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Sustaining the Elderly:
Innovations in Emerging Technology and Service Delivery

Randy Basham
Suk Young Kang
University of Texas at Arlington

Introduction

     Sustainable aging is not an often heard phrase or concept. The term sustainable, or sustainability, may be defined, or understood as, to endure, remain diverse and to be productive over time. This term is often applied economically, and to natural resources, as well as, cultures and populations of which growth is expected. In contrast, aging may be defined, or thought of, as advanced in years, or accumulating of changes over time, or of undergoing the effects of time. Aging is not ordinarily thought of as a condition or status in need of continuing sustainability, or of which improvements in functioning and productivity are normally expected.

     Services to the aged population have been steadily improving in developed or developing nations over a number of decades, in part due to policy and funding allocations to promote improvements in health and quality of life for the elderly and in part due to the development of a number of tools involving some measure of advances in technology. Emerging technologies may make possible for those who are willing and those who have some level of access, the capacity to remain functioning, productive and engaged member of a contributing portion of the society of which they are members, for many more years than previously expected. As the demand for these services and emerging technologies are expected to increase over the next several decades in developed and developing countries, sustainable aging may become a more commonly understand construct and social and economic reality.

     The purpose of this paper is to provide an exploration of emerging technology innovations which may be associated with the potential to meet existing or anticipated needs of the elderly. Further, the paper will argue that these emerging technologies may serve as partial service bridge, in the absence of adequate numbers of human service providers, or care takers, to sustain a productive and valuable aging population. Identified technologies will be presented and related to their capacity to meet some known physical, emotional and social concerns common to the elderly.

Literature Review

     Demographic trends in developed and developing countries suggest that fewer young people will be available to meet the labor and economic needs of their societies while servicing larger and larger segments of the population who are expected to retire, over the next few decades.  This is true with Asian populations in developed areas as well as developed Middle Eastern, African and Western cultures. Immigrations trends in these areas as a result are expected to increase in part due to service needs for the Elderly. The term aging in place has emerged to describe the less mobile, more service dependent and possibly less productive and functional, elderly. These service needs may be generally conceptualized as falling into physical, emotional and social as differentiated in the literature.

     According to International Wealth Solutions, (2008) a global investments organization, the world population of above age 65 years, is expected to increase from 6.9% in the year 2000 to 19.3% by the year 2050. However, population growth is expected to slow with decreases in fertility rates.  In a highly developed country example, the already large aging population in the United States, estimated at 12.3% in the year 2000, will be increasing to 21.1% and peaking earlier by the year 2035. As a result, there may be insufficient numbers of available laborers to service either the needs of the elderly, or in some cases, segments of society as a whole. Employment is expected to be available in surplus, but not enough manpower will be available in some developed areas, to suffice the needs, resulting in expected labor shortages (Foreign-Born Workers and Baby Boomers, 2010). 

     Developed and developing nations have sought various solutions, other than technology, to meet the increasing demand for more service providers and professionals to address the needs of the aging portion of their respective populations (Atul, 2006), as well as, to address the more immediate needs of increasing the overall supply of manpower to service their respective economies. These attempted manpower solutions, have included a loosening of immigration policy (Weil, 2002), various manpower retraining programs (Carmel & Lowenstein, 2007), and changes in labor policy directed at increasing overall labor outputs (Brown & Braun, 2008). Yet, the alteration of immigration policies, labor laws, and vocational training initiatives, has not kept pace with the service needs of the aging populations of the developed and developing countries (Canadian Business, 2002).

Service Need Projections

     The Pew Research Center (Passel & Cohn, 2010), has reported that the elderly population of the United States will double by the year 2050. The number of working age Americans and children are expected to grow more slowly than the elderly population.  By the year 2050, the United States population is expected to reach about 438 million from about 296 million recently in 2005. Approximately 82% of the growth is expected to be due to immigration. The dependency ratio of children and elderly will increase from about 59 of 100 working age adults in 2005 to about 72 per 100 working age adults by 2050. The need for caretaking services for the elderly are expected to rise sharply as a result of these demographic trends.

     The types of services expected range from maintaining physiological functioning and mobility, sustaining mental alertness and competency, transportation and connectedness, continuing economic and social contributions. Social engagements with family, friends and community for longer periods of time, during the later years of life are anticipated as needs. To some degree manpower, or care providers will be an essential element in providing these services, however, gaps of service continuity and limited manpower may be anticipated. Bridging these gaps will require some urgent consideration given the encroaching time frames of changing demography (Singer & Manton, 1998).

