For the government it is a ticking timebomb. For engineers it is a potentially massive new market. For most of us it is just a simple, nagging worry: who will look after me when I grow old?
In the face of a major demographic shift, the government is pouring hundreds of millions of pounds into research into assistive technology – systems that can augment or even replace human carers. But some have accused it of failing to provide a proper structure for the research, allowing funds to be siphoned off into other areas and leaving a gap between development and delivery that could delay mass roll-out of the technology to a rapidly ageing population.
Improved standards of living and health mean that average life expectancy is creeping well beyond 80 years. The thirtysomethings of today could make up one third of the population when they are pensioners. If the health sector were to operate as it is now, up to half of school leavers would have to be recruited into hospitals and social work to maintain the same level of service – a disaster for the rest of the economy. Assistive technology is widely seen as the only alternative.
In the UK a wide range of research projects are underway in a bid to tackle the issue. Their aim is to keep elderly people in their own homes for as long as possible. In theory this is better for the individual and cheaper for the state.
The current generation of telecare systems – a wireless pendant alarm connected to a remote operator – has proved relatively successful, but assistive technology is already moving beyond this.
The focus in second-generation telecare is the development of sensors that continuously monitor the home without being intrusive. The newest systems will trigger an alarm by remotely measuring significant, possibly worrying, changes in daily activities without the need for a pendant alarm. Homes with networks of infrared and pressure sensors are creeping on to the market, pioneered by companies like BT, Huntleigh Healthcare and Tunstall.
Huntleigh’s Insight system, costing £5-8,000, gives an audible warning to the old person when it detects something potentially dangerous. If the back door is left open or the gas hob not turned off, the system will call for help from outside. Unobtrusive off-the-shelf sensors sit around the home, possibly an infrared array on the ceiling, or a pressure sensor under the bedpost.
Prof. Heinz Wolff, one of the leading researchers in the ‘smart home’ field, helped to pioneer the concept through his Millennium Home project at Brunel University. The key factor in making the project a success was to think from the point of view of the end-user, he said. ‘It is actually difficult to put oneself into the shoes of people requiring care, but somehow we must preserve the human angle.
One is dealing with human beings not air engines. I wonder whether when you are 80 you would want a robot to wipe your bottom and feed you.’
Other researchers are taking sensor technology a step further. Researchers at the University of Dundee are developing a visual recognition camera to complement smart home technology. The software determines a dangerous state such as a fall and then raises an alarm, said Dundee’s Prof. Alan Newell. ‘It looks at the image and determines which part of the room is a person and then decides on the orientation of that person, be it horizontal or vertical.’Some researchers are taking an even more interactive approach.
The Bath Institute of Medical Engineering (BIME) is a hub of assistive technology research. The team there has developed a number of devices to spot problems and then actually do something about it rather than just calling for help. If the gas hob or bath taps are left on, for example, the system will turn them off without disabling them altogether. BIME director Roger Orpwood said: ‘It would have been fairly simple just to shut the water supply down. But the device puts a brake on the shaft in the tap, then resets an encoder, which informs the water valve, then the taps operate as usual.’
The next step for assistive technology is the boldest and the hardest – a telecare system that can read the future. Such a system would monitor the wellbeing of an old person and, instead of reacting to something dangerous like a gas hob or a fall, would aim to prevent it from happening in the first place. This is the third generation of telecare, and both researchers and social services are increasingly excited about it.
BT Exact, the telecom giant’s R&D division, is developing a monitoring system made up of a network of sensors that examines the daily life of an elderly person and detects when they are slipping towards ill-health.
Steve Brown, project manager of the Wellbeing project at BT Exact, admitted that third-generation telecare is ambitious. ‘We’re trying to determine whether it’s possible to predict or prevent these emergencies from happening in the first place. We’re going to another level of detail in terms of activities. We don’t just want to know the activity is being performed but how well it is being performed.’
