The Ageing Population and Technology

ETAN Working paper

The Ageing Population and Technology: Challenges and Opportunities

prepared by an independent ETAN Expert Working Group for the European Commission Directorate General XII Directorate AS – RTD Actions: Strategy and Co-ordination

February 1998

Foreword European Technology Assessment Network (ETAN) The purpose of ETAN is to promote communication and debate at the European level between policy researchers and policy-makers on important science and technology (S&T) policy topics. ETAN convenes expert working groups that review, consolidate and synthesise results of socio-economic research to identify issues and options for S&T policy. The groups’ task is to prepare a report in a form appropriate for discussion with policy makers and other stakeholders. ETAN’s ultimate objective is to promote a shared understanding of the issues in order to facilitate, where appropriate, the development of more consistent, concerted and complementary European and national S&T policies. Expert working Group The ETAN expert working group on “Ageing population and technology: challenges and opportunities” met three times in 1997 to consider the implications of ageing population for S&T policies. Starting from a discussion of socio-economic aspects of ageing population and resulting policy needs and technological challenges, the group reflected on appropriate objectives, scope and content of S&T policies in this field. The meetings were attended by Commission officers, who contributed information on EU policies and programmes. IPTS/ESTO provided background material on policies for ageing population in some Member States. The group consulted also with other experts and stakeholders, who were asked to comment on a previous draft of the report . The contents of this report are the sole responsibility of the working group, whose views do not necessarily reflect those of the Commission nor of the external commentators. Purpose of the report Population ageing is seen as one of the main challenges modern socio-economic and policy systems face. However, there are areas of opportunity where innovation may simultaneously mitigate the economic problems of an ageing population, enhance the contributions and quality of life of older people, and create new economic and business opportunities. The purpose of this report is: • to identify areas of opportunity, where innovation is essential to address the challenges and S&T policy has an important role to play in stimulating and fostering innovation; and • to elaborate on the objectives, scope and content of such policies.

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the ETAN expert working group

Chair: Vappu Taipale, STAKES, P.O. Box 220, SF OO531 Helsinki, FINLAND

Rapporteur: Keith Smith, STEP, Storgaten 1, N 0155 Oslo, NORWAY

Members: Françoise Bouchayer, Ministry of Social Affairs - MIRE, 11 Place des 5 Martyrs du Lycée Buffon, F 75696 Cedex 14, FRANCE Adolfo Castilla, Fundacion Airtel, Avda. de Europa 1,Alcobendas, E 28100 Madrid, SPAIN Nicola Fabris, INRCA, PO Box 336, I 60100 Ancona, ITALY Jan Graafmans, Institute for Gerontechnology, Eindhoven Technical University, PO Box 513, NL-5600 MB Eindhoven, THE NETHERLANDS Susan Hewer, RSA, 8 John Adam Street, London WC2N 6EZ, UNITED KINGDOM Christine Marking, Eurolink Age, 1 Place du Luxembourg, B 1050 Brussels , BELGIUM Heidrun Mollenkopf, DZFA, Bergheimer Strasse 20, D 69115 Heidelberg, GERMANY Alan C. Walker, Sheffield University, Dept. Sociological Studies, Elmfield, Northumberland Road, S10 2TU Sheffield, UNITED KINGDOM

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EUROPEAN COMMISSION

Officers responsible Isi Saragossi, Nikolaos Kastrinos, DG XII - Science, Research and Development , Strategy and Coordination, New Initiatives and ETAN

Other European Commission staff Constantinos Fotakis, DG V: Employment, Industrial Relations and Social Affairs; Analysis of and research on the social situation Erhard Schulte DG XII - Science, Research and Development , Targeted Socio-Economic Research Heikki Kallasvaara DG XII - Science, Research and Development; Life sciences and technologies, Medical Research Inmaculada Placencia, DG XIII - Telecommunications, Information Market and Exploitation of Research; Telematics applications for the integration of the disabled and the elderly. Rosalyn Moran DG XIII - Telecommunications, Information Market and Exploitation of Research; Telematics applications for the integration of the disabled and the elderly. Paola di Pietrogiacomo, Joint Research Centre Institute for Prospective Technological Studies

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Expert invited to working group meetings Paivi Topo, STAKES, P.O. Box 220, SF OO531 Helsinki, FINLAND

External experts and stakeholders who commented on a previous draft of the report1 Serge Volkoff, Centre de Recherches et d’Etudes sur l’âge et les populations au travail, 41, rue Gay - Lussac, 75005 Paris, FRANCE Erland Winterberg, Danish Centre for Technical Aids for Rehabilitation and Education - Hjälpemiddelinstitutet, Gregersenvej, DK-2630 Taastrup, DENMARK Raimo Nikkanen, UIAH, Hämeentie 135C, SF-00560 Helsinki, FINLAND Leonor Moniz-Pereira, Universidade Técnica de Lisboa - FMH, Euducacão Especial e Reabilitacão, Estrada da Costa, Cruz Quebrada, P-1499 Lisboa Codex, PORTUGAL Marja Jylha, Tampere School of Public Health, PO Box 607, SF-33101 Tampere, FINLAND Jackie Rafferty, Centre for Human Service Technology, Department of Social Work Studies, University of Southampton, Southampton SO17 1BJ UNITED KINGDOM Britt Öslund, University of Linköping, Dept. of Technology and Social Change, S-581 83 Linkoping, SWEDEN Ger Tielen, Nederlands Platform Ouderen en Europa, Christiaan Krammlaan 6, Postbus 222, NL 3500 AE Utrecht, THE NETHERLANDS Holger Stolarz, Kuratorium Deutsche Altershilfe (KDA), Wilhelmine-Lübke-Stiftung e.V., An der Pauluskirche 3, D 50677 Köln, GERMANY Pirko Karjalainen, The Central Union for the Welfare of the Aged (Finland), Malmin kauppatie 26, SF 00700 Helsinki, FINLAND Edmée Mangers-Anen, AMPIRERAS, B.P. 2234, L-1022 LUXEMBOURG

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The contribution of all commentators is gratefully acknowledged.

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The Ageing Population and Technology: Challenges and Opportunities EXECUTIVE SUMMARY 1. This report looks at the scope and priorities for RTD&I (Research, Technology Development and Innovation) policy with respect to population ageing in Europe, taking a broad approach to how RTD&I policies can support desired socio-economic developments and wider European policy objectives. 2. The European population balance is changing as a result of a double demographic development. In most European countries both fertility and mortality are falling: fewer babies are born, and people live longer. The result is ‘population ageing’, a general trend which has been accelerated by the post-war baby-boom. A European Commission scenario suggests that between now and the year 2025 the European Union will experience: • A fall in the number of young people under the age of 20 of 9.5 million, or 11% of this age group currently. • A fall in the population of adults of working age (i.e. in the 20-59 group) of 13 million, or 6.4% of this age group currently. • An increase in the population of retired adults (60 and over) of 37 million, or 50% of this age group currently. 3. Population ageing will have significant socio-economic implications. There are serious concerns about the viability of pensions systems in many countries (particularly where pension payments depend on current contributions from people in work), about public sector budgets (particularly for health care), about the care implications of a larger population of frail older people, and about the possibility of a growing marginalised and socially excluded older population. Population ageing is seen as a challenge to the European model of social welfare and protection. 4. The concerns are justified, but pessimistic conclusions should not be drawn too quickly. This report presents a perspective in which demographic change is seen as a positive opportunity for the European economy. The opportunity lies in innovative technological, social and organisational responses to the challenges of an ageing population. Through innovation it may be possible to not only avert potential economic problems, but also to enhance the quality of life of older people, and develop new business possibilities for European industry. 5. The future health of the European economy depends in part on how European industry adapts to the changing composition of demand, and whether or not it can produce innovative solutions in response to the actual and potential needs and demands of older age groups. It should be emphasised that many of the goods and services which are likely to emerge can be internationally traded: there will be international competition in the development and supply of such goods. However, adaptation to the new patterns of demand is not simply a private-sector issue –

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government also has a role to play in the development and diffusion of new technologies and in the creation of markets, through: • development of relevant technological infrastructures; • actions to create markets for new age-appropriate technologies; • development of relevant standards and regulations (both technological and organisational); and • diffusion of best practice. 6. This report identifies three broad areas of innovation opportunity. They are: •

Opportunities related to the extension of working life among older people Many of the problems facing pension systems are related to policies of early exit from the labour force, which have been prevalent in many European countries. These trends should be reversed, and people should be given the opportunity to extend their working lives. This will involve new modes of work, new organisational forms, new workplace technologies, and new lifelong learning systems for adaptation to new technological demands at work.

•

Opportunities related to enhanced activity, mobility and quality of life Quality of life is closely related to social activity, which is in turn linked to physical mobility and communications. This raises issues with respect to transport, extending from age-friendly design of transport equipment through to reconsidering the nature of transport infrastructures, as well as issues related to housing design and the diffusion of high-grade communications systems.

