Centre for Ageing Better – Written evidence (INQ0016)

About the Centre for Ageing Better

The Centre for Ageing Better is a charity, funded by an endowment from the Big Lottery Fund, working to create a society where everyone enjoys a good later life. We want more people to be in fulfilling work, in good health, living in safe, accessible homes and connected communities.

By focusing on those approaching later life and at risk of missing out, we will create lasting change in society. We are bold and innovative in our approach to improving later lives. We work in partnership with a diverse range of organisations. As a part of the What Works network, we are grounded in evidence.

1. Introduction

Our increased longevity represents a huge medical and public health success. However, a significant proportion of those extra years of life are spent in poor health. In 2015-2017, men aged 65 can expect to live another 18.6 years, but only 9.8 of those will be disability free. Women aged 65 can expect to live another 20.9 years, but only 9.7 of those will be disability free (ONS, 2018[1]). In addition, there are significant inequalities in healthy life expectancy, with people in lower socio-economic groups developing long-term conditions at younger ages and spending a larger proportion of their later lives in poor health.

Following the lead of the World Health Organization, Ageing Better defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age.” Functional ability is the result of the interaction between a person’s intrinsic capacity (their physical and mental health) and their external environment, which helps or hinders them in doing the things they need to be able to do and that matter to them. A person’s intrinsic capacity tends to decline over their life course due to injuries, long-term health conditions and age-related changes such as hearing or vision loss. Where their environment is not supportive, even minor limitations to their intrinsic capacity can significantly reduce their functional ability. For example, people living with a health condition or disability that limits their mobility can still get around and go where they want to, provided they have the right assistive devices and adaptations at home, accessible public transport nearby, and accessible streets, shops, services and amenities in their area.

Healthy ageing, therefore, is more than simply the promotion of good health and prevention or treatment of ill health. It is also about creating supportive products, services and environments that help to maintain people’s functional ability so that they can continue to take part as active and productive members of society, even when their health limits their intrinsic capacity.

2. What technologies will be needed to help people to live independently for longer, with better health and wellbeing?

Technology has and will continue to play an important role in supporting people to live independently and in good health for longer. As illustrated in our healthy ageing innovation landscape review, technology provides huge opportunities to increase individual capabilities, streamline processes and systems, connect us to our communities, improve access to services and remotely monitor and manage our homes and health.

The past few years have seen a proliferation in the development and use of technology to support everyday living, ranging from smart homes (e.g. remote monitoring systems, automatic hobs/ovens, remotely controlled lights) and wearable technology (e.g. fitness trackers, smart clothes) to online services (e.g. GP/ healthcare apps), robotic assistants (e.g. Echo Dot, Roomba) and innovations in transport (e.g. e-bikes).

Our framework on healthy ageing, produced to inform the design of the Industrial Strategy Challenge Fund on Healthy Ageing, identifies the seven areas where we feel innovation (including technological innovation) could be deployed to support healthy ageing. We believe that a combination of market shifts and market creation are required to improve the impact of technology on healthy ageing, as well as its widespread application and use.

When considering the application of technology to healthy ageing, there are several issues to bear in mind:

1. Ensuring technological innovation is solving the ‘right’ problem: whilst technological innovation may be part of the solution, it will rarely be the only one. We need to ensure that innovations are solving the ‘right’ problem and solutions are ‘tech enabled’ (where technology is seen as a potential route to solving a problem) rather than ‘tech led’ (where we are trying to find a problem that technology can fix). In many instances, technological innovation can also be an effective enabler of improved service provision without being customer-facing.
2. Wider systems and services need to be considered: often the gap in innovation is not the technology but how to connect it with a suitable service proposition. A good example is remote monitoring. Many devices that support independent living at home can now be provided by mainstream consumer-facing connected home devices (e.g. Google Nest). What is needed are service and system models, as these systems develop and become more complex (e.g. better self-care or community care models) which this technology can plug into, so that there is some way of responding to alerts or unusual patterns of monitoring data. In the emerging consumer-focused market, the products often rely on the informal caregiver as the point of response – however, this has clear limitations. Better systems which enable lower-cost support/response services would be hugely beneficial.
3. Focus on prevention: It is essential that we consider issues of prevention and mitigation. Functional decline is not an inevitable consequence of ageing. Currently, entrepreneurs and industry have focused on developing products to manage vulnerability and ill health (e.g. electronic alert systems). There has been limited attention to upstream interventions which are focused on health promotion and disease prevention (e.g. encouraging over-50s to undertake physical activity).
4. We need better ways of enabling consumers to make informed purchases: The growth in options for health and home technology has created a complex market (e.g. the recent growth in number of home monitoring systems) which is difficult for consumers to navigate. Better information around quality, data usage and safety and privacy is needed.
5. We need to ensure products are inclusive by design: We need to be designing all technologies to be inclusive, attractive and affordable rather than focusing on developing specialist products ‘for older people’. Co-design with people in mid and later life will be key. For examples of inclusive design, please see this blog.
6. Not everyone can or wants to use digital technologies: We need to ensure people in later life still have a choice over what technology they, or others, use to enable them to live independently. Our research on digital inclusion in later life highlights that issues of digital exclusion are unlikely to be eradicated in the future, as 4.8 million people over the age of 55 are currently not online. Socioeconomic status, health, age and educational attainment all affect an individual’s likelihood of being online. Therefore, some of those individuals who could benefit the most from technologies to support their health and wellbeing, for example by accessing health or self-care management information online, are the least likely to use them. Inequalities in digital inclusion also go beyond access and into issues of understanding, data privacy, security, choice and control – which are extremely important to consider in this context.

