University College London (UCL) – Written evidence (INQ0027)
C: Scientific basis
1.1 Common cellular hallmarks of ageing, including genomic instability, cell senescence, disordered nutrient signalling, mitochondrial and stem cell dysfunction and altered cellular communication, have wide support from animal studies. The role of these mechanisms in human ageing is less well documented, but they clearly play a role in the aetiology (cause) of multiple age-related diseases.
1.2 Marked socioeconomic differences in longevity and healthy life expectancy highlight the important role of modifiable lifestyle factors (smoking, physical activity etc.), and environment on ageing, diseases of ageing and the potential for general improvement. Direct evidence, quantifying the role of each, the optimal timing of interventions, and the role of individual differences in response, is less clear.
1.3 Capabilities change as a person’s calendar age increases, but not all of these changes are downwards e.g. experience, coping etc. can rise. Collaborative research across disciplines to look at brain, body and mind plasticity with a view to understanding how coping and experience later in life is achieved and/or improved would be beneficial.
2.1 Observational data across the life course clearly indicate that healthy lifestyles are associated with longer life and health span. They also indicate the importance of the whole life course, i.e. optimising early-life reserve (e.g. cognitive, exercise capacity, respiratory function), maintenance of reserve in mid-life, and promoting resilience in later life to enhance healthy ageing.
2.2 Gold standard trial evidence, focussed on interventions in older age, is limited and conflicting, as a consequence of small sample size. It is also limited by a focus on short term mental and physical health outcomes, rather than longer term effects, and on treatment of well-established disease, rather than prevention.
2.3 Practical impediments to the advice being acted on include:
3.1 We anticipate the developments to include:
4.1 There is fairly strong evidence that differences in lifespan by socioeconomic status, ethnicity and geographic region are at least in part due to health behaviours and environment, acting across the life-course. However understanding of the pathways responsible for social determinants of health is incomplete.
4.2 The current focus on individually targeted advice to change behaviour has limited potential for success – population level (government) policy is a far more effective tool.
5.1 There are ongoing developments in e.g. home haemodialysis but much greater attention needs to be paid to developing devices for delivering drugs, and other therapies that fit well with people’s lifestyles/circumstances and are safe and easy to troubleshoot. Patients and lay carers have been found to adapt technology, sometimes inappropriately, to fit their lifestyles. Therefore better design, deployment and education is needed to minimise such adaptations. People also wish to communicate more seamlessly with their clinical teams2 e.g. sharing data from monitoring devices.
5.2 There are many ongoing research projects focusing on different contexts and health conditions monitoring and providing advice. There is a growing body of literature showing that people need to both make sense of their clinical conditions (requiring personalised medical information/advice) and internalise what it means for them (requiring information exchange with “people like me”); this applies across the life-course, but particularly for chronic conditions, and is particularly challenging for people managing multiple comorbidities, and their families.
5.3 Monitoring of some kinds of physical activity (e.g. walking, cycling) is maturing, and include studies on older people. The ‘Get A Move On’ network report also included a focus on older people. Monitoring of other aspects of lifestyle (e.g. other sports/activities, diet, social engagement) are less mature and there are important issues to be addressed around what might motivate individuals to engage in/agree to monitoring, who does the monitoring and how insights are used, particularly where cognitive decline may limit the active involvement or informed consent of an individual.
5.4 Affective technology: There is a need for technologies to monitor affective states, and perceived physical and functional capabilities, in everyday life. This can: enable the application of self-management strategies to remain functional, despite chronic conditions (e.g. chronic pain, stroke) or simply ageing; increase self-efficacy and self-esteem; and ensure social engagement.
5.5 Assistive Technology (AT) - such as wheelchairs, hearing aids, eyeglasses, prostheses, and increasingly, mobile technologies - enable people to live healthy, productive, independent and dignified lives. Older people particularly benefit from AT. The UK DFID AT2030 Programme led by the Global Disability Innovation Hub, UCL, is currently testing “what works” to improve access to AT. The programme will invest and support solutions to scale, with a focus on innovative products, new service delivery models, and global capacity support.
6.1 Technology is an enabler, not a complete solution. It is important to identify real problems and address them, understanding that one size will not fit all (or even fit the same person at different stages of ageing).
6.2 Technology has to match the user’s self-identity. Many older people do not identify as such, and do not want products for “older people”. What is needed is products that work for all (that are accessible to all, and potentially useful for all). There also needs to be a support structure for people who are unable to access services independently through digital communications.
6.3 Older people are strong uptakers of digital communications. The use of software, such as Facebook or Skype, to keep in touch with family, friends and past acquaintances is high. However take up of devices/machines for daily living in the home is much lower.
6.4 Technology should help understand one’s physical and emotional capabilities and enable the application or development of strategies to improve those capabilities rather than only compensate for the lack of them.
6.5 AT and its related services help maintain/improve functioning and thereby promote physical and mental wellbeing and independence reducing the need for formal health and support services, long-term care, and the burden on carers.
6.6 London’s Freedom Pass, management of public transport and its density is better than other cities and rural areas in the UK, which plays well for older people who need services within a reasonable distance and at a reasonable frequency. However the associated infrastructure is less good e.g. bus stops and footways, and their installation, are often poor. The provision and design of benches and other amenities including public toilets are also particularly important for older people, as they support older people to go out and become involved in the community, in turn reducing loneliness and the consequences of mental ill health.
