AGE Platform Europe Research Project Manager Ilenia Gheno discusses the role of digital technology in supporting elderly care during the COVID-19 pandemic.
The COVID-19 pandemic has highlighted existing systemic issues within long-term care systems across Europe. AGE Platform Europe, the European organisation of and for people aged 50 and over, has reported extensively on breaches in human rights in managing the health, economic, and social crises triggered by the coronavirus pandemic and suggested ways forward to recover from the pandemic while paving the way for a fairer society.
Looking beyond the COVID-19 pandemic, AGE Platform Europe’s European Green Paper on Ageing sheds light on issues and opportunities related to demographic ageing. The paper offers a life course approach, showing how socioeconomic inequalities accumulated across a person’s life have a strong impact in older age, and encompasses a strong gender dimension and the intersections between old age and disability. These aspects are all essential in strengthening the European care landscape.
However, more needs to be done: health and care need to be grounded in human rights, to eradicate ageism, to embrace equality and non-discrimination, and to genuinely seek older people’s views on what matters when ageing. Human rights do not diminish with age (see the #AgeingEqual campaign), and older age should not mean weaker rights.
To ensure this in long-term care, AGE’s contribution to the European Pillar of Social Rights and its Action Plan calls for an ambitious European initiative covering all dimensions of care and support. Such an initiative should include clearer and better-tailored indicators and targets, measures to improve working conditions and support informal carers, and a push for integrated care and better regulation of the care market.
Digital technologies and older people
When developed correctly and responding to real needs, digital innovation and technology can be conducive to improving older people’s quality of life, maintaining a good lifestyle and remain autonomous and independent. AGE Platform Europe promotes the inclusion of older adults in research and design of digital technologies: only by meaningfully and genuinely involving the final beneficiaries of technological services and products, is it possible to deliver accessible solutions, suitable to be more easily accepted in real life. Older adults should be involved from the very beginning, from the idea creation until its final validation1.
The European Horizon 2020 Research Programme funds very diverse large-and small-scale research projects. Despite the complexity and variety of the programme, user involvement is mainstreamed across calls for proposals. AGE Platform Europe is currently partner to over 10 research projects, working to implement co-design and co-creation.
For example, the NESTORE project developed a virtual coach able to sustain users’ motivation to exercise, eat in a balanced way and get socially and mentally stimulated. In NESTORE, the ‘exhibition-in-a-box’ methodology was adopted to drive interaction with older people from the outset of the project, with the aim to free the flow of ideas on design and usability of the sought solution, by engaging people in the discussion on everyday objects they could see, touch, and feel in a box.
The MATUROLIFE project uses metallised fabrics to allow our vests, sofas, and shoes to become ‘smart’ and ease the quality of our lives in older age. The project conceived interviews, ‘life logs’ and workshops with older adults across nine countries in the framework of its co-design strategy. A co-creation manual was created, summarising the lessons learnt from the project’s experience.
In the case of the ValueCare project, the goal is to provide value-based integrated care to older people with the support of digital solutions such as mobile applications. Older people, informal carers, care professionals and decision-makers are recruited to share their perspective on how digital solutions can help them manage their own health, provide better care services or improve the care process. Several rounds of co-creation activities will be organised to fine-tune the prototype of the digital solution. Technology can also be used to identify at an earlier stage when a patient should receive palliative care and thus increase his/her quality of life, as is the case of the InAdvance project.
Lessons learnt from a global pandemic
The COVID-19 pandemic accelerated the need for robust, secure and reliable telemedicine.
AGE is involved in a large-scale pilot project, Pharaon, which implemented teleconsultation and remote health monitoring services due to COVID-19. Teleconsultation was introduced in the Casa Sollievo della Sofferenza research hospital in the Apulia region of Italy, in an experimental phase. This ensured that outpatient services could continue to be provided remotely through modern videoconferencing technologies, while fully adhering to existing regulations on data protection.
The hospital reservation system for outpatient services has also been adapted to let patients schedule appointments from home, as well as introducing the capability to make electronic prescriptions, in the hope that outpatient services provided via videocall will be recognised as eligible for reimbursement by the Apulia regional health authorities. This technological solution will be rolled out more widely in the future, confirming that telemedicine is a priority beyond the current emergency situation.
Remotely controlled robotic systems which can help with some tasks, such as remotely monitoring the health status or allowing relatives to ‘visit’ older patients, were also introduced, with the goal of reducing physical contact. The capability of social interaction – albeit at a distance – has been a key need in a pandemic, alongside the continuation of medical care. Social distancing has been among the measures introduced to counter the pandemic; and digital technologies have provided an opportunity to help connect people remotely – although they have also acted as a reminder of the inequalities that exist in accessing them.
Telemedicine can become a practical and useful ally for the health and care sectors. Various innovations are already available, but need a legal framework and adapted policies to be safely and fairly implemented. It is hoped that the European Health Data Space will be a cornerstone in this process.
Support and care for older people
The digital and human support we need when our functional abilities deteriorate should be constantly tailored to our evolving preferences and needs. However, ageing is often presented as a challenge which technology promises to correct and fix, rather than a process to embrace and nurture. Such an approach leads to serious gaps, where the solutions provided are not in line with what recipients may prefer to use because they simply do not meet their immediate needs. Adapting to the heterogeneity of older people is not simple and the temptation may be to use shortcuts, from excluding people from research on the grounds of their age (for example, setting inclusion criteria for people aged 65 to 75), to using acceptance models and predictors to technology adoptions rather than investigating what older people really think and want.
It is therefore crucial to set up a process allowing older people to become active participants in the co-creation and service design of solutions that are meant to support them. This enables designers and developers to meet citizens’ needs and expectations, and to deliver cost efficient solutions. To overcome gaps and barriers, it is key to not only build solutions for older people but also with them as they are the experts of technology-in-use. Because, as stated by the World Health Organization, ‘older people are the ultimate experts of their own lives’2.
2. WHO. (2007). Global age-friendly cities: a guide. Available from who.int/ageing/age_friendly_cities_guide/en/.
Research Project Manager
AGE Platform Europe