Our report on digital inclusion in later life highlights the need for more long-term, responsive and personalised models of support to help people use the digital technologies that they need and that are available to them. Funders, government and the private sector should consider their role in providing support for those who need and want to be online. Further suggestions on how this can be achieved can be found in our report.

3. How can technology be used to improve mental health and reduce loneliness for older people?

Overall, older people are no more likely to report feeling lonely than younger people. Three times as many younger people aged 16 to 24 report feeling lonely than those aged 65 and over. It is therefore essential that any technologies and products developed to reduce loneliness are designed inclusively to benefit people of all ages.

Social isolation increases the probability of suffering from major depressive disorder or generalised anxiety disorder, and loneliness is a risk factor for the loss of social life. Thus, there is a need to address the subjective aspects (loneliness) and objective aspects (social network size) of social isolation in a complementary way in order to improve the mental health of the older adult population[2].

Our Industrial Strategy Challenge Fund Framework (p26-28) identifies a range of areas where innovation is needed to support people to develop and maintain social connections in later life. Innovation across a range of domains is needed, many of which will not necessarily be technological:

• Creating more accessible, inclusive transport options
• Developing accessible social and public spaces
• Supporting people to remain physically active and healthy
• Supporting people to work for longer
• Creating more inclusive social and leisure opportunities

In relation to the particular opportunities offered by technology, consideration should be given to:

• Facilitating both virtual and physical connections
• Using technology to extend the reach of community services – e.g. to improve efficiency and coordination of local service provision
• Support for services to better identify and target support for those who are at greatest risk of loneliness and isolation (e.g. informal carers or those experiencing a bereavement)

4. What are the barriers to the development and implementation of these various technologies?

The diversity of needs, priorities and aspirations of people in later life is poorly understood by the market. People in later life are also rarely involved in the development and design of new products and services. Co-design and working with key stakeholders are essential to overcoming these issues.

Affordability is a significant issue and there is a risk that technologies could also exacerbate inequalities. Despite a significant net spending power, there are significant inequalities in wealth and health amongst people in later life, which ultimately impacts upon how individuals experience later life. For instance, a study demonstrated that 20 per cent of those over 50 in routine occupations said that age prevented them from doing the things they would like to do, compared to 7 per cent of those in professional occupations. Our research on digital inclusion in later life also highlights the fact that socio-economic factors are important in terms of both access to, and use of, technology.

A route to financial viability for many new ventures is to develop premium products that attract a higher-paying customer. However, this ‘trickle down’ approach is limited and often ventures struggle to reach sufficient scale to penetrate the mass market. Without the right incentives they often remain in the more profitable, and often easier, high-end consumer market. We need to shift the market through increased consumer insight and better design to ensure that products and services are designed to be inclusive and effective and enable everyone to realise the opportunities of their longer lives.

5. What opportunities are there for industry in the development of new technologies to help increase health span?

Over-50s account for nearly half of all consumer spending – worth about £320 billion a year. Additionally, consumer spending by this group has increased by 4.4 per cent per year over the period since 2003, compared with growth of 1.2 per cent per year for under 50s, with over 50s responsible for 75 per cent of the total UK expenditure in health in 2016[3].

As outlined in our ageing innovation and investment landscape review, there is increasing interest in developing new products and services that address the challenges, and realise the social and economic opportunities, of our ageing population. This interest comes from a variety of stakeholders, including large corporates, ageing organisations who are establishing innovation programmes, social investors and venture capital firms.

The UK has strengths in its design and creative industry and its extensive academic and research expertise in ageing. The UK also has strong networks of older people. Connecting these with industry, and industry with the right finance will be key to unlocking the opportunities for industry.

6. What more is required for the UK to benefit from commercialisation of its discoveries and inventions relating to healthy ageing, as envisioned by the Government’s Industrial Strategy?

There has been promising growth and interest in activity around ageing innovation and investment in recent years. However, the ventures developed are often limited in scope, developed in isolation of one another and rarely reach significant scale. There are significant gaps in the current investment ecosystem and a need for much greater collaboration between different programmes and funds established to promote healthy ageing.