The system could present regular reports to social services showing a positive or negative swing, or a graphical display of someone’s activities. ‘Social services are very excited about it. It gives them actual evidence for care programmes. They’ll now have data to back up their decisions of care,’ Brown claimed.
BT has identified three broad areas to monitor in the home. Social interaction could be detected by how often the person leaves the house. Physical health, including sleeping and eating is easily picked up by bedroom and kitchen sensors. The final element is mental health. This is the trickiest to pull off, according to Dr. Andrew Sixsmith, a lecturer in gerontology from the University of Liverpool who is working with BT on the project. ‘Could it be possible to pick up if someone is depressed from observable behaviour? Whether a person smiles or not? Facial recognition technology is being developed, but it’s nowhere near robust enough yet to monitor an everyday environment.’
Sixsmith said there are significant problems to overcome before wellbeing technology can be introduced. ‘It’s an extraordinarily difficult task to do. At the moment the concepts are quite far in advance of our ability to implement them,’ he said. ‘It’s reasonably easy to look at whether someone is sleeping, but when it comes to something like whether they’re making a cup of tea in the right way then that’s extremely difficult.’
‘Elderly CCTV’, with an operator keeping an eye on the old person, is the obvious answer but in practice would entail an inolerable breach of privacy.
For the moment BT plans to use simple accelerometers, infrared and pressure sensors dotted around the house similar to a security alarm, and novel sensors to detect, for example, tap use. Sensors are fitted to water pipes that detect vibrations and indicate whether the person is washing or drinking sufficiently. Complex algorithms and ‘fuzzy logic’ mathematics are then used to collate the information from throughout the house and interpret wellbeing.
Brown predicted a future in which wellbeing monitoring could become more intelligent and even make important decisions on behalf of health services, for example about medication. BT is also developing two-way sensors that could be remotely configured. The first system will begin testing this year.
BT is using off-the-shelf components and working on bringing the cost of sensors down. But Brown conceded that although social services see the obvious benefits, wellbeing monitoring would cost them more. Any savings, he said, would come from shorter stays in hospitals and so not directly fill social service coffers.
This is indicative of a wider problem that some fear could seriously undermine the roll-out of assistive technology. Why would social services want to invest a portion of their budget in technology if the NHS reaps the financial benefits? And what clear incentive is on offer to technology companies to push forward developments in the field?
Dr. Frank Miskelly, a consultant physician at Charing Cross Hospital, heads a team at Imperial College, London, that examines the benefits of new technologies for the elderly and is also chairman of a special interest group on the subject for the British Geriatrics Society.
Miskelly claimed the government is shirking its responsibility to offer incentives to introduce new technology. There is a gap between industry and the customer that needs to be closed, he said.
In 2001 the Department of Health set up a team called Integrating Community Equipment Services ( ICES) to encourage agencies to adopt new technologies. According to Miskelly it is not working. ‘ICES was set up to co-ordinate this nationally, but all it’s doing is making a list of what’s going on, and where.’
Miskelly claimed one of the main problems is at the source: nobody is co-ordinating the research being done in academia. ‘There are hundreds of little pilot schemes but no national co-ordination. The Department of Health hasn’t got a handle on it,’ he said. ‘They are handing out money, saying “here, go and play with this” but the pilot project just dies when the funding runs out.’
ICES defended itself, claiming the criticism was a misunderstanding of its role. A spokesman said The Department of Health sets out ‘the vision’ but it is the responsibility of the services themselves to achieve it.
The Foundation for Assistive Technology (FAST), a charity lobbying for a nationwide strategy, accused ICES of failing to assert itself. FAST claimed the state allocated over £200m to social services to double the number of people with access to assistive technology, but much of the cash was diverted for other purposes and many agencies simply failed to comply.
FAST has set up a user forum in a bid to join up the fragmented field of assistive technology and encourage industry to invest in research projects. ‘At the moment you do find projects are getting left on the shelf,’ said Marie Kelman, FAST R&D manager.
