Growing old technically

Imagine yourself when you are over 80 years old. Will you be able to do the things you do now for example your favourite hobby or even simple things such as reading the paper, taking a bath, turning on a stereo, driving a car or using an automatic cash dispenser? Where will you live, in what kind of a house? Will you be able to enjoy your freedom after a life of work?

Ageing & technology is a response to the challenges the ageing Europe is facing. Ageing is also an opportunity for Europe. If Europe can be in the forefront in developing and marketing technologies that for the ageing populations it can thereby improve the competitiveness of European enterprises against those in USA, Japan and other countries.

The Committee on Science, Technology and Energy of the European Parliament commissioned the Institute for Prospective Technology Studies (IPTS) in 1996 to prepare a report for their consideration on Ageing & Technology. The authors of the report were Niilo Saranummi (VTT Information Technology, Finland), Sirkku Kivisaari (VTT Group of Technology Studies, Finland), Tuomo Särkikoski (National Research & Development Centre for Welfare and Health, Finland) and Jan Graafmans (Eindhoven University of Technology - Centre BMGT, The Netherlands). The focus of this report is the role of technology as a partial solution to the challenge. The report was delivered in early December of 1996 and discussed in a colloquium organised by the Committee. It remains to be seen what kind of presence these issues will have in the future V Framework Program of R&D of The European Union.

What is it ?

For the purposes of the report 'ageing & technology' was found to be the best descriptor (at this moment of time) on the one hand of the challenges posed by the ageing of European populations and on the other, of the solutions that can be provided through the innovative use of present and emerging technologies.

In new emerging fields names are invented and 'owned'. Ageing & Technology is addressed by many other 'names' as shown by Figure 1.

Double ageing

Today the numbers of those over 65 and those over 75 years old respectively are 57 million and 23 million, in 2025 these numbers are projected to be 81 and 37 million respectively. In percentages this is an increase of 42% and 61%, respectively. At the same time the number of persons in the working age is decreasing. The consequence is that while today there are sixteen adults of working age per person aged 75 years or over, in 2025 the ratio is expected to be ten, a decrease of nearly 39 %.

Total social expenditure in relation to GDP has gone up from 24% to just under 28% between 1980 and 1993. In all EU countries without exception, social expenditure has increased in relation to GDP between 1990 and 1993.

3rd and 4th Ages

The actual age of a person, however, is no clear indicator of anything more than age itself. In fact this is best described by the 1st, 2nd, 3rd and 4th Ages (see Table 1). Being retired in the modern society does not imply frailty or loss of independence. These are present only in the 4th Age which in the case of a single person can happen at any moment of time and may last for any duration.

Table 1. Life course by Ages

Ages	Characterised by
1st Age	natality, infancy, childhood, socialisation, and education
2nd Age	Maturity, earning, career-pursuit and advancement; family formation, procreation, maintenance and socialisation of offspring; responsibility for the dependent old and young; membership of productive organisations and submission to their authority; self-fulfilment; preparation for full self-realisation
3rd Age	autonomy and self-fulfilment; release from the trammels of the 2nd Age; pursuit of aims freely chosen; cultural activity and satisfaction 'The crown of life'
4th Age	final dependency and death

Ageing & Technology is, therefore, addressing the needs and solutions of two groups of people, i.e. the 3rd and 4th Age, groups with different needs and therefore also different solutions.

Market

The market can be segmented in many directions: 3rd and 4th Age populations, users include also service providers, purchasing decision makers; citizens, service providers both private and public, and third party payers (e.g. insurance companies), and technologies as shown in Table 2 and Figure 2.

Table 2. Categories of technologies for the ageing citizens

Category of technology	Explanation of its contents
Technology for improving the quality of research on ageing	the technology that aids the elderly indirectly by improving the quality of research on ageing refers e.g. to technology for imaging organs and tissues or non-invasive biochemical measures of biological and physiological processes of ageing
Technology to enhance the performance of new roles provided by ageing	refers to new work, leisure, living and social situations. This domain is not well developed, yet
Technology for preventing or slowing of the decline in physical and mental strength, flexibility and endurance that are commonly associated with age	technology for prevention of the decline in physiological, social and psychological functioning to development and utilisation of modern technology assisting in maintaining a good health status. This includes equipment for exercise or systems for monitoring physiological functioning and assessment of progress
Technology to compensate for declining capacities of ageing	the most developed area and includes, for instance, products and techniques to compensate for sensory losses or loss of strength and ability
Assistance for caregivers who care for impaired elderly persons	covers, for instance, technology for lifting and transporting persons who are incapable of moving themselve

In terms of purchasing power the elderly population is a market that industry cannot ignore. It has been estimated that in 2025 the elderly population which at that time is about 1/3 of the total population controls roughly 70% of the money (disposable income + fixed assets).

Projection of the demographic trends on the social expenditure and health care funding indicate that social and health policies and strategies must be reoriented towards decreasing the rate of increase of these expenditures.

Empowerment

We need a positive vision what it means to be old and living in the future Europe. In the last 150 years we have gained 30 life-years. Consequently, the main aim of Ageing & Technology is to enable the ageing population to maintain their autonomy and dignity, to pursue self-fulfilment, to lead an independent life, to care for their well-being, and continue to be members of the society.

This calls for action in three areas:

development of products and services;
providing information of what is available (e.g. knowledge about health, prevention of illnesses, care possibilities);
organising the 'delivery' of these products and services to the customers.

