We are using a lot of technology to help the elderly to live at home: this is their autonomous life in the middle of the demographic winter

In 2017 Roger Guasch took a hard hit, one of the hardest of his life, actually: his mother was diagnosed with Alzheimer's. The news came accompanied by a cascade of questions, the same ones that face each one of the hundreds of thousands of families that deal with the disease in Spain daily. How to help your mother? How to strengthen your independence? How long could you enjoy an autonomous life? Guasch also had much more practical doubts. Safety. Or medication, for example. How can someone with Alzheimer's organize with pills? How, when you have prescribed several drugs, at different times and with doses that can vary from one day to the next and that are not always easy to calculate? The challenge is brought without the need to suffer the ailment.

Rather than resort to a schedule attached to the fridge with magnets or a mosaic of posters with convoluted drug names, Guasch decided to go for it. Together with other colleagues, he promoted the Berdac company and designed IMA, an intelligent pill box that, by means of acoustic and visual signals, alerts the patient that the time has come to take the medicine. Just press a button to receive the exact dose. If they so wish, the patient, his relatives and even the doctor who takes his case can consult a detailed plan with all the medication, updated data and (if any) a follow-up of any forgetfulness or delay in the intake of drugs.

The Berdac pillbox is just one example of a trend that is gaining momentum, here and in other countries: putting ICT at the service of older people so that they can enjoy autonomous lives in their own homes. It is not something crazy in a society that already suffers from the frigid winds of the demographic winter. Spain grows old. And it does it quickly, too. The coronavirus health crisis has made it black on white - the elderly constitute a broad spectrum of the population at risk - but the INE has been confirming this for some time with data.

According to the calculations of the statistical observatory, in half a century around 14.3 million people of retirement age will live in Spain, 29.4% of the total census. Just over a tenth (13.6%) will have already blown the 80 candles. In both cases, the percentages far exceed the current ones —19.4 and 6.1%, respectively— and are accompanied by other phenomena, such as a considerable increase in the population suffering from chronic diseases.

“There are many startups that are launching into projects of this style. The point is that the industrial product costs more because it has associated costs of prototyping, manufacturing ... which are very high and in the end the financing, here in Spain, is as it is. Yes, there is a lot of apps, websites, comprehensive services, software ... But what is hardware and devices costs more, "explains Mateo Gil, from Berdac.

In September the company expects to have the first thousand machines, but Gil and his colleagues have already confirmed a "very good reception" in the market, in which they hope to cover a key need. "Half of the chronic patients do not take the pills correctly and that implies hospital admissions and worsening health," says the company. Once you hit the streets - Gil details - IMA will find yourself with very little competition. "There isn't much else," he abounds.

Like Berdac, for years a good number of companies, organizations and public institutions have used the Internet of Things (IoT) and home automation to design adapted homes, apps that ensure the safety of the elderly or make it easier for them to enjoy a life. more active and wearables that —in a short time— have become first-class allies for doctors thanks to monitoring patients 24 hours a day. Also technology that was not designed for the elderly, but that contributes to their independence. A good example is the Voice User Interface (VUI) —Siri or Alexa, for example— that help people who usually find it difficult to operate with a touch screen or surf the Internet to interact with their devices.

A "hot potato" for the European Union

Apps and devices geared towards the elderly or chronically ill number in the hundreds. And they make up a list that has been expanded for years, often with the support of public institutions. The EU itself, in the framework of H2020, pays special attention to technological development to promote active and independent aging. Since 2008 Brussels has a specific program, the AAL (Active And Assisted Living), which has financed more than 200 projects to assist older people in their homes, monitor their health, diets or activity levels, stimulate their memory or directly combat loneliness and isolation.

The EU has a program, AAL, which since 2008 has promoted more than 200 initiatives that use technology to facilitate the independence of older people. His motto: "Grow old well in a digital world"

“The EU, within the H2020 program, defines 'Health, demographic change and well-being' as one of the seven social challenges, in which technology development is treated with some importance to promote active aging and a more independent life of older people. There are several very specific calls on the subject ”, explains Javier Pereira, deputy director of the Center for Research in Information and Communication Technologies (CITIC) of the University of A Coruña. From CITIC itself, the GERIA-TIC project (2016-2019) was developed, which for three years monitored with wearables the physical activity and quality of sleep of its users to anticipate risky situations. His goals included preventing falls and detecting sleep disturbances.

