6210 Week 8 Discussion

Indian Journal of Gerontology

2015, Vol. 29, No. 3, pp. 259–282

Promoting Active Ageing Through the Use of ICT: From Global and Indian Perspective

Soumyadeep Chakrabarti, Sohom Karmakar and

*Somprakash Bandyopadhyay

Department of Electronics and Telecom Jadavpur University.

*Management Information Systems, Indian Institute of Management,

Calcutta

ABSTRACT

With the advent of science especially in the areas of medicine and physiology the average life expectancy has been on the rise since the past few decades. This, along with decreasing infant mortality rate, has led to an increase in the elderly population all over the globe. With a thriving elderly population the concept of active ageing has gained traction in the last few years and modern society has found widespread application in this area. Not surprisingly, active ageing has benefitted largely from use of Information and Communi- cation Technologies (ICT). It has profound implications in educational institutions, labour markets, social justice, medical care, long term care and relationship between generations. With the ever growing popularity of nuclear families, the condition of the elderly population seems to have taken a backseat in recent years. With children moving away for the sake of careers the older generation finds itself under the care of professional agencies which provide a kind of social security but do not really provide any sense of “activity” to nourish the mind. To address this problem, the theory of active ageing aims to include better opportunities for people to continue working as they grow old and contribute to society in some way or the other. Active ageing has found many

advocates whose policies tend to improve individual quality of life. This paper presents the current situation of market in Europe and United States where active ageing through ICT is already an estab- lished concept. Further, a brief overview of the market situation in India has been discussed along with further scope of implication in this sector.

Key words: Active Ageing, Quality of Life, Telecare

From its very inception, studies on ageing have not only provided description and mechanisms of ageing phenomenon, but have also enhanced the reservoir of existing knowledge required for the change in living situation of the old which would positively affect their ageing process. They have influenced policy decisions of both the private as well as the government sectors since the first world assembly on ageing in 1982 to the first global consensus on providing dignified care of the elderly in the form of the Madrid International Plan of Action on Ageing (United Nations, 2008) in 2002. The concept of “active ageing” refers to the method of ageing by which people maintain a high quality of life as they age, ensuring that they not only receive passive help from the society but can also engage in its activities. One of the basic challenges of research on ageing concerns the question whether active ageing (Tesch-Roeme, 2012), is possible and if so, which factors enable individuals, social groups, and societies to grow older healthily and actively. Three highly important domains on quality of life need to be considered regarding any discussion on active ageing: health, social integration, and participation. Active ageing is normally synonymous to successful ageing. Successful ageing in general includes three main components: low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life. For successful implementation of active ageing the following basic requirements have to be fulfilled.

Early Awareness of Active Ageing

Active ageing should incorporate diverse aspects of life (even before seniority is attained) such as volunteering in childhood and adolescence and education and healthy behaviour. Of these, education has the greatest effect visible in old age.

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Offer Opportunities for Active Ageing Also Later in the Life Course

Lack of energising social integrand and stimulating volunteer activities are prime examples of vanishing active ageing investment even in middle and late adulthood. Even though studies show that changes in health and participation are possible up to late adulthood, the changes are practically growing obsolete. Moreover, efficiency of interventions decreases as one grows older. It is therefore the responsi- bility of the respective authorities to provide life-long health education for the aged along with sustainable environment for everyone, irrespective of their age.

Improve Societal Frameworks for Active Ageing

Active ageing needs a secure base. Health and participation in late life can be fostered by societal frameworks. Results from comparative surveys (United Nations, 2005), show that the extent of welfare state support – through social security systems like unemployment allowance, pension and prolonged elderly and medical care system – seems to be connected to opportunities for active ageing. Although the instruments for building social security differ between societies, governments may provide regulation for the combined effects of different stakeholders. Highly relevant is the prevention of poverty, as poverty bears the high risk of social exclusion. Combing poverty will also help to reduce health inequalities and increase the chances to take an active part in society.

Pay Attention to Images of Ageing

Societal and individual conceptions of ageing influence develop- mental trajectories over the life span. The societal images of ageing have a profound impact on proper utilization of the potentials of active ageing dealing with the restrictions of frailty and dependency in old age. Inflicting new “images of ageing” into the consciousness of the general public might show that older people are a potential societal resource. It should be noted, however, that purely positive images of ageing do not do justice to frail, old people in need of care. Hence, images of ageing should be inclusive and embrace both potentials and risks of old age.

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With the recent developments and breakthroughs in portable communication technology and computing systems, Information and Communication Technologies (ICT) has been given a central role to play in the advancement of active ageing. Due to varying levels of importance attached to the development of these new technologies by the policy-making bodies of different countries, ICT has faced different challenges and achieved different levels of penetration as we will see in the following section.

