This submission for the Lords Science and Technology Committee’s inquiry into Ageing: Science, Technology and Healthy Living has been compiled by Policy@Manchester and the Manchester Institute for Collaborative Research on Ageing (MICRA) on behalf of the following University of Manchester authors:
5. What technologies will be needed to facilitate treatments for ageing and ageing-related diseases, and what is their current state of readiness? For example:
The use of social assistive robotics can support technical solutions for the monitoring of healthy living in older people, for example, robot companions in the home of the user can provide reminders and monitoring on the diet of older people living alone. The same robot assistant can also support the user in performing personalised fitness exercises. Studies have demonstrated that an embodied physical robotic agent can improve motivation and compliance of the user, with respect to other technologies (e.g. computer or tablet).
There is a diverse range of implantable materials and devices that are targeted for age related disease and trauma. These include tissue repair or replacement materials and drug delivery devices. Some of these are in current clinical use and have regulatory approval, however many are still in the pipeline. Additionally devices that are implanted or interface with the body for monitoring and diagnostics are a current increasing area of research.
With an increasing percentage of older people amongst the UK population, healthy living and ‘ageing better’ have been a cross-disciplinary research theme. Among several impairments that affect the older population, balance impairment is one of the most common chronic issues, which can lead to serious physical, emotional and social consequences.
A pilot study supported by the Medical Research Council (MRC) at Manchester explored a discreet sensor based technology aimed to evaluate in real time movement and trajectory of an individual or groups and relative relationships. The recorded data is non-visual i.e. it will maintain privacy and dignity of the recorded person(s) various biomedical features such as predicting the propensity to fall from the changes in gait pattern. It is also possible to detect gesture, pose and identity using these sensors.
The potential applications of this data is enormous and could result in increasing mobility, enhancing security and safety and providing room layout advice. The system is highly accurate, predictable, and more importantly getting better in terms of scalability, suitable for home automation.
6. What technologies will be needed to help people to live independently for longer, with better health and wellbeing? What is the current state of readiness of these technologies, and what should be done to help older people to engage with them? For example:
Assistive Robotics and AI for Healthcare
As our society ages there is an imperative to find sustainable solutions that help maintain health, well-being, and quality of life. Scientific and technological advancement of AI for healthcare and assistive robotics offers unprecedented opportunities to empower older adults to maintain their independence and continue to engage in all aspects of society. For example, applications of machine learning in medicine and healthcare are providing a wealth of opportunities to improve personalised diagnosis and treatment, including for healthcare needs of older people. Progress in robotics offers promising prospects for assistive robots that can support care and social inclusion of older people and people with declining cognitive capabilities.
Assistive robots have the potential to support people to live independently for longer, with better health and wellbeing. For example they can provide support for reminders and monitoring of medication compliance, and to encourage people to engage in physical exercises. In particular, they can offer a “personalised” approach, as the robot can have a specific model of the user’s needs and medical status and adapt its reminders and exercises to the specific and changing needs of the users.
Advancement in the fields of bioelectronics and digital healthcare will also help people to live independently for longer. Implantable sensors or devices that interface with the body can assist in the maintenance of health and wellbeing by monitoring certain markers for disease.
Perception of lack of safety to get around the house is high among the older population. Adaptation of existing homes in order to improve accessibility using scalable, cost-effective technology is one of the key priorities also identified by the leading charity, Age UK. From the relevant literature, it is apparent that such “smart homes” are to be a priority research area in the near future. A survey by the Department of Health suggests that adults lacking necessary adaptations were between 1.5 to 2.8 times more likely to fall, increasing the pressure on the post-trauma care and support system of NHS.
7. How can technology be used to improve mental health and reduce loneliness for older people?
Pilot studies on assistive robotics for older people, including people with dementia, have shown that robots can play a role in providing assistive companionship for people in their own homes or care home. Assistive robots can also be used for telemedicine and for remote access and communication with family members, as well as with health professionals.
8. What are the barriers to the development and implementation of these various technologies (considered in questions 5-7)?
a. What is needed to help overcome these barriers?
Numerous projects in the EU (FP7, H2020), as well as in Japan, have investigated the design and evaluation of integrated assistive robot companion technologies for older people. The UK has had less direct investment in such projects, except for the involvement of UK university partners in EU grants, and for a few, smaller Engineering and Physical Sciences Research Council and InnovateUK grants on assistive robot technologies. Targeted and strategic investment in the design, evaluation and uptake of assistive robot technologies can help develop national expertise and critical mass in this area of expertise.
The effective uptake and sustained acceptability of AI and robotics systems for older people care requires the addressing of two grand challenges in AI and Robotics: (1) Machine Explainability, i.e. to enable AI-empowered robotic systems to interpret and explain their actions to support understanding and collaborative decision-making in assistive robots; (2) Machine Trust, to enable users to understand the robot’s decision making and accept its behaviour and recommendations.
There are many barriers to the implementation and development of these technologies, especially in devices for use within the body, and those that may include nanotechnology and stem cells. Knowledge of the regulatory requirements is essential and therefore appropriate support is required, even at the very start of research ideas. Assistance in the translation of new products and devices, and with the commercialisation of such products is needed. Increased and easier access to funding in these areas is key, and funding that includes all these factors is needed to bridge the gap between research and actual clinical application.
The development of sensors for tracking and assistive technologies will have a much higher up take by the health industry if social, cultural as well as psychological issues are considered at the conceptual stage of the design process.
b. To what extent do socio-economic factors affect access to, and acceptance of, scientific advice and use of technology by older people and those who care for them?
An important issue in the design, evaluation and uptake of assistive robotics is that of the acceptance of the robot technology. For example, recent work on the H2020 project ROBOT-ERA (with the participation of academics and users from the University of Manchester and University of Plymouth) conducted evaluation experiments on the acceptance of robot companions in three different environments (private home, shelter accommodation, and outdoor sites). This study showed that older people increase their acceptance of the robot, after they have had the opportunity to engage and interact with the robots. This allows the user to have direct experience of the functionalities and limitation of the technology. Other studies have also looked at differences in robot acceptance between older people and younger users, showing an intricate set of similarities, and differences, in the preference for different human-robot communication methods (e.g. speech versus use of a tablet to ask the robot to perform a task).
Another key issue is that of trust. That is, even if the user is provided with the most effective and functioning assistive robotic system, they might decide not to use it if s/he does not trust the system. Recent studies have looked at the effects of the robot’s appearance and its behaviour (e.g. social gaze to the user) in improving the trust of the technologies. Additional approaches that can improve trust are those based on transparent and explanatory AI. That is, it is important that the user can understand the robot’s decision-making strategies and for example ask it why a specific recommendation (“It is time to take your medicine”) or action (e.g. invite the user to perform a physical exercise) is being performed.
Funding for Patient interface groups is essential to assist in alleviating any fears of the unknown and enhance user uptake in relation to implantable materials and devices that are targeted for age related disease and trauma. These group sessions need to take place at the early stage of research and continue through to clinical translation.
Design of Furniture and other household accessories should be modular, adaptable, and affordable in order to improve accessibility.
19 September 2019
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