•

Opportunities related to health, well-being and support A growing older population will need new forms of prevention and care; what we refer to as a ’seamless care’ approach to well-being. We are likely to see increasing demands on the care system and a need for new approaches which will improve the quality of medical and social care available, while containing costs. Biological, social and medical research to feed into these new approaches is a priority and so are telecommunications-based technologies for ’distributed’ seamless care systems.

7. There is a tight complementary relationship between three levels of policy with respect to ageing: that is, between economic, social and industrial policies. If population ageing is not to have deleterious economic effects, then we must find innovative and satisfying ways to extend working life; this in turn requires enhanced activity and mobility of older people. Improved activity and quality of life are however independently valuable, and will in turn contribute to reduction of care costs. All of this will open up new areas of demand, and new areas of opportunity for European industry. A vital function of RTD&I policies is to build bridges between these arenas of policy.

8. The view taken here is that successful RTD cannot simply be technological in 6

character. It must take into account the social and organisational context. Considerations of that context have serious practical implications for RTD&I programme design and operation, for which we identified the following three principles: • user involvement in research and technology development; • integration of social research and transgenerational design principles; and • interdisciplinarity in programme structures. 9. Ageing should not be seen as an independent research field: it should provide a focus, or orientation, for a range of areas of RTD&I activity. The following areas emerge as priorities for RTD&I signified by the ageing population: • Life-long learning techniques: Life-long learning is essential for extending working-life, but it is also important for extending generally active life and supporting healthy ageing. Principles, methods, organisations and technologies for such learning and re-learning, across different age groups and sectors of society, are a central RTD&I area with respect to ageing. • Technologies and methods for new modes of flexible work organisation: Extension of working life must mean change in the nature of work and work organisation. This is likely to involve an integration of new workplace technologies with issues concerning forms of work, regulation, health and safety standards, and so on. • Design for age-neutral product and processes technologies: We envisage wide-ranging work on the development and diffusion of generic design principles across products, processes and services to eliminate age-specific features of technologies, and to enable wider groups of users to access and deploy product and process technologies; such work will involve user interfaces, ergonomics, housing and urban design, and so on. Research, but also training and horizontal support to industry (standards, best practice programmes etc.) are envisaged. • Transport and mobility infrastructures. The growing population of older people will find it difficult to maintain the requisite levels of mobility and participation in active life with existing transport systems. Solution of this problem will in part be related to the dissemination of age-neutral design principles into transport equipment. It will also have serious implications for the design, funding, and integration of transport infrastructures; urban and town planning issues. • Age-relevant information and communications technology (ICT) applications in work, domestic environment and support. The development of ICT infrastructures, hardware products and applications is one of the major RTD&I areas in Europe at this time. In many areas – such as work organisation, training and life-long learning, and housing design – ICT will be highly relevant to the ageing issue. This is one of the areas in which ageing can provide an important focus for the content of existing large-scale activities.

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• Understanding and prevention. Development of biological, psychological, social and medical knowledge (biochemical, biological, public health, social, clinical and epidemiological research) will continue to be a prerequisite for prevention of illnesses and promotion of healthy ageing. Research in these areas should increasingly feed into the design and implementation of appropriate policies in the areas of working-life, physical and social infrastructures and care. • Technologies for ’seamless care and support’. The overall field of preventive care and assistance will grow significantly in years ahead. The general need is for integrated or seamless care, involving a wide range of products and organisational forms. • Medical telecommunications for decentralised distance health care. The ageing population will probably place increasing demands on the health and social care system and increasing needs for new approaches which will both improve the quality of medical care available, while containing costs. New telecommunications-based ’distributed care’ systems are a core priority here. 10. The opportunities and challenges are European in dimension, and so are the required responses. What is required with respect to these new technologies is not just the specific technical solutions themselves, but the development of shared, generic knowledge bases and infrastructural resources which will underpin industries as a whole across Europe. In many European countries age-related technology issues are already being addressed, in such fields as housing and care technologies; what is needed now is a careful analysis of where and how such work could be best carried forward at the European level, and the development of a forum of coordination, exchange of experiences, mutual learning and systematic diffusion of good practice. 11. Resolving the general tensions between stability, growth, social well-being and so on requires innovation. RTD&I is not, therefore, a marginal activity with respect to population ageing. It is the key connecting feature which links the objectives and the relevant arenas of policy with innovative change. RTD&I policy-makers in this fields thus face major demands in years ahead. Much depends on their response, and on the ability of the European Union to mobilise effectively in this crucial field.

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Contents

1. INTRODUCTION 2. INNOVATION CHALLENGES IN AN AGEING EUROPE: 2.1. The changing demographic balance 2.2.. Economic and social implications of ageing population 3: KEY INNOVATIVE CHALLENGES 3.1 Extension of working life -

New technology and older workers

3.1.1 Neutralising age -

Life-long learning

-

Design

-

Organisation of employment

3.1.2. Preventing loss of function

3.2. Improving activity, mobility and quality of life 3.2.1. Mobility and transport -

Mobility needs of older people

-

Modern transportation technologies

3.2.2. Housing -

Design-for all at home

-

Domotics and smart housing

3.3 Health, well-being and support 3.3.1. Preventing illness and disability 3.3.2. Compensation of disability/enhancement of activity 3.3.3. Telematics and care system design -

Organisational trends in health-care

-

Objectives for care system design

4. RESPONDING TO AGEING THROUGH RTD&I POLICY

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4.1

Objectives for policy

4.2

The European level: the role of the European Union

4.3

Approach and design principles for RTD&I policy actions -

The social content of technical change

-

Markets and discontinuous change

-

Discontinuous change and SMEs

-

Participation of older people

-

Innovative RTD&I policy design

4.4

RTD&I policy priorities

4.5

Policy co-ordination needs

5. CONCLUSIONS

Figures, tables and inset boxes Figure 1:

A reversal of the relative proportions of age groups

Table 1:

Major policy objectives in relation to the ageing population

Table 2:

Overview of RTD&I policy objectives by area of concern

Table 3:

Instruments, agencies and fields of RTD&I policy for ageing population

Inset boxes: Extending work; the example of a Finnish programme Smart houses for older people in the Netherlands The EU TIDE Programme Aiding the diffusion of Assistive and Supportive Technologies: The Handynet project Criteria for EU RTD&I actions Ageing and New Technology: Policy Developments in Japan Processes of exclusion of older people The UK Royal Society of Arts “New Design for Old” Project Support for age-friendly design: the INCLUDE project

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1. INTRODUCTION

Few things are predictable in economic and social life, but the ageing of the European population is one of them. We are living through changes in the age balance of European society which will reshape the demographic structure of Europe over the next 25 years. This ageing process is often regarded purely as a socio-economic problem, with worrying implications for pension provision, welfare systems and health care. In general, it is seen as a challenge to the European social model. The report presented here proposes a new perspective, in which demographic change is seen as a positive opportunity for the European economy and society. The opportunity lies in innovative technological and organisational responses to the challenges of an ageing population. The basic argument of this report is that there are areas of technological opportunity where innovation may simultaneously mitigate the problems of an ageing population, enhance the contributions and quality of life of older people, and create new social, economic and business opportunities. Some dimensions of ageing have been closely analysed in Europe. However it is probably true to say that technology-related analyses have focused most closely on problems faced by health and care systems.2 Of course in both European and Member State fora non-health issues have also been discussed, and policy actions are contemplated or under way. This report builds on such work. The working group sees innovation opportunities falling into three broad categories: • • •

opportunities related to the extension of working life among older people; opportunities related to enhanced activity and quality of life of older people; and opportunities related to health, well-being and support.

Those areas of innovative challenge and opportunity point towards some major priority areas for RTD, which hold out the possibility of a wide array of innovative products and solutions. However it is not enough for policy to simply establish RTD&I actions. Successful RTD&I will require new approaches to the identification and involvement of users, an integration of social and technical innovation processes, new initiatives for the creation of markets, and an important role for public-sector agencies in these emerging technologies. Moreover there is a European dimension for actions in this field: it is not simply that the problems are European in scope – the solutions also require action at the European level.

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See, for example, the detailed study by EAS (European-American Centre for Policy Analysis, Understanding Future Health Costs of the Aged in Europe (Delft, 1997); but health issues also dominate many other studies of specific aspects of ageing – see for example Prof Maggie Pearson, Experience, Skill and Competitiveness. The implications of an ageing population for the workplace, European Foundation for the Improvement of Living and Working Conditions, Dublin, 1996. A detailed care-oriented approach can be found in CEC, Technology and the Elderly, FAST Research Report, EUR 14419, 1992.