Situation of the Market in Europe and Beyond

The general background to this study was derived from the trend towards an ever increasing ageing population (United Nations, 2012) and this has been observed across Europe and beyond for some time already. For Europe and many other countries around the world, the on-going demographic development has significant socio-economic implications: in the future, there will be more older people both in numbers as well as in percentage of the population. The very-old section will particularly experience a boom, there will be a decrease in their family support system, and there will be a smaller productive workforce to contribute to the creation of economic wealth as well as to the financing of health and social services in particular.

During recent years, the social and economic challenges connected to these developments have received increasing policy attention. In this regard, the potential offered by Information and Communication Technologies (ICT) is of paramount importance in order to cope with them in an efficient manner. Recently, the European Commission has adopted an Action Plan on Information and Communications Technology for Ageing where it is highlighted that better utilization of the potential provided by ICT for independent living in an ageing society represents both a social necessity and an economic opportunity. More specifically, it is emphasised that ICT holds the key for more efficient management and delivery of health and social care for the aged population thereby facil- itating active ageing (Organisation for Economic Cooperation Development, 2007).

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Advancement in Telecare

This section focuses on telecare services, one of the most important examples of ICT. Telecare is defined for current purposes mainly in the form of ICT-supported remote social care services. It is the “continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living” as defined by Tunstall, the leading telecare developer in the world.

Telecare systems essentially perform two basic functions:

1. Detect and Record Emergencies: These systems control processors which process the signals from sensors and detect events such as major falls or heart-attacks, in which case, carers are immediately notified. These systems can also compute the time variation of minor events monitored over a long time and this data in the form of graphs, etc. is useful for caregivers to determine any change necessary in the course of treatment.

2. Reduce chances of an emergency: As an illustration we can consider a sound-producing device attached to asthma inhalers for the elderly which can be remotely activated in order to aid in finding them easily in case of an impending asthma attack.

Telecare includes social alarm services, also known as first gener- ation telecare, and more advanced telecare services involving additional sensors and other variants. Figure 1 represents the use of

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Figure 1

Age -related utilisation of social alarms among the 50+ population in five

EU countries with the age groups listed on the vertical axis

(Kubitschke and Cullen, 2010)

social alarms among 50+ populations in the four European countries mentioned below. United States of America is the only non-European example included in the following list.

Germany

Social alarm services have been provided in Germany for more than 25 years and are available throughout the country. Nearly 90 per cent of the social alarm services are provided by six large social welfare organisations. The rest of the market is made up by commercial providers, such as Recontrol, Tunstall, Vitaphone, HausNotruf Service GmbH and Bosch (Kubitschke and Cullen, 2010). In addition, an increasing number of housing organisations are providing social alarm services, e.g. the housing societies in Wuppertal or in Gelsenkirchen within the framework of SOPHIA. Some of the service providers also offer mobile alarms alongwith GPS localisation. Mobile alarms are not widely used, nor is, since reimbursement in these types of services within the existing framework of the long term care insurance possible yet. The social welfare organisations that are providing the social alarm services often have their own call centres. There are around 180 call centres run by welfare as well as commercial organisations in Germany. While some forms of telecare are widely available in the form of enhancements to basic social alarms (e.g. smoke detectors, gas detectors, fall detectors or movement detectors), in practice there is rather little usage of anything other than basic alarms. Some social alarm providers offer additional services such as organisation of home- and outpatient services, and reminder calls (partly automated), although the latter appear not to be much in use. Apart from social-alarm based telecare, there are only a few other telecare services up-and-running in the marketplace. One example is the SOPHIA service which is a commercial picture-based care and communication service for old people, operated as a regional franchise company which seeks to extend operations nationwide. The service model is for a new standard for safety and security, communication, comfort, telemedicine, multimedia and facility management. It is currently the only picture communication service. Several other efforts to establish comparable services on the German senior market failed. Telecare devices and services are yet not listed in the eligibility catalogues of insurers, which means that costs are not reimbursed

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under the insurance systems and have to be paid for out of pocket. The government here has also helped in setting up the research programme on Ambient Assisted Living (AAL), jointly organised by different countries across Europe.

France

Social alarm services are widely available throughout the country and are provided at the level of counties and municipalities. Service operation may include various players such as local fire departments, commercial organisations and insurance companies. Uptake of social alarms is estimated at about 3 per cent of the population aged 65 and above. Existence of considerable variation in end user charges across the country has been reported. It is estimated that the average monthly service charge ranged between 25 and 35 Euro (Kubitschke and Cullen, 2010). Beyond this, sometimes an initial installation charge may be imposed on the end user, which may amount to about 50 Euro. Social funding is estimated to range between 30 per cent and 50 per cent of monthly costs, while in some parts of the country the service has been reported to be provided free of charge. Users who are eligible to receive support under the social benefit scheme can receive full cost reimbursement.

