experiences to motivate and engage the older players.
The interventions must, however, be built upon a foundation of scientific understanding regarding which activities will yield the desired “serious” outcomes, ensuring that the game theme and interfaces is designed in an accessible, approachable, and compelling way for the target users. (3)
Technologies being adapted to elderly care
There is already technologies on the market that can be of help in the care and autonomy of seniors. Some is more oriented to prevention whereas others involves sticking to a therapeutic process, meaning the right care can be brought to a senior person event if they live alone.
There are many available and you’ll be pleased to read we won’t be highlighting them all individually. However as guidance we cite the following:
- Remotely monitoring patients
- GPS services
- Phone apps
- Cameras
- Virtual/Robot Assistants
- Emergency Response Services
- Medication assistance
- Patches/Implants
Digitization of elderly health care
The digitization of elderly health care in many countries across the world is not new. It has existed for decades. But, the use of digital advanced technologies has revealed its effectiveness in the health sector, and it has been reported that the digitizing of elderly healthcare has the potential to solve any condition and disorders associated in the healthcare industry.
The use of evolving digital and communication machinery has greatly assisted in providing support and enlightenment to individuals. Notably, the success of digital healthcare technology has also been analysed as giving better results than expected, helping to enhance the experiences of the elderly, and assist in revenue growth and cost reduction.
Don’t forget to be a human
However, the technologies are merely tools that can benefit the senior citizen. The human factor is and will be essential in both the care given by health professionals and social services as well as by families and friends. Ethics apply… (4)(5)
References
Cognitive Training
(1.) Development and Evaluation of a Cognitive Training Game for Older People: A Design-based Approach: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651036/
(2.) Computer-Based Cognitive Training in Ageing: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168996/
(3.) Designing “SERIOUS” games for older adults: A cognitive training case study: https://academic.oup.com/innovateage/article/1/suppl_1/14/3897746
Ethics
(4.) Ethics of using assistive technology in the care for community-dwelling elderly people: an overview of the literatura: https://www.ncbi.nlm.nih.gov/pubmed/21500008
(5.) Explaining social differences in ageing: http://www.bioethica-forum.ch/docs/16_4/05_Stringhini_BF9_04_Web.pdf
European Innovation Partnership (EIP) on Active and Healthy Ageing
- Demographic change. Europe’s opportunity: https://ec.europa.eu/eip/ageing/home_en
- Explaining social differences in ageing: http://www.smartsilvereconomy.eu/
- The 2018 Ageing Report: Economic and Budgetary Projections for the EU Member States (2016-2070): http://bit.ly/2Eh0BKe