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2. INNOVATION CHALLENGES IN AN AGEING EUROPE 2.1 THE CHANGING DEMOGRAPHIC BALANCE

What is the basic demographic issue? Although the European Union faces no sudden changes in either the overall size or growth rate of its population, it does face the challenge of ’population ageing’: a change in the balance among the age groups within the population, with growth among older age groups both absolutely and as a proportion of the population. Change is being generated by a combination of falling fertility (with the exception of the Nordic countries and Ireland) and an increase in average life expectancy. While in the past, increases in life expectancy have occurred via declining infant mortality, now they are based on falling mortality at older ages death is occurring later. The results of this - an increasing population of older people, and a changing older/younger balance - are already apparent, and the trend will continue over the next 25 years. Predicting the precise outcomes of such trends is complicated by uncertainties surrounding fertility, mortality and immigration rates. A European Commission (DG-V) scenario based on ’medium’ assumptions about these rates suggests that between now and the year 2025 the European Union will experience:3 • a fall in the number of young people under the age of 20 of 9.5 million, or 11% of this age group currently; • a fall in the population of adults of working age (i.e. in the 20-59 group) of 13 million, or 6.4% of this age group currently; and • an increase in the population of retired adults (60 and over) of 37 million, or 50% of this age group currently. Over the period 1981-2025, we will as a result see a more or less complete reversal of the proportions of the population in the youngest and oldest age groups, presented in Figure 1. Figure 1: A reversal of the relative proportions of age groups % of population 29% 27%

60 years and over 25% 23% 21% 19%

< 20 years 17% 15% 1981

1984

1987

1990

1993

1996

1999

2002

2005

2008

2011

2014

2017

2020

2023

3

See European Commission, DG-V, The Demographic Situation in the European Union 1995, Luxembourg, Office for Official Publications of the European Communities, 1996

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Of course there will be national differences within the European Union. Some countries – such as Finland, Ireland and the Netherlands – are likely to experience very high growth (in excess of 65% of the current level) in the 60+ age group by 2025, while others will be lower. But even at the low end, increases in this age group will be in excess of 40% (for the UK, Denmark, and Greece, for example). While there are likely to be significant regional effects, which have yet to be fully analysed, none of the uncertainties should obscure the fact that population ageing is becoming a significant issue at the European level.

2.2 ECONOMIC AND SOCIAL IMPLICATIONS OF POPULATION AGEING Despite the broad predictability of population ageing, there are important uncertainties with respect to economic and social effects. Outcomes will be shaped in large part by future trends in participation rates (that is, the proportions of people in different categories engaging in economic life), future trends with respect to productivity, impacts of new technologies, organisational innovations, and so on. One of the key messages from this expert group is that nothing is rigidly determined in this area. Outcomes will depend on the imagination and determination with which problems are addressed. However some possibilities are reasonably clear from simple analyses. Adaptation and adjustment will be required at all fronts. Economic and financial issues. A pessimistic prognosis might suppose that there is no major productivity growth, and relatively unchanged participation in employment across generations. Then, a falling working age population is likely to reduce the growth of output and income, and conceivably also the level of overall output, even if unemployment falls (although reducing unemployment will not be an inevitable consequence of a falling working-age population, since employment depends on skills and capabilities). Tax revenues and social contributions are likely to fall, and publicsector budgets will remain tightly constrained. In this context, the growth of the retirement-age population will place great strain on the funding of pension systems, especially where payments depend on current contributions (which is the case in most EU Member States). There may be great difficulties in meeting pension obligations without significant rises in individual contributions by future generations; in some cases it is not clear that future pension obligations can be met.4 There is likely to be a significant increase in the demand for care, and in the composition of the services required from health and social care systems. Health expenditure as a proportion of GNP is already rising in all European countries (except Sweden and Luxembourg) and will continue to rise. This is already having major effects on the organisation and management of health services across Europe, as policy-makers seek more efficient methods for the use of available resources. Such pressures will continue. The impacts of these processes will spill over into all areas of public budgets, producing sharp choices with respect to public expenditure.

4

For a detailed discussion, see European Commission, Modernising and Improving Social Protection in the European Union, COM (97) 102, Luxembourg, March 1997, especially chapters 1.2 and 2.3

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A key challenge for governments in the years ahead, therefore, will be to mitigate the effects of a falling working-age population by increasing the participation of older people, and maintaining and improving their economic contributions. At the same time, governments will seek innovative health and social care solutions which provide more and better services without major budget increases. Private-sector producers of goods and services will also face change. Older age groups in the population will control larger shares of assets and income, and this will produce significant shifts in demand, which are likely to focus on new types of housing provision, consumer products, health and related care services, tourism and leisure activities, and transport services. The future health of the European economy depends in part on how European industry adapts to the changing composition of demand, and whether or not it can produce innovative solutions in response to the actual and potential needs and demands of older age groups. It should be emphasised that many of the goods and services which are likely to emerge can be internationally traded: there will be international competition in the development and supply of such goods. However, adaptation to the new patterns of demand is not simply a private-sector issue – government also has a role to play, both in the development of new technologies and in the creation of markets.

Social implications. The social implications of population ageing are linked to the possible economic outcomes. It is not hard to envision a situation in which an increasing gap emerges between in-work and retirement incomes, and in which income dispersion among older people increases. A significant part of the older population would then become marginalised: limited in opportunity both economically and in access to mobility, adequate health care, housing and the ability to participate in social life. This is a bleak prospect to be avoided. However, the discussion above depends on some simplifying assumptions – in this case that there is no substantial productivity growth, and that there is no significant increase in participation rates across generations. If these assumptions are relaxed, then things look different. If technological advances can be used to increase participation in work, to reduce assistance and care costs (while maintaining or improving quality), to improve the participation of older people in social life, then we can adapt existing European models of social protection to demographic change while simultaneously developing and producing new types of products and processes. Insofar as these issues have been addressed hitherto in policy debate they have been seen mainly in macro-economic terms - through the implications of a falling workingage population, and the pressures which falling taxation and social contributions are likely to place on pension, welfare and health systems. Ageing is already being used as an argument for the non-viability of social welfare systems. Part of our argument is that we need to widen the focus, and to think more broadly about how the trends sketched here can be seen as opportunities.

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3. KEY INNOVATIVE CHALLENGES What are the areas where technological change and organisational innovation might make a significant difference to the effects of population, and what are the RTD&I implications now? This group has identified three major issues where it is felt that research and technology policy can play a central role. These issues are: • Extension of working life. In a number of European countries there has been a sustained process of shortening working lives - via early retirement schemes, changing retirement ages, and so on. There seems to be very little social or economic rationale for this. In many cases the process seems to have been driven by a desire by governments to change participation rates as a solution to persistent unemployment, or to ’downsize’ certain sectors without increasing measured unemployment. One obvious solution to the macroeconomic implications of ageing is simply to reverse this trend. This implies improving overall levels of employment, and more growth-oriented economic policies generally. Furthermore, reversing the trend cannot mean simply a postponement of retirement: it implies new technical and organisational approaches to work, with new technological requirements and significant RTD&I implications. • Improvement of activity capabilities and potential; the quality of life. The social outcomes of population ageing will depend in large part on the activity potential of older people in work and non-work activities. In this context we should remember that both the quality of life of older people, and their contributions to the social world, go well beyond work. Both the extension of working life, and the quality of non-working life raise broad issues concerning technical and social capabilities affecting activity. Here the expert group decided to focus on technological issues linked to mobility and housing. The challenges are partly infrastructural and partly design-related. They include design and operation of transport systems, urban planning, housing design and domestic equipment, communications systems, and so on. What is required is an integration of organisational thinking and technical innovations which enhance general activity levels. • Improved health care, support and well-being. We can expect not only a larger ageing population in general, but an increase in the number of people of advanced age. There will be considerable change in the incidence of different forms of illness, in the regional distribution of burdens on health systems, and on patterns of care requirements. There will thus be major changes both in the overall burden falling on health and social care systems, and in the composition of demand for forms of care and support. The challenge in this field is to increase prevention, to develop new organisations and forms of domestic and health care and the appropriate technologies and technological adaptations. These problem areas have a wide range of implications for technological development, including technologies in the workplace, housing and transport

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(including basic issues in urban design), physical infrastructures with respect to communications and mobility, the urban habitat and so on. Some of the issues here involve ICT solutions – for example in life-long learning, distance working or telecommuting, and in new work methods, communications and information access. These may involve new technological applications (such as network computer technologies), or adaptations of other (rapidly) evolving technologies such as the Internet. In the following three sections of this report we discuss in more detail the issues, approaches and potential RTD&I areas, appropriate to the three challenges..

