As the UK population ages and the support ratio falls, those of us who are more associated with 'long-in-the-tooth' than Bluetooth should be encouraged by the latest developments in telecare. Phil Paterson and Tom Sharpe of the Northern Specialist Group report on a presentation given by Dr Kevin Doughty to the group. 

Our previous article in the December issue of Health Informatics Now looked at a case study of how technology is being used now to help support the elderly. This article investigates how things might look in the future.

'Telecare - the Need for Smart Devices and Systems' was the title of a lecture given to the Northern Group in Manchester by Dr Kevin Doughty, deputy director of the Centre for Usable Home Technology, University of York on 14 December 2006.

Dr Doughty was a busy man that day as he also gave a lecture on 'How telecare fits into the full care package proposition' to a meeting of the BCS-affiliated ASSIST North West Branch at Wrightington Conference Centre in the afternoon.

Dr Doughty's interest in non-invasive sensing arose from his experience of running a residential care home for six years. None of the patients really needed to be there: they were pushed into going by relatives. Could the same fate, or worse, befall members of the BCS?

We cannot rely on a continuing influx of support people from overseas to look after us in our old age as the same demographic trend is seen in Asia as in the UK. In the UK, the support ratio (the ratio of adults aged 18-65 to those over 65) has fallen from eight in 1900 to four in 2000 and is heading towards 2.5 by 2025. In Asia, the support ratio is likely to fall from six in the year 2000, to three in 2025. 

So what can we do? Well, one thing we can do, as information technologists, is to promote the use of information and telecommunications technology, in the form of telecare, to support the independence of elderly and vulnerable people in their own homes. These people are likely to be challenged by sensory, physical or cognitive deficiencies which can all increase the number of risks that they face.

There are now well more than 50 stand-alone devices which give people an opportunity to perform tasks without external assistance and more are being invented all the time. One small but effective device is the Magiplug costing about £6. It replaces a bath plug, turns red if the water is too hot, and lets water out if it is more than 50cm deep. In the US, there are 20,000 accidents involving scalding per year and it would prevent many of these. It is typical of devices which are modular, electronic and low-cost.

Assistive technology is advancing rapidly. There are now four generations of devices: 

• Generation 0 - stand-alone devices which help compensate for sensory or functional impairment, such as vision, hearing, smell, balance, and memory.
• Generation 1 - reactive devices, for example movement-activated lights. G
• eneration 2 - proactive life and health monitoring, where a variety of sensors are combined in a system that raises alerts when a person's normal activity patterns change in a way that may cause concern.
• Generation 3 - advice, information, entertainment and communications. 

The Japanese are now said to have more robots than cars. Such robots can carry out a variety of support tasks, from dispensing medication to walking the dog, but some of the interactions - such as carrying a person bodily to the bath - might be seen as intrusive. 

Assistive technology can be fixed or portable. It can be used to control environments or to provide telecare support to people. Linked devices manage risk by detecting dangerous situations quickly and providing automatic alerts to enable interventions to occur through a remote management system. Dr Doughty described the role of technology in helping to assess problems with coping behaviour, with examples of using activity and vital signs monitoring equipment to predict and prevent emergencies. 

He also looked into the future and outlined a vision of social as well as healthcare support, for example using video technology over the internet to provide a 'telepresence' - at church, in shops or in contact with widely dispersed interest groups - for people whose circumstances might otherwise cause them to suffer social isolation.

'Hug suits' can give the impression of physical contact. More controversially, people can now interact with computer-generated ‘virtual friends’ that pass the Turing test (when human judges cannot reliably tell whether they talking to a machine or human).

Some may find the idea disturbing, but is it any worse than being in front of the TV for hours? 

Increased confidence 

Telecare can hugely benefit both care recipients and care providers. The  recipient is helped to stay independent for longer and be more confident that care would be available if required whilst the provider can handle larger caseloads, focusing time and resources where they are most needed, safe in the knowledge that alerts will be raised if a risk situation arises that needs to be checked out. 

Telecare projects in West Lothian, Northamptonshire and elsewhere have shown significant long-term financial and human resource savings for care providers whilst their clients have benefited from better care provision.

Fewer hospital beds are blocked, unscheduled hospital admissions are reduced and the demand for residential nursing home places is eased by enabling people to cope better on their own at home.

In recognition of the need to do something in response to the national demographic trend the government has made available a Preventive Technology Grant of £80m over two years for Local Authorities to start a smart support service in England and the Department of Health is planning a large-scale, two-year Integrated Care and Assistive Technology (ICAT) project to examine how technology can be used to keep patients with long-term conditions out of hospitals.

Although there are possible risks as well as benefits, we have a vested interest in seeing this work succeed,  as we all grow older. As members of the BCS it behoves us to come to grips with the issues now and promote appropriate use of telecare for everybody’s benefit.

More information on telecare can be found at: 

- The Telecare Services Association

- The Centre for Usable Home Technology