To shift people’s experience of ageing and later life we need to take a much more systemic approach to supporting the development and scaling of interventions across the wide range of areas. As outlined in section three of our healthy ageing innovation and investment landscape mapping paper, a mixture of market shifts and market creation are essential. In particular, we need to stimulate the mainstream market to shift to more inclusive, affordable products. Developing a specialist market of products for older people will result in limited innovation and a limited consumer base. We need to develop a better understanding of the consumer base in order to design and develop more effective marketing and outreach strategies that successfully understand demand and how to stimulate it.

There are a series of relatively low-cost activities that could help create an attractive and effective innovation ecosystem in the UK:

• Supporting partnerships between academia, research and technology organisations, innovators and industries to support more effective knowledge exchange and development
• Supporting partnerships between innovators and the creative and design industry
• Providing access to data and consumer insight for industry and innovators
• Supporting wayfinding or navigating through the various funding sources and mechanisms at different stages of the development and investment pipeline
• Building momentum and interest in the ageing innovation agenda through ‘super conferences’ or other activities.

7. How feasible is the Government’s aim to provide five more years of health and independence in old age by 2035?

The Centre for Ageing Better welcomes the Government’s commitment to addressing the challenges and opportunities of our longer lives through the Ageing Society Grand Challenge. The Ageing Grand Challenge identifies where action is needed to create long-lasting change, with a clear understanding of the importance of the social determinants of health. We recommend that the Science and Technology Committee request the government publish its workplan on the Ageing Grand Challenge pillars to help understand how social determinants underpin the strategy.

Recent analysis by the Health Foundation found that healthy life expectancy will rise by just over a year by 2035 and that it will take 75 years to boost the average number of years that men spend in good health by five years assuming the recent rates of improvements continue. The timelines for disability free life expectancy are similar. They suggested that to achieve long-term changes to health, we need to tackle the social determinants of health through regulation and information. We also need to have legislative commitments to improving health as in Wales and more involvement of Local Government to involve communities in supporting health and ensuring businesses support their employees.

Nevertheless, quicker gains can be made for disability-free life expectancy by changing the environment to mitigate the impact of poor health. It’s possible for people to be in poor health or have a disability and still be able to carry out daily activities if the environment is supportive and accessible. It is also possible to reverse declines in muscle strength and therefore reverse declines in activities of daily living.

Although it is feasible for the Ageing Grand Challenge to make progress towards this goal, it will require actions across departments, not just DHSC. Despite the Ageing Grand Challenge, there has yet to be a cross-departmental understanding of what ageing really means for the whole of government and how departments beyond just DHSC play a part in keeping people healthier for longer. Until this happens, policies will not be joined up and will fail to deliver real change for people in later life.

There needs to be a stronger focus on the wider determinants of health, particularly work and housing. Our home environment plays a crucial role in helping us remain active and independent in later life, even when we begin to experience a decline in our abilities. Over 90% of people in later life live in mainstream housing, yet just 7% of housing in England meets basic accessibility standards. In addition, one in five homes occupied by older people (2 million households) fails to meet the Government’s Decent Homes standard. We need more diverse mainstream housing options that are built to Category 2 building standards in order to future proof the housing stock and a radical upgrade and retrofit of current housing stock.

Workplaces are often a cause of ill health, and poor health is one of the main reasons people leave the labour market before reaching State Pension age (Marvell & Cox, 2017[4]). With 40% of the working age population predicted to have a long-term condition by 2030 (Public Health England 2017), health will play an ever-larger role in determining people’s ability to stay in work. A preventative approach to supporting workers with long term health conditions to remain in work benefits both employees and employers. Reasonable adjustments or occupational health support can make all the difference for workers with long term health conditions. The government must take action to address health at work by trialling innovative approaches to improve recognition of work as a health outcome and integrate work and health support.

We also need to shift the narrative around ageing. Poor health is not an inevitable part of ageing, but the media and public narratives focus on the negatives of our later years. By celebrating ageing and seeing the opportunities of our longer lives, more people might take responsibility for preparing for their future. The Prevention Green Paper highlighted that the policy narrative towards health needs to shift towards looking at it as an asset, and this must be aligned with shifting the narrative of ageing as a whole.

A central part of the Ageing Grand Challenge is the need for strong, effective partnerships and collaboration between a wide range of relevant industries. There are countless examples of best practice, evidence and innovation across the country that will help both the national and Local Industrial Strategies. The WHO have also proposed a decade of healthy ageing from 2020-2030. This encompasses the wider determinants of health, with a particular focus on the Age-friendly Communities global network. There is worldwide understanding that we need to keep people healthier for longer, and the UK should be leading the way in innovation and practices.

16 September 2019

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