3.1 THE EXTENSION OF WORKING LIFE

We have noted above the challenges and problems created by the significant increase in the retirement-age population. At the same time, as a result of the continuous lowering of labour force exit thresholds and the operation of age discrimination in the labour market, even people in their 40s are regarded in many countries as nearing the end of their working lives. There is a, now well-documented, problem of age discrimination which militates against the re-employment of people in their 50s, as well as making it more likely that they will experience redundancy than younger workers. There are now two pressures which are tending to slow down and, in some cases, reverse the trend towards early exit. The first is the ageing of the workforce and the consequent shortages of young labour market entrants. The second is the pressure to reduce social protection costs. Several EU governments including Austria, Finland, France and Germany, have now reversed the support they previously gave to early exit and are seeking ways of reducing the opportunities for and costs of early retirement. Employers are also reassessing their attitudes towards older workers, with some even constructing a positive ‘business case’ for employing this group. Trade unions too are reconsidering their support for early exit strategies5. In short, the case for seeking to extend working life is built on pragmatism, economic returns, and good human resource practice, as well as justice and fairness. A consideration of the role of technology in the extension of working life is therefore pertinent.

New technology and older workers. The relationship between new technology and older workers has often been negative. This group of workers has frequently found itself redundant because of technological change and, when seeking work, it is commonly confronted by stereotypical views about its inability to adapt to new technology. Employers and managers often regard older workers as being much less likely than younger ones to accept new technology. There is no doubt from the available research that such views are often based on erroneous and age discriminatory stereotypes. Research has shown that, although older people do not learn as quickly as their younger colleagues, they can, in fact, 5

See A. Walker, Combating Age Barriers in Employment, Luxembourg, Office for Official Publications of the European Communities, 1997

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acquire substantial new knowledge and skills and they do not forget these faster than younger people. There are some indications of negative views towards training on the part of older workers but this is also something of a self-fulfilling prophecy in that organisations tend to exclude this group from training opportunities. There is a similar exclusion in some public employment programmes. Reversing the process of exclusion and, thereby, facilitating an extension of working life, will involve a broad package of policy measures stretching far beyond the scope of this report. But technology can be switched from being seen as part of the problem to become part of the solution.

3.1.1. Neutralising Age

In the face of population ageing, rapidly changing technology and increasingly flexible employment patterns, the following are key challenges: • Lifelong learning. Lifelong learning is much discussed at the present time, and one of its key concrete applications is with respect to ageing population. A process of lifelong learning has the potential to neutralise the relationship between age and employment. What role might technology play? In our view life-long-learning is a major application area for ICT. We might envisage individual ‘training stations’ in the future, located at different sites (including the home), with access by smart cards carrying details of individuals’ training accounts. Regular Internet access could be encouraged to update skills and knowledge, with specially tailored classes for those experiencing difficulties. The policy implications are vast. At the European level there is a need for standards setting, co-ordination and exchange of experiences. At the national level there are needs for the creation of education and training contracts, continuing educational opportunities, training schemes, open universities, networking and so on. At the organisational level fundamental changes will be required in attitudes towards training, which would need to be seen as a continuous process. This will require a major shift in human resource policy towards a holistic, life-long perspective. Individual workers would also have to take responsibility for accessing lifelong learning opportunities. Two sorts of R & D policy intervention are required: to encourage the development of technology which facilitates lifelong learning and to examine the effectiveness of different education and training regimes for different age groups. • Design. We refer here to the design of process technologies across all sectors of the economy. The challenge is to ensure that equipment in all sectors of employment is designed-for-all in terms of both technological content and its ergonomics. R & D will be required to investigate further the impact of ageing on the use of production and other technologies, and to encourage appropriate design. Research on age related issues will be required to find its way into engineering training for age-neutrality to become an integral part of design culture and practice.

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• Organisation of employment. It seems unlikely that any extension of working life can take the form simply of postponement of retirement within an existing organisation of work. We envisage a need for far more flexible forms of work organisation: flexi-time, job-sharing, multiple work locations, telework and so on. This will require changes in human resource policy, in the management of work at the level of the enterprise, but also changes with respect to more general labour regulation. There are also technological implications: technology can play a part in assisting with changes in the organisation of work which promote flexibility. The potential for such change is likely to be concentrated heavily in certain sectors, such as service sectors which are information-intensive: here the design of new IT systems, integration of networking and work tasks, and tele-commuting solutions are potential areas of change.

Extending work: the example of a Finnish programme The National Age Program which was initiated in Finland by the Ministry of Employment in 1997 will run for five years. A number of ministries, the Finnish Union of Municipalities, the Social Insurance Institution, the National Institute of Occupational Health and insurance companies are collectively responsible for organising information, education, experimental and development projects, developed from the work of an expert committee. The main aims are to support information campaigns on maintaining working capacity, to promote part time pensions systems, and to develop employment services for older workers. Adult education, employment of older workers and flexible working hours should be promoted. In addition, pension and unemployment benefits may be modified to encourage participation in labour force. Campaigns will be launched to change attitudes to meet the actual capacities and possibilities of older workers.

3.1.2. Preventing loss of function Despite the potential of technological change and other policy measures to reduce the impact of age on employment prospects there will remain a pool of workers for whom their occupation is the source of premature ageing and disability. A combination of technological and ergonomic solutions, especially in the interface between users and production technologies, could help to offset decline and, thereby, maintain employment. For example ergonomic keyboards reduce repetitive strain injury - a common problem among professionals using computers. Furthermore, new technology could assist workers to monitor their own health status. There is a need for more R & D work on the use of technology prevent loss of function in employment and, at a policy level, it is important to disseminate existing examples of good practice in this field. It must be acknowledged too that, often, some very low tech solutions are viable: alterations to work processes to avoid lifting, changes in the design of tools and furniture, in the position of work stations and height of benches, alterations in lighting, and so on.

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SUMMARY: EXTENSION OF WORKING LIFE

• • • •

Key issues Technological change combined with inflexible organisation plays an important role in early exits from the labour-market Exclusion of older people from work & training opportunities Working conditions affecting ‘fitness for work’ Policy objectives Age-friendly work environments; access to work for all New modes of flexible and participatory organisation of work new training systems; making lifelong learning a reality age neutral production technology

• • • •

RTD&I challenges Develop new modes and technologies for life long learning Develop new models for work organisation and use of technology (especially ICT) Design-for all workplaces and process technologies Technologies for prevention and rehabilitation at work

• • •

3.2 IMPROVING ACTIVITY, MOBILITY AND QUALITY OF LIFE.

Work is important for social participation and activity. Yet social participation and activity do not exhaust themselves at work. A lot of the issues, challenges and opportunities discussed in the context of working life, apply beyond it. Older people play important social and community roles. It has been estimated that in Europe they contribute 2.4 billion hours of voluntary community service per year. Life-longlearning experiences can enhance social participation and activity and improve the quality of life of the life-long-learners. The social, institutional and organisational contexts of activity and social participation are very important for quality of life. So are the physical contexts: communication and mobility. In modern industrialised societies, the active participation of older people in social relationships, cultural events, services (including voluntary work) and in all types of activities outside their homes is made increasingly difficult through loss of physical ability which is often associated with chronic illness. Such difficulties are exacerbated by unfavourable environmental and technological conditions. The increasing mechanisation of public spaces and services, for example, can lead to problems for older people if they are largely cut off from technological change processes which are associated with work. At the same time social changes increase the need to use technology for communicative competence and mobility, particularly for older persons who live alone. Mobility and housing, transport and home technologies are potential areas of major innovation. 3.2.1. Mobility and transport

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The extent of mobility depends on a person’s individual capacities, needs, and resources (health or frailty status; interests, attitudes, knowledge and fears; economic resources; family and friendship networks); on environmental factors such as housing conditions, geographical and climate conditions, the built environment, the availability of services, or traffic density; and on trip-related factors such as purpose of the trip, distance of destination, availability of and barrier-free access to private or public transport facilities.