‘People just don’t know about them.’ FAST wants researchers to make themselves more attractive to industry. ‘What we’re trying to do is look at the amount of money being spent and the benefit for the end user,’ said Kelman. ‘How much funding is actually invested in assistive technology? Those figures aren’t there at the moment. How much is developed commercially? It’s likely to be very low.’
In theory the technology sector should need little encouragement to step up its efforts in the field. Assistive technology is predicted to be one of the boom markets of the 21st century, and the commercial rewards could be huge.
Miskelly, however, claimed manufacturers are being shortsighted, trying merely to transpose their existing products into a complex new arena. ‘They see healthcare as a massive market but they’re not prepared to invest any money in adapting their existing technology. Then it doesn’t work and picks up a bad reputation,’ he said. ‘All they’re interested in is selling their little bit of kit – and half the time their little bit of kit doesn’t do what they claim.’
Many of the assistive technology products currently on the market are driven by technological opportunity rather than user needs so they simply don’t sell, according to Andrew Monk from the University of York’s Centre for Usable Home Technology, established to bridge a gap and explain the needs of people in a way that engineers can understand.
Monk also believes that technology, such as that in the smart home that controls people’s lives, could be fraught in many ways, so manufacturers are reluctant to move into the area. ‘If you gave inappropriate advice you’d be in big trouble. Dangerous things could happen if you relied on it,’ he said. ‘There are all sorts of safety issues. Do suppliers open themselves up to liability?’
However, the technology sector can point to the fact that – given the apparent contradictions in government policy detailed above – it has no clear public market or framework into which to introduce new systems. The private healthcare sector is where most companies are focusing their efforts. But the smaller revenues compared with the potentially huge NHS market fail to encourage much R&D.
It seems the government is content to watch from the sidelines for now and let manufacturers take the lead. Companies could develop a range of products, but unless the infrastructure is there to support them the industry is in danger of stagnation.
Brunel’s Wolff claimed that companies are bedazzled by an extremely complex market with no umbrella co-ordination. ‘It’s very much easier to sell someone a mobile phone with a camera than to get the local authority, housing authority, relations, occupational therapists and the old people themselves all together. You can’t underestimate the difficulty of doing this. This is why there’s hardly any equipment on sale,’ he said.
It seems that government and industry are procrastinating about who should lead R&D, and the field is in desperate need of a guiding hand.
<b>The US leads the way in ‘whiz-bang’ technology</b>
The demographic timebomb is due to explode all over the world, not just here. The most obvious leader in assistive technology would be the US, and some of its biggest firms are active in the area.
But Bath University’s Roger Orpwood reflected a widespread perception in the research community that the US is investing huge amounts of money in ‘whizzbang technology’ that will never make it onto the market because, while technically advanced, it is impractical for mass application.
‘The work done in the states is challenging, but hardly ever involves any actual users. They are testing on research staff or students,’ said Orpwood. ‘The technology in Europe is not up the standard of the US, but in terms of effectiveness the US isn’t up to the same level as Europe.’
At Pittsburgh and Carnegie Mellon University, researchers are working on a project called ‘Pearl’ – Personal Robotic Assistants For The Elderly. The robot could do everything from important reminders to social interaction. It’s hard to imagine 76 million robots, however, being built to talk to the 76 million US baby boomers due to retire in less than a decade.
Bigger players such as Intel have recently moved on to the market and may change the direction of research for the better. Intel is developing similar wireless digital sensor technology to that developed in the UK, and also employs social scientists to study the actual needs of the elderly.
Researchers at Intel and the University of Washington have built a prototype that can infer a person’s activities of daily living. Sensor tags on toothbrushes or coffee cups can determine if the person has brushed their teeth or taken medication.
Another Intel prototype delivers timely reminders via mobile phone or TV, and the company has also developed wearable wireless sensors to alert carers to a fall.