In 2014, the median age of the UK population passed 40 for the first time. Over the next 20 years, the number of citizens aged over 60 will increase from just under 15 million to nearly 22 million. By 2039, more than 70 percent of UK population growth will be in that age bracket and many of those people will live in cities that are themselves ageing.
This is why healthy ageing is one of the government’s ‘grand challenges’ under the revamped Industrial Strategy, alongside clean growth, future mobility, and strategies to support the spread of artificial intelligence (AI).
Technologies such as AI, robotics, the Internet of Things (IoT), sensors, big data analytics, wearable devices, autonomous vehicles, and 5G communications will play an increasingly important role in healthcare support, and in connecting people both physically and digitally.
According to a new white paper from the government, Future of an Ageing Population, this may include the “mainstreaming of technology-enabled care services” – for example, home health-monitoring tools, online communities for people with shared interests, and the use of health data to improve clinical treatments.
Certainly, the government sees the combination of AI, big data, health tech wearables, and robotics as being critical components of the future care system, and in citizens’ ability to manage their own health and fitness.
But that’s not all. Developments such as 3D-printed joints and organs, therapeutic robotics, and genomics offer the potential to improve health outcomes across the population, says the white paper, while improvements in personalised/precision medicine may allow better targeting of drugs, making treatments more cost-effective.
Meanwhile, increases in real-time data collection (driven by advances in wearables and other forms of tele-monitoring) could enable doctors to provide better treatment and support for patients and carers, while the resulting datasets could drive research in many areas, improving prevention and early intervention.
However, the rapid evolution of medical and assistive technologies also makes predicting the scale of their impact difficult, and creates a need for new methods of evaluating their effectiveness and security.
Ethical and privacy issues arise too: technologies such as alarms, home monitoring systems, and GPS locators could help carers locate people with dementia, for example, but could equally be used to impinge on the privacy and well-being of other people in care environments.
To capitalise on the advances in assistive technology, a number of barriers will need to be overcome, acknowledges the white paper. Some of these are financial. As with many new technologies, cost can be a barrier to their implementation in the short term, though in the longer term they may generate cost savings.
According to the paper, a number of recent studies have shown that the use of telecare to improve social and healthcare for vulnerable older people is not yet cost-effective, while the future deployment of new technologies could be inhibited if a provider doesn’t benefit directly from the savings. In the long term, however, the NHS would gain through reductions in hospital admissions, suggests the paper.
Cost may be a factor in other ways too, via the creation of a two-tier society of technology haves and have-nots. As a result, there is a risk that the potential of new technologies to support improved health will not reach those with the greatest need, exacerbating existing inequalities.
Often overlooked in discussions about AI, robotics, and health is the issue of connectivity: something the white paper seeks to put right. It says:
“Connectivity – the ability to use technology, access services, travel easily, and socialise – is a key issue as the population ages, and includes not only physical mobility but also virtual and digital interactions.
“Connectivity is crucial in allowing people to care for others, interact socially, participate in society (for example, through volunteering and working), and access services such as health prevention and health treatment.
“In 2011, 630,000 of over 65s found it difficult or very difficult to travel to their GP, while less than half of those aged 80 and over said they found it easy to travel to a hospital. Those in the worst health and with the lowest incomes found it the most difficult to travel to health services.
“Loneliness and social isolation have impacts for individuals and society, for example people with a high degree of loneliness are twice as likely to develop Alzheimer’s as people with a low degree of loneliness.
“A large proportion of older people ‘feel lonely some of the time or often’, with those in the oldest age groups being most likely to feel this way. A range of factors cause isolation and loneliness in later life, including children leaving home, death of partners, retirement, and reduced mobility.”
Isolation affects all age groups, but is often associated with later life, where social connections are an important dimension. Improving the factors that facilitate social connection, such as transport, bring other benefits to the ageing population, such as access to services.
Mobility is not just important for practical reasons, but also to help facilitate social networks and promote identity and self-esteem. It can also help fulfil people’s more aesthetic needs, such as visiting nature, travelling and leaving the house for its own sake. However, most transport provision for older people centres on improving mobility for practical reasons, says the white paper..
New technology has the potential to address some of the transport challenges that arise from the ageing population, it continues. The trend towards people purchasing transport as a service (as opposed to owning cars) is being facilitated by apps.
That said, technology may also reduce older people’s need to travel in the first place. Innovations such as social networks and online shopping can provide social interaction, participation, and access to services without the need to leave home.
Technologies such as augmented reality services can enable virtual participation in a wide range of activities, such as social events, the pursuit of hobbies, or virtual tourism, claims the white paper. Older people – especially those who are geographically isolated or who have limited mobility – could benefit by feeling more connected, empowered and independent in this way.
However, ICT could also lead to the breakdown of traditional forms of social interaction, and is often used to reinforce existing social contacts, rather than to build new ones, says the white paper.
Across all ages, there is a broad ‘digital differentiation’ in technology uptake within cohorts, usually associated with factors such as material deprivation, ethnicity, gender, and geographical location, it warns.
While 99 percent of the population earning £40,000 or over use the internet, under 60 percent of those earning less than £12,500 do, and while 84-95 percent of people with qualifications use the internet, only 40 percent of those without qualifications do. Such differences are likely to become more entrenched as these groups enter old age.
The barriers include a lack of digital and technological skills: 79 percent of 65-74 year olds had ‘low’ or ‘no’ internet skills in 2013, according to the government’s figures. Evidence also suggests that many older adults are ambivalent towards ICT.
“Many older adults perceive ICT to be a luxury and are reluctant to spend money on items that need continual updates and maintenance,” continues the white paper. “Many older adults fear that using ICT will have a negative effect on their sense of privacy and personal security, with choice, control, and fear of reduced social interaction being key concerns for older people considering assisted living technologies and telecare.”
Another form of connectivity is critical to this fast-emerging future: broadband and citizens’ ability to access the internet fast enough to participate in new services.
The white paper says the government is “already doing much to improve technology infrastructure, including planning to provide superfast broadband coverage” to the majority of the country. However, it is here where the government’s strategy is signally lacking in the real world.
Statistics reveal that the UK has among the slowest fixed-line broadband in the developed world, and is doing even worse in mobile access. And the reason is largely to do with greed and inaction by the very market forces that the government looks to for innovation and to bring citizens online.
According to the latest global indices provided by Speedtest.net, which publishes monthly assessments of the average fixed-line broadband speeds of 179 countries and the mobile broadband speeds of 138, the UK is languishing at 41st in the global league in fixed-line speeds, behind most of Asia, North America, and all of its Western European allies except Italy and Austria. In Eastern Europe, only Slovakia, Slovenia, Estonia, and the Czech Republic have slower broadband than the UK.
In mobile broadband, which the UK has largely been able to build without being hobbled by its legacy of ageing copper connections, the UK is barely in the top 50, languishing at 49.
As of September 2018, only six percent of UK premises had access to full-fibre connections, according to the government’s own figures, just two percent more than in the Spring. At that rate of progress – roughly four percent a year – the UK will only have two-thirds of premises connected to full-fibre broadband by 2033, the year when the government intends to have the entire nation hooked up.
So for many of the UK’s millions of ageing citizens, the future may be on hold for a long time yet.