Mobility needs of older people. Is the observed decrease in mobility with age an autonomous choice - or is it the result of reduced physical abilities, of increasing psychological or social problems? Or is it caused by spatial barriers or insufficient and inappropriate transport facilities? Research has shown that the majority of trips of older people are short distance trips, made as pedestrians or by bicycle. About the same share is carried out by car (as driver or passenger). Whether public transport is used depends greatly on the area and on the quality of service on offer - but in general, the public transportation share for older people is higher than average. Overall the results of an international research project6 comparing the mobility and activity patterns of people over 55 in three very different European countries (Finland, Germany and Italy) show clearly that: • older people do not withdraw from mobility by preference; • people who feel impaired in their mobility are less satisfied with possibilities for participating in leisure and other activities; and • the subjective feeling of poor personal mobility is the most relevant factor influencing the level of satisfaction with activity in general, whereas biological age is of relatively little importance. Car owners tend to be satisfied with mobility conditions even if they are physically impaired. Thus, demand for cars among older people is likely to remain strong, and specific design solutions aimed at the older population may be appropriate. The sustained importance of private transportation will have differing effects for the ageing population. While easier access to private cars will contribute to an increase in mobility, the concentration of traffic can, above all in cities, also lead to older people feeling uncertain and withdrawing from public activity. At the same time, there are obvious limits to car use. Difficulties reported by older people (e.g. poor tram and bus connections, difficulties in entering and exiting buses or trams, cars parked on the sidewalks, and so on) indicate important areas of potential improvements to infrastructure and public transport. Some transport innovations recommended by older people are purely organisational: they concern for example the provision of company and assistance to frail older people on public transport. Others involve large technical components, such as design-for-all adaptations to the lay-out of buses and trams. 6

See Mollenkopf, H and F. Marcellini; (eds) ‘The outdoor mobility of older people: technological support and future possibilities’. Luxembourg 1997: Office of the Official Publication of the European Communities

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Modern transportation technologies. Modern transportation technologies have the potential to enhance mobility significantly. There are nowadays technical solutions to the most diverse limitations to mobility, from a vague insecurity while walking up to a total inability to move. An array of mobility aids has been developed, especially in wheelchairs. In this area of technology, an adequate adjustment to individual disabilities is less a technical than a financial and organisational issue. In some countries, the needs of older and disabled people are increasingly being taken into account in the technical specifications of buses and trains: wheelchair lifts and various low floor conceptions are being provided when purchasing new or replacing old vehicles. Nevertheless many challenges remain. The ageing population is likely to be an important source of demand for new transport services. Design issues here extend from specific features of transport means (age-friendly design aspects of buses, trams etc.), to the provision of new types of transport infrastructure, where ease of access, integration, connectivity, reliability and regularity, and security are likely to be very high priorities. There is a need for more systematic research on the nature and functionality of transport infrastructures as a whole. Infrastructures, both for urban and rural areas, involve major costs and major economies of scale, and this is therefore an area where much can be gained from high-level co-ordination. There is therefore a case for extending current research in transport from its focus on increasing the performance of systems and means of transport (e.g. high-speed rail), towards user- and age-friendliness (e.g. design-for-all high speed rail). Such research would have to take a broad systematic view of transport technologies not only involving technical issues with respect to design and performance of system components, but also research into organisation, management and finance of transport infrastructures.

3.2.2. Housing Mobility is essential for activity levels inside as well as outside the home. Thus, the arguments for a better mobility infrastructure apply also to the design of the housing stock. Design-for-all at home. Simple design aspects such as the width of doors and windows and smooth access to different levels constitute parts of a design-for-all approach to housing. Similarly, design-for-all interfaces with common household appliances can make a great difference. Overall the most important feature of designfor-all in housing is adaptability. This implies: flexibility in the layout of homes, userfriendly ergonomic interfaces with technology at home, and compatibility with networks of services provided from the outside. Domotics and smart housing. Domotics is a term describing ICT applications in home technology. There has been a great deal of speculation about the usefulness and utility of domotics in the future and opinions are still divided. Needs and opportunities associated with ageing population emphasise new home technologies,

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including domotics. For example, in the areas described above – extension of working life, and communications and mobility – there are technological opportunities such as teleworking solutions which require an extension of technological capabilities within the home. Research is required into housing design, communications, and software systems, as well as standardisation of interfaces and infrastructures which is essential for the development and diffusion of such technologies. Demonstration of smart houses for older people in the Netherlands Model houses with domotics, specially designed according to the demands of older people are already available. Such a house has been erected on the campus of the University of Technology in Eindhoven. Also, a fully equipped demonstration house for disabled people has been built at the premises of the Institute for Rehabilitation Research in the Netherlands. This house is connected with outside networks (one high- and two low-voltage networks) through a single switchboard, anticipating a very intense use of technology in the future. Under discussion for the ‘Very Smart House for Older People’ (and not only) are control systems that will monitor and adjust every conceivable aspect of indoor atmosphere and might monitor also the medical condition of residents; such functions can in turn be linked to audio information in and around the house, and to television, telephone, Internet and other sources of information and entertainment.

SUMMARY: IMPROVING ACTIVITY, MOBILITY AND QUALITY OF LIFE Key Issues • Quality of life, activity and participation in society depend heavily on mobility, communications and housing. Policy Objectives • Safe public spaces • Age-friendly transport infrastructures, systems and means. • Design-for-all , adaptable, technologically advanced housing. • • • •

RTD&I challenges Ergonomic design of buses, trams and other transport means. System aspects of transport infrastructures: nature, functionality and integration of infrastructures, including low-tech systems. Enhanced use of ICT in system access and integration, at home and transport systems. Design-for-all housing

3.3 HEALTH, WELL-BEING AND SUPPORT

Many of the issues discussed in the earlier sections have important implications for health. Actions to improve mobility and activity are likely to impact positively on

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health. Improved housing is associated with mental and physical health. Several studies have found that morbidity is more frequent among unemployed people. The longer unemployment lasts the higher the risks to mental and physical health. Extension of working life, through alleviating poverty and promoting participation, is likely to have positive health effects. Health and well being not only issues of access to medical care but also issues for social policy, agricultural and food policy, consumer protection, environment, transport etc.

3.3.1. Preventing illness and disability Maintaining the abilities of older people by preventing threats to health, even challenging the ageing process itself, should be of our fundamental concern. It is essential to develop strategies for early diagnosis, controlling nutrition and physical and mental exercise, to promote research in basic sciences, especially biology, medicine and chemistry, and to facilitate adoption of its results. Such strategies need to be based on understanding the processes of ageing from a physiological as well as social perspective. For example, population ageing is likely to increase the occurrence of neurodegenerative diseases, and that is an important consideration for the distribution of medical and pharmaceutical research budgets and for prevention strategies.7 Research is needed to understand better the factors contributing to the occurrence of age related diseases. The results of that research need to feed into strategies for eliminating those factors and/or their influence. The medical field aside, RTD&I challenges here relate to adjusting aspects of the physical environment to preventive strategies, especially those closely associated with people’s life-styles. Promotion of prevention is a great policy challenge. A particularly important aspect of life-style is diet and nutrition. A healthy diet plays a significant role in the prevention of many chronic diseases (atherosclerosis, hypertension, metabolic diseases). Technologies and procedures to improve the quality of food are important here. Important are also aspects of the promotion of prevention such as the definition of recommended dietary allowances (still lacking in many EU countries) and regulations covering consumer information. Another important aspect of life-style relates to physical activity. Fostering even modest physical exercise has been proven to be beneficial for various age-associated diseases, such as diabetes, cardiovascular diseases, and hypertension. The benefits of physical activity include among others reduced demand for medical care, reduced institutionalisation and increased autonomy for older people. Technological aspects of physical activity include accessible infrastructures, specialist devices involved in the activity itself (e.g. equipment used in rehabilitation techniques), as well as automated (or/and on-line) status monitoring systems and services.

7

For a detailed discussion see the STOA report: The Ageing of Society, PE 166.665, Luxembourg, July 1997

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3.3.2. Compensation of disability/enhancement of ability

While promotion of prevention can delay the onset of disease, population ageing, especially the substantial increase in the numbers of very old people, will result in a growing number of potentially disabled, dependent people with reduced quality of life. Combating disability, Assistive Technologies (AT) and Supportive Technologies (ST) can be very important. The role of assistive technology (AT) is to maintain autonomy even in the presence of disability and lack of formal/ informal supports. AT compensates for disabilities while ST aims to enhance the remaining abilities. The use of AT and ST is quite limited in the majority of EU countries. The reasons probably lie in requirements by Europeans of different design standards, in the lack of information on items available (marketing is frequently at local/regional level), in the paucity of enterprises in this area and/or in the lack of interest by major big companies in this field. AT (and to a lesser extent ST) have been addressed in programmes such as the EU TIDE programme.

The EU TIDE Programme In 1991 the European Commission launched its technology initiative for disabled and elderly people which became known as the TIDE programme. This aimed at improving European industry and markets in products and services to meet the needs of older and disabled people. In particular it focused on assistive technologies promoting individual functional autonomy. In its pilot phase (1991-1993) the programme funded 21 technology development projects with ECU 18M. The BRIDGE phase that followed (1993-1997) funded, with a budget of ECU 42M another 55 projects in the following areas: • access to communications, IT and support for interpersonal communication; • life at home and remote care; • mobility and transport; • control and manipulation technologies, • restoration and enhancement of function; • diffusion and awareness promotion. In the fourth Framework programme, the activity of TIDE was integrated into the Telematics programme (1994-1998). The line Telematics Applications for Disabled and Elderly people has a budget of ECU 70 M and supports RTD&I projects on two broad areas: support for independent living, and compensation for functional disability. The main change from TIDE has been a broadening of perspective, where the focus on technologies that can be used by older and disabled people, was supplemented by technologies for service providers to older and disabled people as well as design-forall mainstream technologies.