     The United States Congressional Budget Office (1999) has estimated in a published report that Projections of Long Term Care Expenditures for the Elderly (Estimated in year 2000 U. S. dollar values) for services provided in institutional settings will rise from 85.8 billion in the year 2000 to 217.9 in the year 2040 with no changes or improvement to elderly functioning. Services in the home are expected to rise from 37.2 billion dollars to 128.2 in the same time frame, though this number could increase if improvements to elderly health and functioning were established and could also be reduced if care provider expenditures were offset. Total expenditures of these two forms of care then are projected to rise from 123.1 billion dollars to 346.1 billion dollars per year during this time frame. Changes in the value of dollars, the cost of providing manpower to provide services, improvements in the overall health and functioning of the elderly, and the utilization of less expensive care models could reduce these overall estimates.

Physical Issues and Aging Needs
     According to a comprehensive review by Campisi, (2003), some of the physiological causes of aging at the cellular level include: the loss of cells, the accumulation of unwanted cells, nuclear chromosomal mutations, mitochondrial chromosomes mutations, intracellular and extracellular waste, and extracellular proteins. Studies completed by the Dana Farber Cancer Institute and Harvard Medical School have elsewhere suggested that there are a number of socialization and behavioral preventative strategies and practices that can ameliorate many of these aging effects and sustain overall physical functioning.

Cancer and Aging: Rival Demons

     Cellular loss may be prevented or reduced through activity that may be technologically monitored. Bone and muscle loss can be reduced with daily activity regimen and evaluated with health service providers locally, or remotely.  The accumulation of unwanted cells and dying or toxic cellular waste may be separately addressed by improving the knowledge of nutrition and digestive elimination practices for the elderly, through technologically delivered programs or services. According to Campisi (2003), chromosomal mutation of cells that produce cancer and accelerated aging may be addressed though education on limiting exposure to cancer risks and to health practices (antioxidants in the diet and exercise, etc.) which may be provided through various distributed education programs, supervised by trained health providers. Intracellular and extracellular undesired materials that contribute to debilitating health conditions, such as Alzheimer’s, Multiple Sclerosis and various neurological communication disorders require medical and pharmaceutical intervention and therapies that may be coordinated and monitored through technical means. Extracellular proteins that inhibit elasticity and functioning can be addressed through several of these health and activity measures and managed technologically. All of these may be improved through technological applications and increase functioning and independence of the elderly, in the absence of adequate numbers of available and trained care providers. A few emerging technology applications that may be useful in improving overall physical functioning are presented in Table 1 below.

Table 1.  Examples of Emerging Technologies Designed to Improve Independent Living Options For the Elderly

Physical Conditioning and Wellness

  1. Sensory Organization Test created by NeuroCom International, Inc. - which specializes in balance and mobility testing. The test looks for abnormalities in the subject’s use of the three sensory systems that contribute to balance: vestibular (inner ear), visual and somatosensory, which helps the body detect touch, pressure, temperature, pain, muscle movement and joint position (NeuroCom International, Inc. 2010).
  2. HealthWorld Online (www.healthy.net) - is one of the largest sources of information on integrative medicine and alternative/complementary health care on the web. Thousands of articles are offered from leading health care professionals and authors covering over 320 different health conditions and a wide range of alternative modalities (HealthWorld Online, 2010).

Medical Self Care

  1. Center for Future Health; Located at the University of Rochester; the center works toward Proactive Health System that puts health care technologies into everyday lives, and off loads formal institutions when appropriate. It is a system of sensors and information technology that alerts individuals when their health status trends away from normal, and helps them return to health (Center for Future Health, 2010).
  2. Sentry Data Systems: Datanex Platform provides secure healthcare cloud data computing. Secured medical data services accounts that can be accessed anywhere with commercially available accounts that can be set up in a few minutes (Sentry Data Systems: Datanex Platform, 2010).

Emotional Issues and Aging
     A number of emerging technologies, also show promise of monitoring the physical aspects of elderly functioning remotely. However, others have demonstrated the capacity to sustain or improve emotional and social functioning as well (Smith 2008; Mazzù, Scalvini, Giordano, Frumento, Wells, Lokhorst, & Glisenti, 2008).  These technologies can be organized to meet a hierarchy of anticipated elderly needs, so that the elderly can continue to make important and needed contributions, while addressing their safety, belonging, intimacy, and self esteem concerns (Istrate, D., Vacher, M., Serignat, J.,  Besacier, L., & Castelli, E., 2006), including remote monitoring options.

     Coughlin, J.  &  Lau, J. (2006) have proposed a systems approach, or hierarchy of needs for the elderly relative to developing, technology based initiatives to service the demographic challenges posed by the expanding aging population.  The hierarchy concept is based upon the Hierarchy of human needs proposed originally by Abraham Maslow and addresses several emotional needs (Maslow, 1987). The hierarchy of technology for aging needs recognizes heath needs as the foundational level of technology development to maintain longevity and functioning, followed by safety needs of the elderly, connectivity needs, contribution needs, and finally, legacy needs. The proposed hierarchy has been adapted to current emerging technologies and illustrated in Table 2 below.

