Agile Ageing Alliance – Written evidence (INQ0052)

The following response has been produced by the Agile Ageing™Alliance. AAA is a campaigning social business which aims to demonstrate that through innovations in technology, business and service models, our agefriendly homes and neighbourhoods of the future can enable multigenerational communities to enjoy healthier, happier and more agile lives, leading to a reduction of the financial burden on State and citizens.

Like most complex problems the demographic shift cannot be addressed through the lens of a single sector or discipline. It is a major concern for private, public and third sectors alike and although there is no silver bullet, there is an opportunity to mitigate this risk by working together collaboratively, in a spirit of open innovation. To this end, AAA has been organising “meetings of minds” across Europe since 2015. The programme, which is working towards the development of a ‘Reference Framework for Agefriendly Housing’, is called Neighbourhoods of the Future. This 2 minute video for the European Commission is a good scene setter.

Insights from these events were captured in two white paper reports, Better Homes for an Ageing Population – Improving Construction, Health, Care, Design, Technology & Finance. The first, published in 2017, anticipates a new breed of “Cognitive Home” which will assess and manage our needs and desires in later life. (Download 2017 report here). Launched at the House of Lords earlier this year, in partnership with Tata Steel, the second edition focuses on the potential of Modern Methods of Construction to reimagine the outlook for agefriendly housing and multigenerational neighbourhoods. (Download 2019 report–here)

AAA is about to embark on a 21 m Euro “Horizon 2020” large-scale pilot, focussed on promoting innovative technologically enabled age-friendly housing and multigenerational neighbourhoods. Currently under media embargo, the project will engage more than 2k older adults in 15 pilot sites across 10 EU Member States. AAA is responsible for fostering age-friendliness, which will include extensive research among older adults, to inform development of the aforementioned Reference Framework for Agefriendly housing.

In December AAA will stage an Ageing Society Transatlantic Leaders Forum, in partnership with AARP, a highly influential US non-profit whose stated mission is "to empower people to choose how they live as they age.” With over 38 million members and revenue in excess of 1.6 billion USD, AARP is now working on creating a long-range strategy aimed at bolstering the age-friendly housing supply, boosting consumer demand for such multigenerational housing, and advancing enabling policies across the States and beyond. This international outlook dovetails with AAA’s aspiration to connect likeminded thought leaders around the world. To better understand the relationship between housing and healthy ageing see this article:

Multigenerational Communities: Reducing Loneliness and Dementia.

Given we were only made aware of this call a few days ago, our response is somewhat limited (starting from Q5.) Our responses take into account:

• A more holistic consideration of ageing recognising that health and life span are not equitable.
• That the duration of Ill health, both physical and psychological, coupled with increased loneliness, is overwhelming both funding and human resources, and failing those in need.
• The need for an increase in health span i.e. independent for longer, with better health and well-being.
• And that the aim of getting 5 more years of healthy ageing by 2035, should also give consideration to where these healthy older adults are going to live, and be achieved in a way that helps reduce the gap between the richest and the poorest.

Assumptions:

• The rate of technological advancement over the next 15 years (to 2035) will be slightly better than the last 15 years change e.g. contrasting a slow-down in Moore’s Law, with advances in AI.
• Over the next 15 years an increasing proportion of older people will be OK with technology, as they have grown accustomed to it; but it would be inappropriate to assume they will therefore readily embrace all emerging, solutions.
• Looking for new technologies to be embraced at scale will require additional psychological approaches e.g. those that have been used in social media/website design today.
• Improvements will be made in the reliability and maintainability of devices.
• Technologies that are expensive today will be cheap, free or obsolete in 15 years’ time.
• Designers/developers will give more thought to user experience and all age needs when developing products and services.
• A continued reduction in people-based health care and societal acceptance of data sharing will catalyse the adoption of technologies that are proven to help.
• A lack of joined up systems thinking/engineering will continue, and various technologies will remain ‘apart’ and never quite achieve their potential.

(5) What technologies will be needed to facilitate treatments for ageing and ageing related diseases, and what is their current state of readiness? e.g.

• Technologies for monitoring conditions and providing personalised medical advice
• Technologies for monitoring healthy living e.g. fitness, diet, etc.

Prevention is better than cure; especially when early signs can be detected through AI (Artificial Intelligence) M2M (Machine 2 Machine) and other innovative non-invasive scenarios. MOT style health checks will become common place; involving routine ‘trend’ checking at home and on the move (wearables), with more advanced devices in clinics, healthcare retailers, surgeries, etc. Ideally these should not be intrusive/observable.