United Kingdom

The UK has a well-developed infrastructure of community alarm services provided by local housing authorities, social service organiza- tions and voluntary and private sectors. Social alarm services are provided to both section of people, those who are living in sheltered housing and those in ordinary housing in the community. There is also a significant private subscriber market. Overall, there are an estimated 1.5–1.6 million people using some form of social alarm in the UK, representing about 15 per cent of those aged 65 years or older (Ibid). Most local authorities run an alarm scheme, either directly provided by themselves or with outsourcing to a private supplier. In general, it seems that outside the sheltered housing context, family carers are typically the main responders once the call centre has been alerted, although in some areas the social care services also provide a mobile response team in addition to the nominated informal carer response. The charging/reimbursement situation varies across local

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authorities. As a general rule, it seems that equipment is provided free of charge to those with an assessed need and users pay a monthly usage charge unless they are eligible for a waiver on the basis of low income. User costs may vary from 10 to 25 euro per month, depending on location and provider. In recent years, social care authorities have been putting into place telecare sensor services (e.g. smoke, heat, flood detectors) and the UK is on the verge of taking telecare into the mainstream. This has been driven by policy and funding, including the Preventative Technology Grant in England and other programmes on telecare in Scotland, Wales and Northern Ireland. It has been reported there were nearly 1,50,000 new telecare users in England in 2006/7, and a further 1,61,000 in 2007/8. This approximately amounts to about 3 per cent of the population aged 65 years or older who are receiving ‘telecare’. Provision and charging approaches vary consid- erably across local authorities. In general, the most common approach of telecare sensor services seems to be similar to that of social alarms although sometimes at a higher level because of the additional extras provided. Preventative Technology Grant funding is given to councils in England with expectation that they will work with volunteers and government authorities in housing to establish new services. Some local authorities/primary care trusts have recently claimed to be providing mainstream telecare services. It would appear that telecare is now embedded in government health and social care policy but it is yet to be fully embedded in mainstream services. The Scottish government have been promoting telecare service provision through a Telecare Development Programme since 2006. Regional care providers have started providing practical and implementable solutions tailored to the local environment. The Welsh Telecare strategy which was launched in 2005 gives grants to local authorities. A Telecare capital grant of £9 million has been made available (with a policy target of providing 10,000 homes with telecare equipment), together with additional money to support the development of telecare strategies. All 22 Welsh local authorities have now produced telecare strategies, which in many cases are very ambitious. Based on monitoring reports it is expected that by the end of the grant period some 45,000 people will be using a telecare service other than a community alarm (this would be about 7 per cent of the population

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aged 65 years and older). The Minister for Health, Social Services and Public Safety in Northern Ireland announced a grant of £1.5 million in January 2008 for pilot projects to promote the development of new technologies to assist people to live at home over the next two years. The European Centre for Connected Health was established at the same time to promote improvements in patient care through the use of technology and to fast track new products and innovation in health and social services. Substantial investment was planned to use remote tele-monitoring to improve care for people with chronic conditions.

Italy

Social alarm services are widely available, although many local service offerings seem to have emerged only during recent years. Today, the major municipalities in Italy seem to have initiated social alarm schemes and in some cases such schemes have been initiated by the Provinces. Uptake is estimated between 1 per cent and 2 per cent of the overall population aged 65 years and above (Kubitschke and Cullen, 2010). In many cases the technical infrastructure, notably alarm centres, and the service itself are operated by commercial service providers or third sector organisations. This accords with the general situation in Italy where social and welfare service frameworks are determined on local or regional administrative levels and are often complemented by services provided by commercial and/or voluntary organisations. There seems to be no general charging model that applies across the whole country. Individual examples suggest that users tend to be charged a monthly service fee of about 20–40 Euros.

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Figure 2

Sector-wise utilisation for social alarms in the European countries

(Kubitschke and Cullen, 2010)

Under certain circumstances users may be eligible to use the service free of charge.

Figure 2 illustrates the utilisation rate of telecare in different countries of Europe.

