The surge in people with special needs – a new area of research and development for medical and biological engineering and market relevance for international standards

Facing the issues of an ageing society

Recently the global reach of the problems being created by the rapid growth in the number of older people, in developing as well as in developed countries, has been noticed in the various fields of biomedical engineering. With 1999 having been designated by the United Nations the "International Year of Older Persons (IYOP)", biomedical engineering should begin the discussion by noting that the "explosion" in the numbers of elderly people could be considered as an "increasing natural resource" for the world.   

Ageing is characterised as a "lifelong" process for individuals, families, communities and the "macro-societal environment". The UN has started various initiatives to develop the new strategy on ageing for the 21st century:

• Formulation of a policy framework for a society for all ages,
• Establishment of an Internet data base of policy approaches and innovative projects, and
• Identification of social technologies supporting multi-generational ties within the family and community.

The UN also emphasised the support for national programs that incorporate the UN Principles for Older Persons aimed at protecting the interests of ageing consumers. These should be complemented by the development of international standards of products and services for all ages. In USA, the goals of the IYOP are to incorporate the issues for assisting the elderly into the policy and program agendas of 40 United States agencies, such as the Department of Transportation’s initiative to assist seniors in accessing community resources and the Department of the Interior’s efforts to ensure that the nation’s car parking system is able to meet the needs of older consumers. In addition, there are also new proposals such as "life-course planning", which would provide comprehensive counselling and public information programs in each state "on economic, health, social, housing, and other types of daily activities".   

Japan, like many countries, is experiencing a very rapid decline in its fertility levels, while having attained a far greater life expectancy for its people, with the result that the population is ageing very fast. The percentage of Japanese people over 65 – which stood at 15.7% in 1997 – is expected to reach 28.2% by the year 2025. This drastic demographic change will have serious effects on social systems, including healthcare, and on industrial and economic activities. The human ageing process affects people’s physical and mental capabilities. Although increasing numbers of elderly people have to rely on help from others, most elderly persons can still live independently while facing difficulties in using products and in living in environments not well designed for meeting the needs of a wider range of human abilities. There are about three million physically handicapped people and about two million mentally handicapped people in Japan. Over half of those are also elderly persons. In fact, other countries are experiencing the same trends as in Japan.

Diminishing capacities means a growing need for medical and biological engineering research and development and international standards

On the occasion of the ISO COPOLCO General Assembly in Washington D.C. last year, "meeting the needs of an ageing population through standards" was addressed by John Kean, ISO’s Vice-President of Technical Management and Chairman of the ISO Technical Management Board. He stated that national and international standard-developing organisations generally have not addressed the specific needs of ageing populations. For the most part, standards for both products and processes are designed for use by able-bodied people. The task ahead for organisations such as ISO is to develop standards for products and processes that are designed for use by people with diminishing capabilities, and this requires "a change in attitude". He also requested that the elderly directly participate in the development of standards.   

Electronic tools such as the Internet may help to facilitate consumer involvement. He added that awareness at national level would be helpful, as would guideline documents at international level on items to be considered in developing standards addressing the needs of the ageing population. He furthermore noted that with the growing number of older people, there is now a new market sector to supply and a guideline document could also be useful to manufacturers and marketers in designing or re-designing products. As ISO is increasingly concerned with the market relevance of its standards, the needs of this growing sector need to be addressed and satisfied.   

He viewed ageing as "a synonym for living" and claimed that the ageing baby boomer generation is revolutionising "the nature and perceptions of ageing", and generating individuals who were shattering traditional myths and perceptions of older people – individuals who were not "acting their age." Citing the "growing market of informed, discriminating and assertive older consumers", we call upon research and development to meet consumer expectations, especially of quality, emphasising that research and development needs to understand its customer base, recognise its diversity and respond accordingly.

ISO / IEC standards tackle the issues of "meeting the needs of ageing populations"

JISC is the Japanese standardisation body set up by the Industrial Standards Act of 1949. JISC examines draft Japanese industrial standards and recommends them to the Minister of International Trade and Industry (MITI) and other relevant ministries for adoption. In January 1998, JISC set up an ad-hoc committee on standardisation for the elderly and people with disabilities in order to formulate a standardisation plan in this field. The discussion in this committee formed the basis of a JISC proposal for ISO/COPOLCO to set up a working group.   

After the COPOLCO meeting in Tunis in May 1998 and its resolution 5/1998, JISC established another technical committee inviting relevant industrial associations in order to consider how to prepare for this working group. JISC also set up two research committees for drafting standards of consumer goods and technical aids. To support the standardisation work, it is necessary to provide data on the characteristics of people including the elderly. Therefore, the JIS Centre and the National Institute of Bioscience and Human Technology are conducting research into ergonomics. JISC believes products and services are increasingly traded internationally. International standards in this field may encourage industry to develop more accessible and usable consumer products and services.   