7.1 Digitally enabled communications need to add value rather than being used as a superficial substitute for meaningful interpersonal engagement. Voice interfaces and agents offer a new kind of intervention for being informative about health, providing companionship and connecting people but more research is needed to see how socially acceptable they are.
7.2 Affective Sensory Technology can increase confidence in one’s body and capabilities and self-esteem.
8.1 Barriers include: insufficient focus on the variety of “problems” that digital technologies are designed to address; insufficient consideration of the needs/values/situations of individuals and communities; awareness of the complexities of lives as lived and the places where technologies can add value.
8.2 To overcome these barriers we need to:
8.3 Innovations in AT often fail due to a lack of the following: R&D funding, investors willing to engage in developing new AT, early adopters and clinical trials and access to user testing. AT2030 launched the Innovate Now project to help support AT innovators. The Scoping Study found that cost is not the only barrier to use of AT. Issues, in the UK and elsewhere, include undeveloped policy frameworks, inefficient/non-existent markets, poorly resourced services, and stigma and discrimination.
8.4 To overcome these barriers in AT, as summarised in the Scoping Study report15, we need:
8.5 There is a situation where expenditure on policies for older people by one government department (Work & Pensions) benefits another department (NHS/local authorities) – this imbalance needs to be addressed.
E: Industrial strategy
9.1 The UK has excellent technical capability and entrepreneurship culture, supported by incubators, innovation hubs, etc. It is world-leading in areas including Human-Computer Interaction, imaging, AI and Human Factors. The UK science base in biomedicine of ageing is quite strong however exploitation of discoveries about mechanisms of ageing is predominantly led by the US.
9.2 Understanding what older people can do well, enabling people to do what they are good at, and designing work practices so that these can be utilised to the best effect, including flexible working hours, would be a huge gain in terms of enabling older people to work and bring in an income.
9.3 Developing the concept of a ‘career profile’ in which the aptitudes of people are regarded as malleable – some things become better as people become older and some things become worse. Working later in life should be made easier and less stressful, not just necessary until pensionable age, but because it is better for the person’s mental and physical wellbeing. For those who cannot, or choose not to, work for ever, this should be possible too.
10.1 The “pathway to impact” is difficult for companies to navigate when those companies are start-ups and SMEs. Companies need support in:
10.2 Scientists need support to engage with tech transfer and venture capital organisations in order to identify and develop opportunities for the commercialisation of discoveries/inventions.
10.3 In the case of AT what is needed are the factors highlighted in the AT2030 report (see bullet 8.4 above).
F: Healthier ageing
11.1 Success will depend on early and sustained engagement with all stakeholder groups, including local communities across the country. It also depends on finding new ways of working across professions and disciplines in ways that are courageous, agile and disruptive without being destructive.
11.2 Policies to enhance health across the whole of life will be required, including investment in education in early life, improved interventions to prevent and treat ill health in mid-life, and maintenance of physical, cognitive and social function in later life. The improvements in education are vital not only to improve individual health but also to equip our future workforce with the skills it needs to support an ageing population in a rapidly changing society.
11.3 Ageing in the future will take place in a very different context from the past and will be profoundly affected by phenomena such as climate change, air pollution, antibiotic resistance and social change. Policies around ageing will only be successful if they accommodate these changes.
11.4 Organisations to involve are those that have the capacity to make a difference and the openness to work together; for example AT2030 programme, GDI Hub, ATscale, World Health Organization as well as the Government as this is a cross-departmental issue. The work should be led by a trusted party with the longevity, resources and authority to provide coherent leadership over such a timescale
12.1 There is a risk that a strong commercially driven model may exacerbate existing digital and socio-economic divides, leading to even greater health inequalities. There needs to be grass-roots engagement, involving local communities, from the outset to mitigate the risk of extending the divides that already exist and a focus on population-level interventions as individual-based interventions will likely widen inequalities in older age.
13.1 A culture shift is needed to see older people as a full part of society where, just like in all other age groups, some will be engaged through working, others through volunteering, others in other ways, but all are seen to contribute to society. This culture shift needs to start in education, from school age onwards. Having achieved the culture shift it will be much easier to encourage industry to modify its approach to the career profile so that the best can be achieved by everyone throughout their working life.
13.2 It should be easier to ‘volunteer’ for things, and for bodies (e.g. charities and other social organisations) to employ older people in suitable roles without negatively affecting their pensions or tax situations. Organisations to be involved in supporting the changes as a result of the culture shift include human resources organisations, Age UK and HMRC.
19 September 2019
 For example, https://www.i-sense.org.uk/ and https://www.irc-sphere.ac.uk/.
 For example, https://uclic.ucl.ac.uk/content/6-news-events-seminars/20190409-ucl-will-have-a-great-presence-at-chi-2019/paper665.pdf
 Economist 6 July 2017: Economist Special Report ‘The Economics of Longevity’): Tablets for Every Problem.
 https://doi.org/10.3389/fnhum.2017.00379 and https://doi.org/10.1145/3290605.3300888
 PAS 277 is the British Standards Institution (BSI) Health and wellness apps – quality criteria across the life cycle – code of practice. https://shop.bsigroup.com/forms/PASs/PAS-2772015/