United States

Social alarms are known and used as personal emergency response systems (PERS) throughout USA. There are both national and local providers, including private companies, hospitals and social service agencies. It has been estimated that about 2.3 per cent of the population aged 65 years and older use social alarms (Ibid). The main forms of provision are either linked to healthcare facilities or private companies. In the former case, the response may often be provided by staff employed by the healthcare facility; in the latter case, response would normally be by local, user-nominated contacts. Historically, the focus seems to have been especially on provision by hospitals or other healthcare facilities with a view to reducing bed-occupancy and other costs. There also has been provision by religious/charities as a more social welfare oriented service, and by manufacturers and security companies. Most PERS are purchased out of pocket by the individual or their family members. Purchase prices range from $200 to more than $1,500. There are additional charges for installation and monthly monitoring ranging from $10–$30.

In America, there has been an overall increase in interest in telecare, with the emphasis apparently more on healthcare than social care in a wider sense. Such ‘telecare’ services are provided by a range of providers including medical practice sites, hospitals and social service providers, both public and private. The availability of services varies from state to state with little or no coherence in application or utili- zation. The extent of take-up varies hugely across the country and there is no data available on the extent of take-up. To date, the Veterans Administration healthcare system seems to be the main provider of telecare services with an independent living focus, even though the main focus of its remote support monitoring is telehealth. Some of the services have been mainstreamed. In Florida, for example, the Low ADL Monitoring Program (LAMP) is a Community Care

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Coordination Service (CCCS) program designed to address the needs of veterans with activities of daily living (ADL).

Summary of Benefits Obtained and Preliminary Identification of Barriers

A successful telecare application is seen to have certain established benefits:

1. The most important benefit is the improvement in patient prognosis, including both the number of emergency hospital admissions and mortality rate.

2. The old will also be able to live a more independent life, taking care of themselves with their dignity intact.

3. Also, the respective governments benefit from the decrease in monetary benefits (given to people with disability) and higher tax returns which in turn leads to more spendable income.

4. Finally, ICT in the form of telecare has been a boon to unpaid caregivers as it allows them to pursue paid employment in addition to the care-giving job and also gives further assurance about the security and well-being of the elders.

The extent of mainstreaming of home telehealth is very limited to date and in many countries no major drivers can yet be discerned. In general, increased attention being given to more effective management of chronic diseases and increase in importance of this with population of ageing provides the most important underlying driver, even if this is not leading to a lot of mainstream telehealth yet (Figueras, et al., 2008).

In relation to first generation telecare, the key factors of influence seem to vary considerably across countries. In fact, some countries may already be at ‘saturation’ point to a certain degree (Solow, 1956) and thus have no concrete barriers, as such, to the achievement of higher penetration levels. Underlying this may be some important variability in perceptions of the role of social alarms in social care, and of where it fits in the spectrum of human and other services that are needed. More generally, where they exist, the main barriers appear to be limited public provision and lack of public funding and disparities in geographical availability in some countries. It also seems that technology and, especially, technological change may be a limiting

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factor in some countries, for example upgrading old systems to work with new digital telecommunications networks and providing services to IP telephony user.

Role of ICT In Ageing: An Overview of the Situation in India

Ageing of population is a major aspect of the process of demographic transition. The developed regions of the world being ahead of the developing countries with respect to demographic transition have already experienced its consequences and the devel- oping world is currently facing the consequences. Even though the relative number of elderly in some developed countries seems to be on the lower side, the sheer population size of these countries signifi- cantly increases the absolute numbers (Chen, 1998). There has been a spurt in the studies focused on developing countries’ elderly population: this can be understood to be the result of the deteriorating living conditions of the elderly in these countries. Natural demographic change account for the increasing numbers while the shift in traditional family structure due to modernisation and migration of younger family members is to blame for the socio-economic degradation of the elderly.

Projected increases in both the absolute and the relative sizes of the elderly population in many third world countries are a subject of growing concern for public policy. Such increases in the elderly population are the result of changing fertility and mortality regimes over the past 40 to 50 years. The combination of high fertility and declining mortality during the twentieth century has resulted in large and rapid increases in elderly populations as successively larger cohorts step into old age. Further, the sharp decline in fertility experienced in recent times is bound to lead to an increase in the population of the elderly in the future. Besides, given that these demographic changes have been accompanied by rapid and profound socio-economic changes, cohorts might differ in their experience as they join the ranks of the elderly. Against this backdrop, we may now preface our discussion with an account of the structure and size of the elderly population. The number of elderly in the developing countries has been growing at a phenomenal rate; in 1990 the population of persons aged 60 years and above in the developing countries exceeded that of

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the developed countries. According to present indications, most of this trend of growth would take place in developing countries and over half of this would be in Asia. Obviously, the two major population giants of Asia, namely India and China would contribute a significant proportion to the growth of the elderly.