Demonstration of the assistant robot RIBA II.

One of the initiatives supported by the EU that has achieved the greatest recognition is Activage: Internet of the Things for aging well, a project endowed with 20 million euros and which has formed an "IoT ecosystem" that includes nine pilot points spread throughout from seven European countries. Thanks to a dense network of sensors, buttons, apps, wearables ... the users of the project - elderly, often with chronic ailments or who live alone - live in a safe, autonomous and healthy way in their own homes. Part of the deployments sites They are located in regions of Spain, with quite different realities and profiles: Galicia, Madrid and Valencia.

In Valencia 740 retirees participate. Thanks to the sensors installed in their homes, technicians can monitor, for example, how their activity levels evolve or the temperature and humidity of the rooms. In Galicia —where Activage's tests focus on the social health field— the IoT is also used to detect risk situations, follow-up on medication or monitor the health status of its 700 users, all over 60 years of age. In practice, in addition to reinforcing the independence of the elderly, Activage facilitates the early detection of ailments and reduces visits to health centers and hospital admissions.

"The use of these technologies is essential to guarantee the medium and long-term economic sustainability of the health and social protection system," explains in the promotional video for the Sebastián Pantoja program, by Televés, one of the companies participating in the Galicia test. together with entities such as the Red Cross, the Galician health service (Sergas) or the Vodafone Foundation. It is not a trivial observation. According to the forecasts managed by the Government in 2017, the gradual aging of the population and the increase in chronic diseases will mean that health spending will increase more than 580 million a year over the next decades.

In its aid history, Brussels has initiatives such as Mario, a robot designed to combat loneliness, isolation and dementia; Fate, focused on fall detection and accident assistance; o Lean Elderly Assistant (LEA), by Silver, a walker with an autonomous navigation system that allows you to report the presence of obstacles or get closer to your user. Others, such as Long Lasting Memories (LLM), pay special attention to cognitive and physical training thanks to special software.

On its website, AAL reports a dozen and a half projects from the 2019 call that have not yet been completed. The ongoing actions use sensors - some even installed in beds -, apps, gesture codes and pictograms, robots or virtual reality (VR), among other resources. You vary the tools and "battles", but not the "war": the autonomy of the elderly.

Aph-Alarm, for example, helps people with difficulties to communicate after having a cardiovascular accident, ReMember-Me detects cognitive decline early, mHealthlNX helps alleviate stress and JAME the disabling symptoms that accompany some diseases like tremors. There are initiatives as ambitious as the Guardian, which develops automata capable of assisting both the elderly and their caregivers. The projects are also plated with a clear vocation to reach the market.

The candy of the "silver economy"

The private sector has also seen the opportunity represented by what is known as silver economy, the flow of expenses and investments that revolves around the elderly. Its logic is overwhelming: it may raise and lower the interest of the markets in certain products and energies, but what is "unthinkable" is that there will be more and more older people. According to a report prepared by Oxford Economics, the European Commission and Technopolis, the spending of the population with more than 50 years will grow 5% annually to reach 5.7 billion euros in 2025, representing 32% of the EU's GDP and 38% of employment. The figures may seem high, but they are supported by population pyramids: by the middle of the century, it is expected that there will be more than 400 million people in the world who will have already passed 80 springs. And the data adds up and continues.

The market offers a wide range of home automation, wearables, sensors, apps, robots, services ... that, like IMA, are designed to reinforce the autonomy of the elderly. For example, Securitas Direct has a special package for the elderly, Senior Protection, which works with a central unit and smartwatch that —among other utilities— allows the user to request help, monitor their activity or even combat loneliness through a voice chat to through which you can contact other people with similar tastes. V-SOS Band, from Vodafone, Nock Senior, from Neki, also offer smartwatches with GPS and that are used to ask for help, Silincode uses wristbands with QR codes that can be scanned to access information.