Table 2.  Hierarchy of Technology for Aging Adapted from Coughlin and Lau, 2006

Level of Need                                      Emerging Technology

  1. Legacy Needs               Transfer of knowledge and heritage to enrich younger generations
  2. Contribution Needs       Cognitive Retraining Software, technology to promote lifelong learning and productivity
  3. Connectivity Needs       Innovations in community design, transportation and communication
  4. Safety Needs                RFID (Radio Frequency Identification Device) sensors, remote video, audio and biosensors
  5. Health Needs                In home monitoring of nutrition, fitness, chronic disease and healthy behaviors

Note: Derived from Abraham Maslow’s Hierarchy of Human Needs

     Though health needs are foundational to functioning and are also related to emotional health, safety is of concern to many family younger members who may not be accessible to their more senior members. Perhaps the most controversial emerging technology is that of implantable RFID (Radio Frequency Identification Device) sensors. These devices once implanted under the skin, can provide a unique identifying number for the individual implanted, and their medical, consumer, financial and other forms of identification can be matched or accessed by their number, at any location having a frequency monitoring device including security portals (Motoki, Sadanori, Ryozo, Taro, & Susumu, 2009). However, they are considered highly controversial (Kenner, 2008), in part due to their likelihood to be resisted by Western cultures, where they have been negatively associated with Christian apocalyptic prophesy and summarily dubbed the “666” chip (These Last Days Ministries, Inc. 1996-2006, 2010). Yet other sensor packages and configurations can provide various levels of safety for the wandering, but not fully competent, elderly.
New RFID Chip Implant (Video)

     Connectivity needs are considered a major component of emotional well being among the elderly. Difficulty over the next few decades of keeping the elderly mobile, with respect to transportation, is expected to become a major issue of concern. Social isolation and loneliness are well documented problems for the elderly, especially those requiring services within institutions not frequented by their family members and perhaps for those being counseled to age in place over the next several decades. These problems will likely require more organized community based technological applications to address. The formation of either designed, or naturally occurring retirement communities (NORC), may allow for group subscriptions to connectivity services, including transportation and product delivery, as well as mobile connectivity, in or out of residence, to maintain familial and social relationships critical to emotional well being (Bookman, 2008).

     Of course, to maintain the need for human beings to feel like valued contributors may be enhanced by emerging cognitive retraining programs that can technologically be delivered locally and monitored and evaluated remotely. Additionally, the elderly may retain extended or partial employment or consulting careers with sustained health and functioning along with use of connectivity resources. There is a need to retain learned skills and knowledge for longer periods to promote the overall economy and social fabric of developed and developing countries, though utilization of their elderly populations as a resource (Foster, 2005).

     Legacy needs, as indicated in the previous table, involve the transfer of knowledge and skills to the younger generations. A number of technologies and application can serve this important social function. Information can be archived, in video or audio format and accessible online. Some programs and technology resources allow for the transfer of knowledge about family history and culture. These may be introduced as recreational pastimes, to promote a sense of legacy transfer across multi-generations of family or community. Skills and knowledge can be preserved and redeveloped by future generations, as needed (Foster, 2005).

Social Issues and Aging
     According to the American Association of Retired Persons’ (AARP) survey of 1,200 respondents titled, IMAGES OF AGING IN AMERICA (1994), some of the social and economic concerns of the elder over 65 years of age were identified. Approximately 37% of respondents identified fear of crime as a concern for themselves, 15% identified poor health as a concern, and 12% reported that not having enough money was a concern for themselves.  Approximately 8% reported being needed as a personal concern, 6% reported loneliness as being a personal concern, and 4% perceived that keeping busy was a personal concern.

     This same set of survey respondents perceived these as greater for others, in that, approximately 69% of respondents identified fear of crime as a concern for others. Approximately 57% reported poor health of concern for others, 55% reported not having enough money as a concern for others. Approximately 41% reported being needed as a concern for others, whereas 46% reported loneliness as being of concern for others, and 26% perceived that keeping busy was a concern for others.

     The incorporation of systems of care that are in part technology based can overcome a number of these concerns while greatly reducing others. Safety and security systems referred to in Table 1 and elsewhere, can provide continuous and multiple systems of monitoring and continuous availability of health care providers and family, or other service providers. Isolation and loneliness can be overcome though matching tele-video technology to peers and distant intimates. Even the increase of social and cognitive activity and the possibility of earning income through technologically based tasks is possible and will likely be in greater demand, as the numbers of proportional younger workers decrease.