AT and ST are extremely important in fostering informal support: family members are frequently burdened by assistance provided to disabled older people and this is a main factor behind institutionalisation. Reduction of institutionalisation of older people would be a significant social and economic benefit. Thus, efforts should intensify to: • improve integration of mechanical, robotic, telematic and other technical items in the natural living environment of older people; • train and employ (recruit as well as use) intermediaries in this field to be positioned between older people and technology (service delivery personnel as well as

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“informal carers” - usually relatives); and • sensitise a broad range of actors involved in the diffusion of AT/ST (marketers, engineers, media, educators).

Aiding the diffusion of Assistive and Supportive Technology: The Handynet project The Handynet project produced a CD ROM which included information on more than 10,000 Assistive Technology devices. The Handynet project was a part of the European Commission HELIOS program; it has now ended. Several organisations involved in Handynet have gone on to create their own assistive and supportive technologies, with Internet data bases to serve users, produces and care organisations.

3.3.3. Telematics and care system design

The well being of ageing individuals and populations depends on the integrated interplay of scientific achievements, industrial applications, social organisations and information flows, all provided by distinct categories of professional actors and agencies. A basic problem in provision is that organisations usually tend to develop products and services independently on each other. Organisational change and innovation is therefore paramount. A direction for innovation is to sub-merge health and social care services into “seamless care”: a person-centred integration of prevention, welfare-improvement and health care. Seamless care is closely linked to the implementation of new information and communication technologies (ICT) in health and social care organisations.

Organisational trends in health care. In health care the enormous technological advances of the last decade have been associated with a trend towards fewer ‘centres of excellence’, generally located in metropolitan areas where the concentration of high-cost technologies and human resources guarantees the best and updated medical practices. At the same time there are more and more health-care settings, generally located in non-metropolitan areas, that offer a wider but arguably less sophisticated services. This dichotomy has some major consequences: • • •

at ‘centre of excellence’ level, there is sustained increase in demand for all sorts of services, leading to an underexploitation of the excellence potential of such centres; at ‘peripheral level’, there is reduction of the capacity to assure continuity and adequate quality of care to people, and problems in maintaining and updating professional skills; and at the ‘people level’, there are costs and discomforts in moving to centres of excellence, for which the only alternative is to forego expected care. There is inequality of access among citizens, which is particularly crucial for the older segment of the population. 25

Objectives for care system design. In thinking about a new architecture for provision of care services, we should take into account the following: First, most health and social services are labour and skill-intensive, with a unique relationship linking service provider to user. This means that industry-like automation or robotisation, which has lowered costs in industrial fields, is not applicable. Second, knowledge underlying health and social care, at least in industrialised countries, has much increased in the last decades, with diffusion of advanced knowledge resulting from improved information flows. Finally, many technological advances in the medical field can now be transferred to more easy-to-use equipment (analogous to the shift from mainframe to minicomputers and then to PCs from the 80’s). Objectives to be pursued in support of a new care system design include: • • •

•

integration of health and social care services into seamless care services; full utilisation of the potential of centres of excellence in distributing highquality services towards peripheral settings; here, tele-consulting and telemedicine tools should be designed and developed for routine use; promotion of industrial RTD&I towards biotechnological (bio-sensors, molecular markers) and electro-medical resources, capable of transferring instrumental competencies to peripheral level (such as dispensaries and general practitioners - GPs), thus extending high-grade care, and giving to peripheral settings the medical, social and organisational support for optimal interface with tele-consulting services from centres of excellence; and promotion of industrial RTD&I towards diagnostic and other care tools to be used at home level, thus favouring “self-care”, with accompanying safety controls.

Fostering such innovation would improve the potential of the whole care system to provide for increases of care demand, expected as a result of population ageing, without major increases in levels of expenditure. Seamless care organisation is expected to increase the transfer of good organisational practice between “health” and “social” care and act as a co-ordinating force in the fragmented demand for assistive and supportive technologies. As with issues related to the extension of working life, we have here a simultaneous possibility for increasing well-being, developing new products and services, and alleviating public finance problems.

SUMMARY: HEALTH, WELL-BEING AND SUPPORT Key Issues • Substantial increase in frail and dependent population will emerge, changing the amount and balance of care needs. • Regional and socio-economic inequalities in health will increase if not tackled by policies • Prevention and health promotion are great challenges in ageing societies

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Policy Objectives • Prevention of, and compensation for, loss of function and illness • Better opportunities for self-care • Development of decentralised seamless care systems with significantly reduced costs • • • • • •

RTD&I challenges Understanding further the fundamental processes of ageing and illness New technologies for health promotion and self care New generations of preventive, assistive and support technologies Design and development of technologies for caregivers Medical telecommunications: tele-consulting and tele-medicine New technologies for seamless care organisation

4. RESPONDING TO AGEING THROUGH RTD&I POLICY In the preceding sections we have argued that there are major opportunities to alleviate social and economic problems related to population ageing. If the opportunities are realised, we can expect reduced pressures on public budgets, a more dynamic industrial and employment setting, an enhanced quality of life for older people, and an improved health environment. In this section we turn to the policy implications and the role(s) of the public sector, looking at: • • • • •

objectives for policy action in relation to ageing population; the role of the European Union in RTD&I for population ageing; approach and policy design principles for RTD&I policy actions; priority areas for RTD&I policy; and policy co-ordination issues

4.1 OBJECTIVES FOR POLICY

What should be the broad objectives of policy in the field of population ageing? A key part of the argument of this report is that there is a tight complementary relationship between three levels of policy with respect to ageing: that is, between economic, social and industrial policies. The vital function of RTD&I policies is to build bridges between these arenas of policy. The economic objectives include a stable macroeconomic environment, focusing on maintaining healthy public sector finances as the population ages, and a favourable growth environment. Such objectives, however, are not separate from achieving the social and employment objectives which have been at the core of this report; they are dependent upon them. The economic objectives are likely to require extended and

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enhanced working life, which in turn rests on organisational and technological innovation in the workplace, and for this a wider background of actions to enhance activity and care must also be achieved. In our view enhanced activity and care are desirable in themselves, but it should be noted that in achieving them, new areas of product development will be opened up. These are likely to be significant opportunities for European business. We should not see the objectives of policy, therefore, as separate, but as inter-linked. In our view the major targets for policy action in these areas are summarised in Table 1:

Table 1: Major policy objectives in relation to the ageing population

Ageing challenges and opportunities: policy objectives Extending working life • Age-friendly work environments; access to work for all • New modes of flexible and participatory organisation of work • New training systems; making lifelong learning a reality • Developing age neutral production technology

Activity, mobility and quality of life

Health, well-being & support

• Safe public spaces accessible to all

• Development of seamless care systems

• Accessible Information Society for all

• Prevention of and compensation for disability

• Safe transport accessible to all; new and integrated transport infrastructures

• Enhanced independent living with self-care opportunities

• Adaptable housing; development of ‘smart housing’

• Efficient decentralised care delivery

Those policy objectives require new technologies, and innovation and adaptation by European industry. These in turn require a set of related RTD&I policy actions: • development of relevant technological infrastructures; • actions to encourage the creation of markets for new age-appropriate technologies; • development of relevant regulations and standards (both technological and organisational); and • diffusion of best practice. 4.2. THE EUROPEAN LEVEL: THE ROLE OF THE EUROPEAN UNION The issues sketched above have important implications for European Union policy objectives, particularly concerning cohesion, employment and growth. Cohesion refers to the objective of reducing income and wealth disparities between Member States and regions of the European Union. But this objective is usually seen in the context of wider economic performance, where the improvement of competitiveness through innovation and technological change is central. One of the key problems of population ageing is that it threatens to add inter-generational income disparities to existing

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regional disparities, as well as exacerbating some existing regional problems. Moreover, as we have seen above, it holds the threat of damaging Europe’s growth performance. The issue of ageing is therefore one which should be of serious concern both to policy-makers at the European level, and within the Member States. What are the arguments for a European role, for policy at the European level? The case for such a role should be made with respect to three sets of criteria: subsidiarity; contribution to the social policy objectives of the European Union, and criteria linked to economic development and scientific and technological prospects. From examining each of these sets of criteria in the context of population ageing, we believe that they offer a prima facie justification for action at the European level.

Criteria for EU RTD actions: Subsidiarity implies the following conditions for action at the European level: • A need to establish a critical mass in human and financial terms in particular through the combination of complementary expertise and resources in the Member States; • A significant contribution to the implementation of one or more Community policies; • A need to address problems arising at Community level, or questions relating to aspects of standardisation or questions concerned with the development of the European area. • Overall, this implies the selection of objectives which are more efficiently pursued at the Community level by means of research activities conducted at that level. Criteria linked to social objectives are: • improving the employment situation, • promoting quality of life and health • preserving the environment, • further major social objectives of the Community reflecting the expectations of its citizens. Criteria linked to economic development and scientific and technological prospects are: • expanding areas creating good growth prospects; • areas in which Community business can and must become more competitive; • areas in which prospects of significant scientific and technological progress are opening up; • areas contributing to the harmonious and sustainable development of the European Union as a whole.