Through a network of sensors distributed around the house, Sensovida collects real-time data that is analyzed using intelligent algorithms and allows it to learn behavior patterns, routines from its user. In practice, it translates into being able to detect if one night spends more time than usual in the bathroom, takes longer than usual to wake up, does not arrive home at the scheduled time, unusual inactivity ... It also includes an SOS button, an app that allows family members to monitor activity and weekly wellness reports in which parameters such as sleep, pulse or activity are analyzed, which helps prevent ailments.

The market offers a wide range that uses wearables, IoT or home automation to reinforce the autonomy of the elderly. They allow from monitoring their health or activity to helping them with medication or getting up from bed

The deployment of resources in the market is wide: the QardioCore electrocardiograph, smart pillboxes like PillDrill or VitaCarry, “connected home” solutions like Wiser, apps that, like Help Launcher or Ultimate Volume Booster, adapt the handling of smartphones for old people; CogniFit, designed to stimulate cognitive skills; Robots that assist the elderly (TIAGo or GrowMeUp, for example) and keep him company (Nuka) or beds connected to the cloud (BAM Labs) that facilitate doctors to know the vital signs of the elderly.

In some countries, such as Japan, which faces a situation quite similar to that which Spain will experience in a few decades - about 30% of its population is over 65 - it is already going one step further and adopting measures that sound almost to science fiction. In Fujisawa, a Kanagawa prefecture city with 434,000 residents, a robot designed to take out the trash was tested in late 2019. Not too far from there, in Iruma, four years ago QR codes attached to the nails of the elderly were tested as cards with all their data. The Land of the Rising Sun is also the birthplace of Paro or Robear robots, the improved version of RI-MAN that helps the elderly move. Even exoskeletons are tested that help, among other things, to prolong the working life of workers, key in a country that is aging with strides.

Technology within everyone's reach or toasts in the sun?

The million dollar question is ... How implanted are these gadgets, robots and services in Spanish homes? Do they arrive at the homes of the elderly once they complete their pilot tests and launch them on the market? Are they affordable or are their prices prohibitive?

The price range is very wide, but in most cases requires some initial investment. IMA, for example, will cost about 199 euros, the TabTime pill dispenser is around 80, according to the website Comparaiso, the Senior Protection service requires 24 euros a month, the V-SOS Band an initial outlay of 79.9 and fees of 5 euros. Although it has different payment methods, getting the Senior Nock requires paying 95 for the device and 12 euros per month for the service. When the leap is made into the world of the most advanced and complex robotics, the values ​​skyrocket.The Nuka seal robot is around 6,000 euros, a considerable sum, but that falls short when compared to the prices that are handled in principle for Rober.

"In the end the design, making prototypes ... implies very high costs for the company, although once an acceptable quantity is manufactured, these drop quite a bit. We know that price is a barrier to entry. But telemedicine, hospitalization at home ... is a step that has to be taken. The costs involved in this rotated population pyramid are unaffordable and we have to find technological solutions to improve people's care. We are getting older, more dependent, ”reflects Mateo Gil, from Berdac, the company that drives IMA.

From the Fundación Tecnología Social (Funteso), its president, Enrique Varela, points out the complexity of talking about prices, especially when it comes to services backed by the public administration. “It is neither expensive nor cheap. It is a social service in a welfare state. For example, we would not say that a cancer operation is expensive. Well this is the same. You just have to provide it, "he reflects.

His focus is not so much on price, but on the focus of the technology itself and its accessibility. "Without denying what has been done, in the specific case of older people I think that some progress has been made, but I do not think that ICT is still people-oriented. We adapt to them, not the other way around ”, he highlights.

And for sample, a button. Varela remembers one of the most widespread services in Spain for assistance to the elderly, the famous red remote care button. "The older people call the cowbell a pendant. It is a clear example that when people are not available when designing things, people can reject them. The problem is that those of us who work in technology often forget about the people for whom it is designed, ”says the person in charge of Funteso.

The group is in fact immersed together with the company Appogeo Digital in promoting a service based on the IoT and home automation to provide personalized care to the elderly who live in their homes: CleverCare. “We have held meetings with caregivers and older people and they are pulling out things as curious as they would like to be reminded that they have to take the pills in human language. Some even want to say the rosary, "says Varela. In April Funteso and Aiste (Accessibility, Social Intelligence and Technology) presented a webinar on the initiative.