The home devices and embedded algorithms could include:

• Pressure sensors and cameras to passively monitor gait, weight, activity in specific rooms, trips/trip hazards, breakages/breakage hazards, etc. Needs advances in sensor pads, vision algorithms and other innovations, but can be there in 15 years.
• Microphones to passively monitor breathing, sneezing, TV/tablet volume levels (hearing capability), changes in voice. Microphones with suitable sensitivity available now, algorithms to determine changes and risks of changes will need development.
• Cameras (webcams) to track cataracts, changes in skin colour, changes in skin blemishes. Higher definition cameras will be needed e.g. 4K-16K resolution, with optical zoom capabilities; but can be available in 15 years.
• Artificial noses (akin to smoke/CO detectors) for one or two indicators e.g. urine (incontinence), specific compounds in flatulence, indicating bowel issues, mould spores. This may go beyond 15 years, but with focus prototypes could be available.
• Water meter algorithms, detecting changes in water usage e.g. frequent/infrequent toilet usage, below par cleanliness. Would need water meters capable of remote data gathering with data connection and with timing periods of 1 second intervals. Doable but smart meter rollout for other utilities doesn’t bode well.
• Electric/gas meter algorithms, detecting changes in energy use e.g. skipping meals, heating frequently inactive. Smart meter rollout will probably hit 100% coverage by 2035 so this is doable. However, needs fine grain data collection of energy usage e.g. Watt usage per second.
• Humidity detectors, spotting environments that could be prone to higher levels of bacteria and mould. Sensors already exist and are cheap, just need incorporating into other devices.
• Chatbots, able to engage and pick up clues about changes in mood, language deterioration, detachment, etc. Rudimentary chatbots in development, should be good enough in 15 years, with suitable algorithms if focused on.
• Barcode readers and cameras for detecting food into/out of fridge/cupboards/bins.

On body monitoring will continue through further phones/watch integration e.g.:

• Bespoke devices monitoring health adults + long term and life-threatening conditions.
• Blood oxygen levels – additional sensors required – are the lungs working?
• Skin temperature – too hot/cold?
• Gait – based on various accelerometers – wobbles, potential trips and muscular weakness. Predictive: Likelihood of a fall, take preventative action.
• Activity – various activity apps/heart rate monitoring – evidence of fitness inducing activities.
• Sweat / exertion – based on electroconductivity, is health inducing activity happening; are there any signs of fever/illness?
• Breathing - based on various accelerometers/microphones – coughs, sneezes, wheezes, etc.
• Sleep states - based on various accelerometers/microphones – are they sleeping well e.g. sleep apnoea? If not the system should offer advice.
• Location – GPS, Wifi triangulation – are they frequenting healthy places?

The specialist equipment could include:

• Advanced artificial noses to detect changes in breath components, skin odours, bowel conditions, etc.
• Muscle condition meters, to detect changes in muscle mass.
• Fast blood analysis systems; detecting changes in sugar, protein, gases, microbes; without the need for expensive lab analysis.

(6) What technologies will be needed to help people live independently for longer with better health and well-being? E.g.

• Digital communications for services, social interactions, etc.
• Devices, machines, etc. for daily living in the home
• Transport, infrastructure, services, etc. for involvement in community
• Accessible public spaces
• Smart homes

60+ are turning to social media, in fact it is the age group that is adopting it fastest now. There are many groups they can join, that connect people with like-minded interests; they just need a bit of show & tell /encouragement to use social media responsibly.

That said, tech is not the be all and end all. In a world where social networks are leading to a pandemic of loneliness, addressing the Ageing Society Challenge at a physical neighbourhood level is a sound and attainable ambition. Neighbourhoods –and especially public spaces - are the settings where residents can socialise, realise common values, and achieve a level of social control and personal purpose.

Telecommunications relentlessly increases pace, while the effective cost per Mbs and data capacity per month is dropping constantly. 15 years ago, it was 2Mbs max, now it is around 200Mbs. Therefore 15 years from now, it is likely the minimum will be 50-100Mbs, with some connections around 10Gbs. Video conferencing is improving with ever better call quality and higher picture detail (camera dependent), it could be possible to have augmented reality video calls, with the other person ‘sitting’ in your room.

The need for robotic devices that can perform the jobs between current appliances is most needed e.g. sort and load clothes into a washing machine; sort and move wet clothes to the tumble dryer/drying line; pack and unpack the dishwasher; put food into the fridge/cupboard and note what went where with use by dates. And there remains utility in additional appliances e.g. robotic vacuum cleaners, ‘tipping’ kettles, etc.

Control and meter devices need to be moved and scaled to allow easy reach and reading, or connected to apps that provide for this from the armchair. This includes all current appliances (heaters, washing machines, tumble dryers, etc.) and future devices e.g. robots.

Fix the point to point time it takes to travel to places. Technology detectors and algorithms can help with traffic management, in concert with redesigning roads for maximum flow – few stop/starts (and potentially moving pedestrians onto pavements away from the roads).