The widespread character and Europe-wide impact of population ageing suggests a serious need for expertise, research and resources to complement those of the Member States. Additionally, there are serious implications for Community policies particularly related to cohesion, employment and social protection, and there are major challenges with respect to generic technologies and standardisation at the European level. If employment levels and the quality of life of European citizens will depend heavily on actions in the near future in this area, then we can go further: it is quite possible that macroeconomic stability and the entire European model of social protection is at stake.

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From a competitive point of view, age-related technologies and services are areas of economic opportunity, involving both growth and increased international competition. The opportunities and challenges are European. What is required with respect to these new technologies is not just the specific technical solutions themselves, but the development of shared, generic knowledge bases and infrastructural resources which will underpin industries as a whole across Europe. In many European countries agerelated technology issues are already being addressed, in such fields as housing and care technologies; what is needed now is a careful analysis of where such work could be best carried forward at the European level and the development of a forum of coordination exchange of experiences, mutual learning and systematic diffusion of good practice.

Ageing and New Technology: Policy Developments in Japan As part of the Industrial Science and Technology Frontier Program of the Agency of Industrial Science and Technology of MITI (Japan’s Ministry of Industrial Trade and Industry,) the Research Institute for Human Engineering for Quality Life (HQL) is creating a comprehensive database of older people's physical functions, such as vision, hearing and muscle strength in relation to their activities of daily life. The database consists of five levels of human characteristics (the first four levels are near to completion): (1) human body shape and measurements data, (2) data on human body movements, (3) data on physical functions, (4) data on human senses, (5) behavioural and cognitive data. This data base is aimed at enabling Japanese manufacturers to develop “human-oriented” products and services that provide older people with safe and comfortable living environments. The first phase of the programme (1990-1994) had a budget of 7.75 billion Yen. After a positive evaluation a much larger second phase is planned. The programme is carried out in close collaboration with universities and National Research Institutes in metrology, mechanical engineering, materials and chemical research, bioscience and human technology, electrotechnics and the governmental Industrial Research Institute. Registered users of the programme include Fujitsu, Mazda, Nissan, Matsushita, Mitsubishi, Ricoh and Sanyo.

4.3 APPROACH AND DESIGN PRINCIPLES FOR RTD&I POLICY ACTIONS

In facing technological possibilities with respect to ageing, one of the things we wish to emphasise in this report is that it is impossible to separate social, cultural and technological issues – we cannot take a technocratic approach to age-related technologies, but must always bear the social dimensions in mind. The social content of technical change. Technology is best seen as involving both technical and social processes. It is social firstly because it is based on learning in organisational and social contexts – often via interactions between producers and users of technology. Secondly, it is ultimately society and social choices which select which technologies will become developed, accepted and used. At the same time, public policies for research and innovation are a major element in shaping technology, and this also is a way in which technological evolution is socially influenced.

Markets and discontinuous change.

Needs for RTD&I policies begin from the

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inadequacies of markets in relation to particular innovation processes. Markets are a way of linking users and producers, but there are important cases where market signals work poorly. One of these is where new technologies are emerging and user needs (and hence potential markets) are not well defined. We can distinguish here between incremental change – that is, marginal technological improvements within well-defined technologies and markets – and discontinuous change, where technical principles are new for the product area and relevant users are poorly defined. In the latter case, non-market actors and processes often come into play: specialised interest groups and stakeholders, public sector agencies, and so on. Innovations with respect to population ageing often fall into the category of discontinuous change. We do not necessarily mean by this that the technical changes are radically new. It is rather that they involve some kind of break with current practice; empirical innovation research has shown that even when technological change is relatively minor, the discontinuities can be very difficult for existing firms, especially for Small and Medium-sized Enterprises (SMEs).

Discontinuous change and SMEs. It is important here to recognise that SMEs are implicated not only as the providers of many technological solutions to problems caused by ageing, but also as part of the organisational context wherein policy goals are pursued. For example, any strategy designed to extend working life would have to recognise that in the EU 66 per cent of workers are employed by SMEs. While large enterprises may have ready access to new technology this will be more difficult for many SMEs. Thus, there is an important role for trade associations, chambers of commerce or other umbrella organisations in creating frameworks which can deliver economies of scale to facilitate access to the technology required for skill development; there is a facilitating role for public policy here. There is also a role for government agencies in providing support for training and facilitating access to technological and managerial resources and innovation finance for SMEs. In other words, ageing provides one specific focus for the broad range of policies already in place at regional, national and European levels aimed at SMEs.

Participation of older people. The development of technologies with respect to the ageing population requires the participation of a broad range of stakeholders in the process of development and direction of technologies. At one level it means that older people should not be excluded from the production and use of technologies, and a major challenge is to conceptualise and define relevant users, and to operationalise their participation in innovation processes (through specific user groups, promotion of transgenerational design and design-for-all). At another level it means that older people should be included in social debates as to the directions of technological development effort.

Processes of exclusion of older people Exclusion from the production process: . • older people are in the main retired from work. There is a lack of practising

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older engineers and designers. Exclusion from the use of technologies: • technologies are rarely designed with older people in mind (engineers tend to design things using themselves as the image of the user); • older people often lack the incentives to keep up with technological developments and thus there is a lack of incentives to industry to involve them; • industry has stereotypical images of older people as a potential market. Exclusion from shaping the direction of technological development: • technological directions are largely determined by industry on the basis of existing markets, or markets closely connected to existing markets; • the needs of older people are often mediated by institutional actors (care agencies, hospitals, and so on) rather than via well defined groups of users which can form a ‘demand’ complex.

Innovative RTD&I policy design. We have argued that successful innovation in any field requires an explicit or tacit recognition of the fact that technology is both technical and social in nature. In the case of innovations for an ageing population, these considerations have serious practical implications for the creation of markets, for policy design principles, and for selection of relevant technological fields; they have implications also for the nature of RTD&I programme design, where user involvement and social research should be integrated into programme structures. In particular they imply the following three principles in RTD programme design and operation: • user involvement in research and technology development; • integration of social research and transgenerational design principles; and • interdisciplinarity in programme structures. There is scope for the development of specific age-related, problem-oriented programmes which require innovative design and management methods. We need to recognise that – at least within the framework of this report – ageing is not only an independent research field: it provides a focus, or orientation, for existing areas of RTD&I activity. The issue of ageing should shape the objectives of research, for example, within such fields as ICT or transport. How this should be done remains a complex issue, cutting across virtually every area of RTD&I within the European Community and the Member States. A wide range of existing programmes could be adapted to take account of age-related concerns.

4.4. RTD&I POLICY PRIORITIES

Following the design principles suggested above, we propose that the following RTD&I priorities ought to be at the core of an integrated response to population

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ageing: • Life-long learning techniques: The general needs for flexibility and adaptation which underpin the life-long learning concept are particularly relevant for older people. The acquisition of new generic or specific skills, in an increasingly turbulent technological environment, will be central to the ability of individuals and society to extend active and/or working life in a reasonable and acceptable way. Principles, methods, organisations and technologies for such learning and re-learning, across different age groups and sectors of society, are a central RTD&I area with respect to ageing. • Technologies and methods for new modes of flexible work organisation: Extension of working life must also mean change in the nature of work and work organisation. This is likely to involve an integration of new workplace technologies with issues concerning forms of work, regulation, health standards, and so on. • Design for age-neutral product and processes technologies: Here we envisage wide-ranging work on the development and diffusion of generic design principles across products, processes and services to eliminate agespecific features of technologies, and to enable wider groups of users to access and deploy product and process technologies; such work will involve user interfaces, ergonomics, housing and urban design, and so on. Research, but also training and horizontal support to industry (standards, best practice programmes etc.), can be envisaged.