Varela, linked to computing since the late 1970s, trusts that the confinement forced by the coronavirus and the problems registered in some nursing homes help to make visible the potential of ICT for the care of the elderly at home. “The pandemic has a positive part: it is going to greatly encourage technology. There were already many people who did not want to live in residences, change their lifestyle. A great opportunity is coming for all those who work with social technology, designed by, for and with people. ”

“We cannot ask an older person to adapt to a technology that he sees as something distant. What we are doing is creating interfaces that are very easy to use. Many of the people who feel a technological rejection are adapting because they find a direct benefit, often even without perceiving it, as occurs with wearables, ”says Fernando Suárez, president of the Professional College of Computer Engineers of Galicia (CPEIG) and director of the Transparency and Open Government Area of ​​the Diputación de Ourense. To gadgets designed or adapted for the elderly, Suárez points out, there is the benefit that can be obtained from other tools such as WhatsApp, Skype, Hangouts ... not focused on that segment, but which strengthen their independence.

The head of CPEIG indicates that Galicia provides a good “photo” of what Spain will be like in a couple of decades. In 2019, the average age of the Galician population was 47.24 years, slightly below Asturias (48.28) or Castila and León (47.5), but almost four years above the national average. In Lugo, the population over 80 years old already represents 11.5% of the entire census and in Ourense 12%, double the state average, which in 2019 was slightly over 6%. In addition to the demographic pyramid, it is added how dispersed the population is and, at times, the orographic difficulties in getting around.

“Galicia has a bit of what Europe will be like in the 1950s in terms of aging. Every time we are going to live longer and each time, too, we will have greater opportunities to do better thanks to technology, ”says Suárez, convinced that both companies and public administrations pay increasing attention to provide the community with a comfortable life.

In Galicia, in addition to being implanted the famous red remote assistance button, Activage is tested, the company Televés has developed social health services that take advantage of ICT and the autonomous executive itself tries to bring technology to older people (and vice versa) from platforms such as the CeMIT network.

Age and geographic gap

There are challenges on the table. One of them, crucial, highlights José García Fanjul, professor in the Department of Informatics at the University of Oviedo, is investment. “Finland has a triple budget for the elderly care service. Here it is 0.7% of GDP, there 2.2%, the difference is brutal ”, he highlights. The percentage of GDP destined for R + D + i does not leave Spain well among the OECD countries either. Despite this scenario, Fanjul highlights initiatives such as Active, developed by the CTIC, which, by means of sensors in the glasses, sneakers, watch ... of the user, allows them to closely follow their physical activity and monitor it to detect any behavior that falls outside the guidelines.

The professor at the University of Oviedo points out another equally important challenge: the "gaps". “The confinement I think has opened people's eyes to see the possibilities of ICT in daily use, but we still have a digital and territorial gap. There are places where it is difficult to access certain services because it is difficult to have good coverage. Now comes 5G technologies. We are going to cross our fingers for the administrations to pull them and reach the whole world ”, comments the expert.

“We still have a lot of work left because there is a digital divide. If we were to eliminate it, we could go a long way because as long as the concept of technology exists or expands, it will always have to be button-based, ”says Estefanía de Regil, head of eMayores, an initiative that arises with the aim of facilitating access and use of ICT. "When I work with them, one of the things I ask them, for example, is that they be rude to personal assistants because they tend to be very polite and say thank you," he says. Paving the way for tablets, smartphones, or VUIs for things as simple as talking and seeing family members from a distance is crucial.

According to data collected by the INE in 2019, only 24.8% of Spaniards with 75 or more years of age acknowledged having ever used the Internet. In the cities where more than 100,000 inhabitants or provincial capitals reside, the percentage rose to 31.2% and in the smallest, with standards below the 10,000 registered, it halved until it remained at 15, 5%.

The index improves significantly in the 65-74 age bracket, in which just over 63% of the population uses the Internet. A report released in 2019 by UGT warned that the closing of the digital divide had stagnated in Spain and also pointed out that gender, age, income or training are factors that clearly determine the levels of use.

The Minister of Social Welfare of Castilla-La Mancha, Aurelia Sánchez, with a user of the telecare service.