     Though a separate source (Beauvior, 2010) provides some balance with regard to role ideals for the elderly as perceived by their younger middle aged peers. These roles may become more achievable through utilization of some of the technologies previously described. For example Table 3 below enumerates some of the roles of the admired elderly as perceived by younger peers.  Clearly the advent of available IT (Internet and telecommunication) technologies of the last decade and a half and continuing can readily extend working careers, civic engagement, provide outlets for ongoing lifelong learning, and record experiences and wisdom for transfer to younger peers. They can provide more and varied leisure options even though some level of independence and functioning may be lost. Furthermore, they can provide access to information and knowledge to improve health and to interact with larger social networks.

Table 3: Admired Social Roles of the Elderly (Perceived by middle aged peers)

The workers:  Admired elderly whom have highly internalized drives toward work and profession, which may be differentiated by those who continue their careers and those who begin new careers late in life.
 
The civics:   Admired elderly whom remain engaged in community betterment through service and the funding of projects to benefit the community.

The continuously growing:  Admired elderly whom continue to learn and develop beyond their working years.

The wise:  Admired elderly whom advise and consult by sharing experience the accumulation of a lifetime of wisdom.

The leisured:  Admired elderly whom develop strong leisure pursuits to include travel, athletics and sports, or become subject experts in some hobby or pastime.

Those who have overcome personal adversities and adapt with grace:   Admired elderly who overcome micro level crises such as illness, or adversity and then succeed in major micro or macro level pursuits and win fame or fortune, for themselves or other causes.


Source:  Adapted from Beauvoir, S. (2010)

Sustainable Aging
     Developing a sustainable aging service delivery response to the rapidly growing aging population will require in part, changes designed to prevent age related disease. For example, a number of guidelines have been developed through the Farber studies (Dana Farber Cancer Institute, 2010) that suggest personal and professional service delivery approaches that may be in part augmented by technology. Dental hygiene and keeping good dental health among the elderly is highly associated with the prevention of heart disease. So, if the elderly are expected to “Age in place”, changes in dental service such that they become more mobile may require both modifications in technology and changes in dental service delivery models. Similarly, programs that provide mobile nutrition services and technology based, or enhanced exercise programs may be needed to maintain optimal elderly functioning. The technological dissemination of disease prevention strategies to maintain greater independence, along with technologies to provide various levels of personal support may contribute to sustained quality of life for the elderly.

Technology and Service Delivery
     Values conflicts are likely to occur with the deployment of technologies unfamiliar to the aging population. Other values conflicts may occur between serve provider and other portions of the population, such as younger and differentially trained service providers and the elderly. There are cost allocations as well to sustain the elderly on a larger scale in anticipated times of scarce resources due to historically higher national debt and declining economic markets.

     Privacy, self determinism, informed consent, and moral and religious factors affecting utilization of technology may be expected to impede, or obstruct, the delivery of some technology applications. Some solutions may, as a result, be effective in one population of elderly, yet completely unacceptable in another due to cultural differences. Autonomous decision making may be more or less valued in some demographic segments, so as to make some forms of service delivery and emergent technology less preferred.

Implications

     Little has been done to apply this knowledge and technologies systematically so as to improve independence and functioning and to preserve the accumulated social capital of the elderly. The social sciences, to include possible health, social and economic policy considerations, in partnership with emerging technological and service delivery applications, could contribute greatly to sustainable aging for many and contribute to elderly centered subsequent sustainable institutions and societies.

     As a result of the above, social scientists, and service delivery professionals, including Social Workers are likely to experience a number of ethical, moral, and values related conflicts related to the implementation of these technologies to include in part; client-self determination versus the need to conserve resources, informed consent versus the need to triage or provide group level technologically bases care, confidentiality and privacy issues versus the open access nature of technology, as well as, cultural differences regarding their social acceptability and the understood social capital value of the elderly.  

Discussion

     Rapidly occurring shifts in population toward the elderly will create new problems and demands for the social science and social service community of professionals, as well as the technology and engineering community. Cost effective ways of keeping the elderly functional and productive longer, coping with rapid technical changes, and having greater autonomy and access to resources is paramount to sustaining a functional society, in the absence of adequate numbers of anticipated trained health and personal care providers. As a result, there are likely to be demands on youth to accept greater responsibility for the rapid transfer of knowledge and skills from seniors in need of passing on critical legacy information, and demands for developing the technologies and service delivery response to sustain the population. This process may be therefore, expected to create, over time, substantial social tension and values shift and the increased utilization of emerging technologies the demands on the younger members of the society.

References

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