Every country faces the challenge of growing numbers of older persons. ISO and IEC should develop international standards that meet this challenge. At the initiative of Japan, COPOLCO has started work on developing an ISO/IEC policy statement and a guide with the purpose of overseeing that the needs of the elderly are taken into consideration in international standards and to secure a better environment for them. It is urgent to provide standard developers and designers of products, services and environments with a guide on how to consider the needs of all parties and everybody, including older persons and persons with disabilities.   

The initial tasks of the ISO/COPOLCO working group on older persons and people with disabilities are to:

1. Develop an ISO/IEC document providing basic principles and considerations on how to design products and environments adapted to the needs of older persons and people with disabilities
2. Consider the form of document that would best meet the purpose (guide, statement, etc.)
3. Identify the specific needs of older persons and people with disabilities with a view to ensuring that they are covered by international standards work.

The working group has been very active, and has met five times between October 1998 through February 2000. After that the ISO Council transferred the development of the ISO/IEC Guide 71 addressing the needs of older persons and people with disabilities in standardisation to the Technical Management Board (TMB) for further handing. This resulted in an ISO ad-hoc TAG, which met in Geneva 19-20 June 2000. The ISO/IEC policy statement is now being voted on by both ISO and IEC and is expected to appear by the end of year 2000. The draft Guide 71 has been distributed for comments, and it is scheduled to be completed for voting by the end of January 2001. CEN, CENELEC and ETSI have also agreed to await the outcome of this activity and to transform it, once available, into a common publication.   

The policy statement says that the increasing prevalence and complexity of technology in everyday life presents both opportunities and challenges. So that older persons and people with disabilities may participate in society on equal terms, it is necessary to improve the accessibility of products, services and environments. Improved accessibility further enhances the quality of life and reduces discrimination. This statement is also aimed at encouraging the development of standards that promote design that enables the use of products and services by older persons and people with disabilities. As there is a continuum of abilities, standards should address the needs of people throughout this continuum. It is recognised that all standards cannot meet the needs of all people with severe and complex disabilities. ISO and IEC recognise the need to include the requirements of older persons and people with disabilities in all relevant standards production and revision work. This can clearly be achieved by following the basic principles of

1. universal and accessible design,
2. direct consumer representation of older persons and people with disabilities, and
3. relevant information exchange.

Guide 71 describes the abilities that need to be considered and presents the characteristics in a matrix format.

The role of biomedical engineers in meeting these needs

Medicine, medical aid of different kinds, care and treatment can obviously make a considerable difference to the life of older persons, and lengthen their life-span or help soften and make more comfortable their last years. However, medical care costs money, and is reserved to a large extent for the wealthier in wealthier countries. For most other people, the recourse has been essentially the family up to now, the elderly being taken care of by their children, placing a financial, moral and even physical burden on them. There are areas now to be studied to see how they can stay in their homes, the wish of most of the elderly. The effects of ageing are variable; some escape and reach a ripe old age without suffering. Others suffer cruelly and have diminished physical possibilities even at 50. Treating the old as a race apart, however, is not a solution, and can be vexatious: "elderly" is a relative term. One answer lies in "universal design". This means "designing-in" all the factors for all ages and conditions (the requirements of the disabled sometimes overlap with those of the elderly) to get an "all-in" treatment for a product to be capable of being all things to all people.   

Specialised agencies such as ISO and IEC work in tandem with the governments or national agencies in each country, where matters of national legislation are frequently involved. One way to go to use international standards usefully, therefore, would be to bring out ISO/IEC guidelines on approaches to be adopted when developing standards, national, regional, sectorial or international so that the elderly are taken into account.   

Dr Albert Einstein said that "the significant problems we have cannot be solved at the same level of thinking as that at which we created them". This is invariably true, not only in pure physics, but also for the socio-economic problems that we face these days. This suggests that we need to take a dynamic and leading role in meeting the needs of ageing populations through biomedical research and development and international standards.   

I do believe age did little to impair the brilliant mind of Albert Einstein, who died at 76. Old people do not "act their age" any more, and with improvements in healthcare the elderly will be able stay in better mental and physical condition.

Makoto Kikuchi

Chair, New Initiatives Working Group of IFMBE

Professor of Department of Medical Engineering,

National Defence Medical College, Japan

Email: mkikuchi@cc.ndmc.ac.jp