Segue-style devices and electric bikes/trikes, employing inclusive design, can provide easier mobility; either in rental or ownership form, and with space to park and charge them cheaply and securely. Autonomous cars are also suggested but these are just proxies for taxis and would need to be markedly cheaper, which require new business models.

Consumers are coming to expect their experiences to be enabled by technology. This includes healthcare, where remote consultations, connectivity, and location-aware mobile services are transforming the landscape. Trials are already going on to better plan appointments, get advice based on symptoms, without using NHS staff. Apps and AIs coupled with doctor/patient approved releasable medical data could be used to improve diagnosis and initial/complete suggestions of remedies.

Emerging ‘smart’ technologies and big data analytics present possibilities for everyone. However, their potential impact on the way people, especially older adults, engage with them at home is relatively unexplored. The drive for IoT devices (video doorbells, interconnected heating controls, burglar systems, various cameras, microphones, mood lighting, lighting controls, door locks, window locks, curtains, blinds, sockets, etc.) are enabling people to monitor and control all aspects of their house from their armchairs using home apps built into smart phones.

(7) How can technology be used to improve mental health and reduce loneliness for older people?

Lonely –mobile - people can make use of social media clubs and groups to talk and connect, and to discover real-world gatherings that may be of interest. If less active, Apps and AIs could reveal what is already going on in an area and make recommendations, put meetings for them in diaries and arrange transport.

Based on web search history, out-loud conversations, personal ‘grumblings’, etc. AIs/Apps could build profiles of the sorts of activities, clubs, groups or others apps, a lonely person may like to try. It may be possible for the App to ‘auto-enrol’ them to reduce the barrier to giving it a go. (Great opportunity to grow Social Prescribing)

Appropriately developed AIs/chatbots should be able to detect mood indicators, withdrawn behaviour, body language, spoken language that indicates someone is lonely / prone to being lonely.

Some people are already finding that just talking to Alexa/Google/ Siri is having a positive effect and alleviating some symptoms of their loneliness.

‘Find my friends’ type apps (this one is built into iOS) can already be used to indicate when friends are nearby. This could be advanced to alerts when friends are nearby or on a route that, with a small detour, could bring them to see the lonely person.

This of course presupposes that the older adult wants to mix. Some people drift into loneliness and technology will not make much difference. The government and local authorities should be looking to pre-empt loneliness by encouraging development of more multigenerational and intergenerational neighbourhoods.

(8) What are the barriers to the development and implementation of these various technologies?

While many people are trusting or have risk-assessed the dangers of giving their data to apps/corporates, many are distrustful, don’t agree to the T&Cs, or do not want to give their personal data to anyone. This latter group will have difficulty accessing the AIs, apps and other services that technology can enable.

The marketing hype is often well ahead of the actual technological capabilities. E.g. Some people have embraced voice triggered apps, while others have found they can’t get the device to understand what they are saying and soon give up. It may take them a while to re-try. Autonomous cars have been promised since the 1960s and are only just getting a ‘middling’ stage of autonomy. And that doesn’t come cheap e.g. Tesla is about to charge £5K to enable ‘around town’ autonomous driving in their cars that can adopt this feature.

The greatest barrier is the technological fragmentation of the smart home ecosystem. Many devices are ‘standalone’, with poor application programming interfaces disabling seamless connectivity with other devices, services, data streams, etc. Consumers need multiple devices and apps in order to run a smart home. This leads to problems around interoperability and confusion. Moreover, these interfaces are often poor from a security perspective making them easy to hack, take data from, and own for nefarious purposes.

Devices may require careful placement within the home/work/neighbourhood environment. While some devices may be quite cheap to purchase e.g. £5-30, UK skilled installation labour is not e.g. £50-100 an hour. And older adults are generally very nervous about allowing workmen/strangers into their homes.

AIs are nowhere near properly capable of human conversation/interaction and will take years to perfect. And the human skills needed to develop AIs are still rare and evolving.

Technology has a bad habit of breaking down, often within 1-3 years of its creation. With device faults difficult to diagnose, easier to replace than fix, and expensive to do so. And the more complex and integrated they are (see latest smart phones) the worse this becomes.

It’s also worth reiterating that most older adults want to socialise with other people, and technology will never be a substitute for that real time engagement.

What is needed to help overcome these barriers?

Create and embrace interoperable/highly adopted ‘platforms’ upon which multiple apps and other devices can interplay. This is happening with iOS, facebook, IoT building organisations, etc. But new capabilities will need their own open OS/platform and a business model with a public service agenda.

Longevity needs to be thought about from the earliest design stages; what technology is fixed and what modules can be changed out/replaced.