Social dimension

In contemporary society we cannot speak only of social ageing (social gerontology) but also of technological ageing. If technologies which we have learnt to use turn out to be obsolete, the social skills interrelated to these technologies will also become obsolete. Technologies and persons' relationships to them are in a continuous state of change.

For keeping elderly people integrated in the social life, it is, therefore, important to study elderly people's attitudes towards technology and their ability to adopt it in their everyday life.

Technological innovations have a profound influence on life styles and life situations. Changes of family structures have influenced the provision of services. The use of new technology may again increase the role of families and other close helpers. It is probable that in the future the provision of services for elderly people will be a mix of different types of informal and formal care.

Gender is another relevant issue mainly because the majority of the elderly are women. Also formal and informal care work in western societies is mainly done by women. Thirdly, on the basis of recent knowledge on gender and technology we can assume that similar problems are faced in Ageing & Technology as in other fields of technology as well. Women are weakly involved in the development of technologies and, thus, their needs and perceptions for example due to involvement in caring work are not well incorporated. One can assume that due to their weak involvement in the development of technology women´s resistance for new technologies may be stronger than men.

The social perspective is valuable in enforcing research and industrial actions. Technology should serve the needs not establish 'needs'. Instead of letting technology lead we need to build also the social structures at the same time.

Complexity

As technology is shaped by people, organisations and groups the technological and social aspects of technological development cannot be separated. Technology is not neutral: its implications are not generated only in the implementation stage. The implications have been built into a product or system already in the development stage.

From this point of view the shaping of Ageing & Technology should focus on the development process itself: who are involved in development and planning process and how, what is the conception of a user / customer, how is the user involved, how do use-related meanings evolve in the interaction between actors?

Encourage the process

It is not feasible to build a top-down action program with a vision, mission, strategy, policies and projects that will guarantee results. But it is not wise either to leave it on its own to find its solutions by trial and error.

The 'middle road' is to accept its complexity and instead for trying to control it, encourage the process of research, development, piloting, evaluation and implementation of Ageing & Technology. Additionally some ground rules should be established to point the direction.

One of these ground rules is the fact that the responsibility for the development of the infrastructure on which the Ageing & Technology products and services will exist remains with the society. Similarly social and health policies will determine the incentives for industry and service providers. Thirdly, consumer power should be brought to bear on this domain as well.

Innovation

All actors are involved in shaping the outcomes of innovation processes regardless of the awareness of these actors (not using one's possibilities fully is also participation). It is, however, in the interest of every actor to be aware of the prospects related to taking an active part in the process. Success in solving the ageing related challenges calls for a higher awareness of value formation as an interactive dialogue from the part of all key actors.

Workforce

Some of the consequences in responding to the ageing challenge will be work force related. For instance in the Nord-Rhein-Westphalen region it has been estimated that ageing would produce a 3x growth in the number of persons involved in public and private services. As mentioned above this is clearly not possible. New services and products supporting these must be innovated. A new service-mix must be innovated which among other things puts more emphasis on citizens for their well-being and health. Care structures must become 'lighter' implying a shift of work force from institutional to ambulatory care. New products and services call for different training and education.

New incentives

The speed at which the ageing and technology market develops and the directions of its growth depend on how the different stakeholders experience and view the incentives. Therefore the 'ground rules' mentioned above are highly important.

Issues to be considered include:

shaping of the public funding and service provision systems to foster a welfare-mix public and private services co-existing with a consumer market of technological devices and systems used by the citizens themselves (e.g. the use of 'service cheques' given by the public sector and which can be 'upgraded' with private money to buy a product or a service)
involve mainstream industry and SMEs to invest in research and development of Ageing & Technology on a large scale, for instance through an action program run by the industries
similarly involve service providers both from the public and private sectors
technology has to fulfil a need, if not it will be rejected. However, also new services will have to be created to take advantage of the technology potential.

Table 3. Involvement of Directorate Generals of the European Commission in actions related to ageing and technology

Responsible	Description
DG III Industry	within the IT program special emphasis to 'adaptable housing', the smart house
DG V Employment, industrial relations and social affairs	HELIOS (Handynet), HORIZON; European Union programme 'in favour of older people' (1991-93) within which a 'European observatory on ageing and old people' was established
DG VII Transport	action programme 'Accessible transport', which aims to increase the usability of transport for persons with reduced mobility. Inside Transport program 'studies into the accessibility of transport for people with reduced mobility'
DG XII Research	In Targeted Socio-Economic Research program social exclusion, science and technology policy in general tasks also focus on the ageing and its consequences for research policies. BIOMED-2 addresses age-related problems, health services research etc. in a number of projects. For instance, Technology, Ethics and Dementia focuses on the ethical issues Industrial and Material Technologies program includes materials and technologies for innovation of products, including materials for biomedicine and bio-engineering. Standardisation, Measurements and Testing program addresses the measurement of human biological constants important to the restoration and maintenance of body function
DG XIII Tele-communications, Information market and Exploitation of research	ACTS addressees advanced communications and validates this by means of applications and services for elderly people. In the preceding RACE program several projects addressed this sector TIDE (more in a separate chapter) Telematics applications in its sub-programs such as Health Telematics, Rural and Urban Areas, Transport and Support Actions contain a number of projects relevant to the field (e.g. EQUALITY, ETHOS, INCLUDE, PLANEC, ...

Additionally, at the national level social and health policies will have to be shaped to be an incentive for the other stakeholders to develop solutions.

The full report is available at IPTS.