The UK RSA “New Design for Old” Project Educational aims

Target audience and action

Results, outcomes

•

To incorporate agerelated design issues in curricula

•

Students studying on a wide range of design courses throughout the EU

•

Around 300 students work on the project each year

•

•

•

To set realistic, challenging design tasks for students

Making teachers aware of the relevance and importance of age-related issues; encouraging work with user groups

Students carry age awareness into their later work

•

Students bring fresh and innovative responses to design problems

•

Winning work is exhibited – included in

•

To encourage intergenerational exchange

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•

•

and debate

•

To raise awareness in industry of the potential market

Each year acts as an exemplar to subsequent years of students

•

Industry is targeted for support and encouragement of the project

To help collaboration between industry and the education sector

the RSA Review publication and promoted regionally, nationally and internationally •

The schemes is increasingly viewed by a variety of audiences as being highly important in design education

•

Industry participation in the judging process heightens awareness of agerelated design issues

Support for age-friendly design: the INCLUDE project New technological possibilities, changes in legislation and standards, together with increasing demands by users to have their say in the design of products and services present many new possibilities for actors in the field but also pose real challenges. The history of innovation is littered with wrong predictions about markets and the use of new products and services. We all know of instances where researchers got it wrong over even basic factors for innovations, such as ‘who is going to use them? How they are going to be used? And for what purpose?’. One reason for this is that producers’ conceptions about the user are often very limited. How can designers keep up-to-date about legislation and standardisation issues? How can designers get in contact with the users, and the variations in their needs, so that products and services can be designed for a wide range of people with different abilities? The INCLUDE information server aims at answering many of these questions. There is information about legislation and standardisation issues, market trends, telematics issues, variation of user abilities, contact points to users, assistive and support technologies and much more. The headings of INCLUDE web-site have been arranged according to basic questions in the design process. To assist in the search for information, there is also a map of the INCLUDE site in a text and picture format. Both can be used to navigate through the site and to search for topics under interest. In addition a text search engine is being constructed to further assist the search of information. A Help Desk Consultancy Service is available to the Telematics community. INCLUDE is an EU Support Action. INCLUDE is at http://www.stakes.fi/include

• Transport and mobility infrastructures. It seems unlikely that the growing population of older people will be able to use existing transport systems (particularly private cars) to maintain requisite levels of mobility and participation in active social life. Solution of this problem will in part be related to the dissemination of age-neutral design principles into transport equipment. But it is also likely to have serious implications for the design, funding, and integration of transport infrastructures; this in turn relates closely to urban and town planning issues. • Age-relevant information and communications technology (ICT) applications in work, domestic environment and support. The development

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of ICT infrastructures, hardware products and applications is one of the major RTD&I areas in Europe at this time. It is clear that in many areas – such as work organisation, training and life-long learning, and housing design – ICT will be highly relevant to the ageing issue. This is one of the areas in which ageing can provide an important focus in terms of content to existing largescale activities. • Understanding and prevention. Development of biological, psychological, social and medical knowledge (biochemical, biological, public health, social, clinical and epidemiological research) will continue to be a prerequisite for prevention of illnesses and promotion of healthy ageing. Research should increasingly feed into the design and implementation of appropriate policies in the areas of working-life, physical and social infrastructures and care. • Technologies for ’seamless care and support’. The overall field of preventive care and assistance will grow significantly in years ahead. The general need is for integrated or seamless care, involving a wide range of products and organisational forms. • Medical telecommunications for decentralised distance health care. The ageing population will probably place increasing demands on the health and social care system and therefore implies a need for new approaches which will both improve the quality of medical care available, while containing costs. New telecommunications-based ’distributed care’ systems are a core priority here. As we have suggested above, these priorities cover a number of cross-cutting research fields, and they are by no means exhaustive. They are relevant to a wide range of research fields currently supported by the EU. In Table 2 we offer a somewhat wider view of the relevant RTD&I policy objectives and priorities, classified according to these major RTD&I areas. It should be noted that we include here a wide variety of social science research fields: all technologies have a social dimension, but this is particularly important in the case of age-related technologies.

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Table 2:

Overview of RTD&I policy objectives by area of concern

Extension of working life Areas of RTD&I policy • Lifelong learning aids, tools and environments ICT • Design-for-all principles for information society interfaces and non-discriminatory codes of conduct; • new leisure services • assistive and supportive technologies and infrastructures • health and safety at work Life sciences • prevention of work related health risks • compensation of disability • ergonomics for work • rehabilitation • design-for-all technologies Production • physical access to the workplace technologies • accident preventive design principles • ergonomic design principles • lifelong training / training • deriving design principles from social observation • flexible, adaptable designed-for-all means of transport Transport technologies & • continuity and interfaces in transport systems infrastructures • deriving design principles from social observation

Urban planning and housing Social research

Horizontal:

• • • • • • • •

Innovative challenges Improving activity , mobility and quality of life • • • • • • • • • • • •

design-for-all principles for information society interfaces and non-discriminatory codes of conduct; information society compatible smart homes assistive technologies / supportive technologies activity and social participation enhancing technology healthy life-styles health and safety at home; prevention chronic conditions / age specific conditions living environment rehabilitation technologies and techniques design-for-all consumer goods and services Accident preventive materials deriving design principles from social observation

• • •

flexible, adaptable designed-for-all means of transport continuity and interfaces in transport systems deriving design principles from social observation

health , well being and support • •

systems supporting independent living systems supporting distance diagnosis and care delivery (and deliverers)

• • • •

healthy nutrition / appropriate food technology organisation of care delivery care evaluation restoration and rehabilitation

• • • •

service design new materials for care ergonomic tools for carers deriving design principles from social observation

•

flexible, adaptable designed-for-all means of transport continuity and interfaces in transport systems deriving design principles from social observation Care in urban areas interfaces between housing and ICT mediatedservices

• • • •

• Design-for-all spatial planning / transport / infrastructures access to workplace (architecture / transport / infrastructures) • Accident and crime preventing public places accident preventing infrastructures design principles • accident preventing housing deriving design principles from social observation • information society compatible smart homes • • discriminatory practices in work and leisure life-long learning • social observation (life-styles, biographies, habits and • appropriate social security structures needs) • employment policies and employment structures • deriving design principles from social observation discriminatory practices • best practice in policy design and implementation best practice in policy design and implementation indicators, databases, standards, best practice diffusion, demonstration, training of engineers professionals designers and users.

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efficient life-long care deriving design principles from social observation best practice in policy design and implementation

4.5. RTD&I POLICY CO-ORDINATION Population ageing as a policy issue is a rapidly developing area for Europe, with somewhat haphazard and uneven development across the Member States of the EU. Given the complexity of the fields and actions involved there seems to be a more than usually pressing need for policy co-ordination in this field. What does this imply? • First, a need for a policy forum, which would exchange information, transmit best practice, co-ordinate policy, facilitate dialogue with respect to research initiatives and so on. This might include providing a forum for different types of stakeholders to express views and ideas concerning the scope and content of policy: organisations of older people are likely to be particularly important participants within policy development. • Second, a need to integrate the content of RTD&I programmes within a number of policy arenas and agencies. Table 3 simply sets out some of the relevant RTD&I fields and agencies; the complexity of the relevant administrative structures, and the commonalities in many of the fields, suggest that there might be significant benefits from improved techniques and practices of co-ordination. Table 3: Instruments, agencies and fields of RTD&I policy for ageing population RTD&I Policy instruments

Agencies and Fields

RTD & demonstration programmes (including best practice demonstrations)*

Agencies

Best practice diffusion networks*

Agencies

Fields

Fields

Regulations / standards

Agencies

Fields Education / training

Agencies Fields

Metrology / data bases

Agencies Fields

*

Ministries of S&T, Industry, Labour, Health, Social Affairs, Transport, Planning, Education; Research funding agencies, Industrial Associations Assistive & Supportive Technologies, Health, ICT, Urban environment, Transport, Organisation, Housing, Social research Industrial Associations, Engineering Associations, Chambers of Commerce, Associations of care practitioners, Health and Social Security agencies, Education & Training Agencies, Unions Design for all, Service design and management, Involving older people in technology decisions, Ergonomics, Life- long-learning, Work organisation, Engineering training Infrastructure Regulators (Transport, Buildings, Telecoms), Health and Safety Regulators, Metrology Institutes, Standards Organisations, Engineering Associations, Trade Unions Transport, Production technology, Buildings Design, ICT, Working life Ministries of Education, Industry; Non-profit Organisations, Industrial Associations, Professional Associations Ergonomics, Design for all, Involving older people in design, Training for intermediaries and users of technology Industrial Associations, Research Organisations, Metrology Institutes, Standards Organisations, Engineering Associations, Human characteristics, Social behaviours, Medical data, Service efficiency and effectiveness, Consumer needs

Best practice networks involve exchange of experiences between practitioners. Best practice demonstrations involve demonstrations of technologies and practices in their proper working context (technical, organisational, economic and social).

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5. CONCLUSION There is no contradiction between economic stability and growth, continuation of adequate pension and social protection systems, and improved quality of life for the growing numbers of older people in Europe in years ahead. If we are willing to face the challenges of innovation, both at the European level and that of the Member States of the European Union, then population ageing provides a major focus for our RTD&I policies in the years ahead, and major social and economic opportunities for Europe. The opportunities to strengthen the European social model, while improving the competitiveness of European industry, are there. The challenge is to seize them. Resolving the general tensions between stability, growth and social well-being requires innovation. RTD is not, in this context, a marginal activity with respect to population ageing. It is the key connecting feature which links the objectives and the relevant arenas of policy with innovative change. RTD&I policy-makers will face major demands in years ahead, in terms of program design, management and coordination. Much depends on their response, and on the ability of the European Union to mobilise effectively in this crucial field.

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