The so-called "empty Spain" is often also the "disconnected Spain". Although the country enjoys a good fiber optic network, a study published in January 2020 by UGT warned that there are still 26,767 towns with less than ten residents that are not served by quality Internet. The data provided by the union concludes that some 13 million people would have trouble connecting. Only in Catalonia would touch four million.

Groups such as the Spanish Confederation of Senior Organizations (CEOMA) seek to combat the digital divide that is rooted in age. And in that effort, the confinement forced by the Covid-19 has provided, in a way, an opportunity. “For many older people who are living alone, we provide apps so that they can communicate, chat with people who have their same interests and give talks. We are also looking at ways for a doctor and nutritionist to guide the elderly at home now that they have less mobility so that their diets are not out of balance, "explains Javier García, manager of the organization.

Extending the use of ICT to the elderly requires closing two large gaps in Spain. The first is digital in the oldest group, that of people over 75 years old. The second, the geographical one, marked by areas with poor coverage and worse Internet connection

"There are two very important factors. One is cost and the other is the need for connectivity. There are autonomies, such as Galicia, in which due to the orography there are areas without access to the network. There are two key limitations ”, explains Suárez about the challenges of ICT implementation. How to monitor data without Internet access? How to offer telecare in areas with little coverage?

“Telematic security and connectivity, in addition to accessibility, are essential aspects for the proper use of these technologies. If I am an older person, I go down the street, I fall and I need to take out my cell phone and press a button in extremis, it is not possible that I will run out of data or be in a black spot without coverage ”, explains Miguel Ángel Valero, deputy director general from the Accessibility Office at the Madrid City Council and who served for five years as managing director of the State Reference Center for Personal Autonomy and Technical Aid (CEAPAT).

Valero claims that "there is a lot of technology to help older people", but points to another crucial challenge: the need to publicize it, to give visibility to the range of gadgets and services so that it reaches homes. "The problem is that sometimes it is not known by the elders, nor by their children, nor by other people in their immediate environment, nor by professionals," says the director of the Madrid service, reluctant to use the expression "technology for the elderly."

Technology for the elderly?

“There is appropriate assistive technology and fairly accessible solutions. Although in reality the 'technology for the elderly' is a very questionable form of old age since this group of users, very heterogeneous and diverse, often does not want 'technology for the elderly'. Suppose I'm 90 years old… I don't think I wanted to buy a 'phone for the elderly', but rather one as cool as the one my grandson carries, but easy for me to use, accessible, very practical and easy to understand. I don't want to have to know about IOS or Android, nor do I want to know how to distinguish between brands. The apps that are now on mobile phones are generally not intuitive enough, easy to use and accessible ”, reflects Valero.

Many of the ICTs that are often labeled "for the elderly" actually facilitate accessibility and are just as useful, for example, for people with vision, hearing or travel problems. “The idea of ​​telephones or special technologies does not seem to me the most appropriate, but rather, where appropriate, specific solutions for a specific demand or group and not necessarily exclusively and mainly focused on older people. If they are accessible, they are for everyone. Then there will be aesthetic, cultural factors ... For example, if at 49 I have presbyopia, even though I am not an older person I have a specific need when browsing with my mobile. Maybe another 90-year-old, with a better view, does not require it, ”says the head of the Madrid Accessibility Office, who claims the importance of home telecare - the famous red button - promoted in the 90s by the FEMP and the Imserso.

“The classic telecare technology is at a very interesting moment thanks to the advances. Tablets, mobiles or smartwatches can provide great added value in mobility, and even at home, provided they are reliable and data protection is guaranteed at all times. Telematic security and connectivity, in addition to accessibility, are essential aspects for the proper use of these technologies ”, Valero stresses before stressing another aspect:“ Privacy for me in health or socio-sanitary issues is sacred ”.

While waiting for ICTs to go deeper into the homes of the elderly to help them strengthen their autonomy, Spain has models to look at, such as Finland or especially Japan. “The country sees it as an imperative to build robots for health care and systems that monitor health at home. Without them, the nation's health system would not resist, ”caregiver Yasuko Amahisa explained to the BBC in 2016. The reading of the demographic pyramids - nowadays rather inverted cones - leave a clear reading: Spain is on the verge of making similar approaches.

Image | IEEE, Government of Castilla-La Mancha (José Ramón Márquez), La Diapo (photo by Fernando Suárez)

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