Availability, reliability and maintainability need to be properly considered, along with (remote) diagnosis and self-healing/in-built redundant capacity.

Trust needs to be built with older adults and their families/carers, so they know their data is secure on the device, in transit, and when being analysed by private and/or private sector stakeholders. T&Cs need to be very clear. Exploiting their data needs to be an easy to understand option the user can opt into (not out of), with benefits clear/accessible.

Misuse cases need to be properly investigated, and products/services should only be allowed to operate if they clear mitigation strategies and standards across development and operation.

Skills need to be built in the developer/engineering community to understand how to design and build AIs, devices, Apps, etc. to quality standards.

Psychologists will need to be employed (as they have been on social media platforms) to help design products and services that engage with the users, encourage their continued use, and get those users to extol the virtues of them to their peers.

Devices, apps, etc. need to be desirable, inclusive and welcomed by all age groups e.g. iPhone, iWatch, etc. Not a small demographic singled out as ‘losers’ or the vulnerable.

Technology roadmaps should be built to understand when technologies are likely to mature, become common place, and whether alternative better solutions will supersede them. E.g. powered exoskeleton or a pill that rebuilds the muscles back to good strength.

But let’s not get too hung up on the power of technology to cure all. A recent longitudinal study, published in PLOS Medicine, claims that increased social contact between ages 50 and 70 is associated with a significantly lower risk of developing dementia later in life. According to the study’s lead author, Dr Andrew Sommerlad of UCL Psychiatry: “This finding could feed into strategies to reduce everyone’s risk of developing dementia, adding yet another reason to promote connected communities and find ways to reduce isolation and loneliness.”

(9) What opportunities are there for industry in the development of new technologies to help increase health span? In which areas of medical research and technology development does the UK excel?

According to PWC the current global connected home market is estimated at $150b and is expected to grow strongly from 2020 onward, based on the assumption that a ‘new’ generation of older people, who are more tech-savvy then the previous generation, will be more inclined to invest in smart home solutions.

In parallel, BCC Research predict the global market for ICT solutions for healthcare monitoring in private homes is expected to grow from nearly $11.3b in 2016 to roughly $33.1b by 2021. These services also change the focus from treatment to prevention.

(10) 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?

The UK boasts many leading universities & research institutions focused on ageing. While there is much going on, there are few beacons of best practice; best in knowledge, best in experience and best in impact. What’s needed is a paradigm shift, but this will not be achieved through the lens of a single sector or discipline. It will necessitate a more holistic, collaborative and open approach to R&D, data sharing and commercialisation.

The burden of evidence for adoption by health and care systems are barriers to innovation. Government-led, grant funded, projects are often slow and lack agility, while more innovative start-ups struggle to both experiment and scale because of risk averse providers and regulators. There needs to be more space created to take risks and to build evidence of the case for digital health and care solutions. This requires work between private, public and third sectors to create pilots and share the evidence and data created.

(11) How feasible is the Government’s aim to provide five more years of health and independence in old age by 2035? What strategies will be needed to achieve the government’s aim?

While the aim is admirable, the challenge -according to Judith Torrington, author of Future of Ageing: adapting homes and neighbourhoods (Government Office for Science, 2015) - is that “UK housing stock is not well adapted to older people, and there are many mismatches between their needs and their homes.” This dichotomy was the primary reason that AAA joined forces with Tata Steel to submit a £20m Expression of Interest to “Reimagine our homes and neighbourhoods of the future” for ISCF wave 3 in 2018. After being shortlisted and engaging in a comprehensive “Deep Dive”, the panel said that “this was a compelling challenge area that could have a transformational social and economic impact on the UK construction and healthy ageing sectors.” They suggested that our challenge “would benefit from having a sharper focus supported with matched funding from a larger consortium, encompassing more of the housing supply chain, and from fully considering the issue of customer pull, given the complexity of this area.” Consequently AAA has been focusing on bringing together not only the housing supply chain but also local authorities, universities and other key stakeholders necessary to generate real impact at scale.

There is no shortage of innovation in the UK. What’s missing is a collaborative framework, a better understanding of the tools required/available to help local authorities support the needs of an ageing population and the means of assimilating interoperable systems at scale.

Whilst technology has a critical role to play, this is essentially a systems challenge which requires a cooperative effort to allow innovative and disruptive thinking to gain a foothold, and in so doing breath life into a potentially huge global market brimming with innovation.

It would be Counterproductive for investments to solely focus on developing new technologies that support healthy ageing without simultaneously taking account of the urgent need to disrupt current models of housing and the built environment. Prioritising investment in this area will help to shape these schemes and ensure that the UK has a world leading framework for lifelong housing and neighbourhoods fit for 21st Century living.

20 September 2019