In India, the 2011 census has shown that the elderly population consisting of 28 states and 7 Union Territories accounted for 97 million. In 1961, the elderly population had been only 24 million; it increased to 43 million in 1981 and to 57 million in 1991. The proportion of elderly persons in India has increased from 5.63 per cent in 1961 to 6.58 per cent in 1991 and to 8 per cent in 2011. Within the elderly population, persons aged 70 and above have also grown rapidly; from a mere 8 million in 1961 to 21 million in 1991 and to 40 million in 2001. The growth rates among the different groups of the elderly, namely 60 years plus, 70 years plus and 80 years plus during the decade 1991–2001, were much higher than that of the general population growth rate of 2 per cent per annum (Bose and Shankardass, 2004), a trend continuing to this day. Available findings on ageing suggest that fertility as compared to mortality has played a predominant role in the ageing process. As far as India is concerned, there has been a substantial reduction in mortality compared to fertility since 1950. For instance, while the crude birth rate declined by 52 per cent from 47.3 during 1951–61 to 22.8 in 1999, the crude death rate fell more steeply by 70 per cent from 28.5 to 8.4 during the same period (Chakraborti, et al., 2004). Logically, therefore, India is expected to undergo a more rapid decline in fertility in the immediate future than mortality because mortality has already fallen to an extremely low level. The ageing process in India is expected to be, therefore, faster in the years to come than in other developing countries. Moreover, the transition from high to low levels of fertility is expected to narrow down the age structure at its base and broaden it at the top (D’Souza, 1989). In addition, improvement in life expec- tancy at all ages would allow more old people to survive thus intensifying the ageing process. In this context, an examination of the rising trends in life expectancy indicates that the gain is going to be shared more and more by elderly people, a process which would make them live even longer (Clark, et al., 1997). The size of India’s elderly

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population aged 60 and above is expected to increase from 77 million in 2001 to 179 million in 2031 and further to 301 million in 2051. The proportion is likely to reach 12 per cent of the population in 2031 and 17 per cent in 2051. The number of elderly persons above 70 years of age (old-old) is likely to increase more sharply than those of 60 years and above. The old-old are projected to increase five-fold during 2001–2051 – from 29 million in 2001 to 132 million in 2051 (Bordia and Bhardwaj, 2003). Their proportion is expected to rise from 2.9 per cent to 7.6 per cent.

Health Concerns of the Old in India

Health care of the elderly is a major concern of a society as old people are more prone to morbidity than young age groups. Ageing is invariably accompanied by multiple physical ailments, but the less publicly acknowledged fact is that the aged are more prone to mental ailments as well, which arises from nervous system disorders, old-age and perceived quality of life including comfort and independence.

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Figure 3

Dependency Status among the Elderly (Irudaya Rajan, et al., 2003)

Preliminary studies by government and private organisations point to the deplorable health status of the Indian elderly population.

The proportion of the sick and the bedridden among the elderly is found to increase with age; the major physical disability consists of blindness and deafness. A study of urban elderly in Gujarat found deteriorating physical conditions among two-thirds of the elderly, such as poor vision, impairment of hearing, arthritis and loss of memory. An interesting observation made in this study relates to the sick elderly’s preference for treatment by private doctors. Besides physical ailments, psychiatric morbidity is also prevalent among a large proportion of the elderly. An enquiry in this direction provides evidence of psychiatric morbidity (Darshan, et al., 1987) among the elderly. A sharp distinction between the functional and organic aspects of ailments is suggested by a large number of studies. Functional disorder strikes first and gradually develops into organic disorders around the age of seventy. Another rural survey reported that around 5 per cent of the elderly were bedridden and another 18.5 per cent had only limited mobility. Given the prevalence of ill health and disability among the elderly, it was also found that dissatisfaction existed among the elderly with regard to the provision of medical aid. The sick elderly lacked proper familial care and that public health services were

Promoting Active Ageing Through the Use of ICT 273

Figure 4

Health Service by Elderly (Irudaya Rajan, et al., 2003)

insufficient to meet the health care needs of the elderly. The uptake of healthcare from different sources is illustrated in Figure 4.

Among the elderly, 80 per cent died at home and only 17 per cent died in hospitals (9 per cent in government hospitals compared to 8 per cent in private hospitals). Similarly, close to 30 per cent of the elderly had not received any medical attention before death (D’Souza, 1989). A few had been examined by medical practitioners. One in three was reported to have died of old age. More than 5 per cent of the elderly died due to causes such as disorders related to the lungs, blood circu- lation and digestion.

Approximately 50 per cent of all elderly Indians are under lifelong medication for at least one chronic disease and this trend is stronger among the urban population. The Eastern region led all the other regions in India in the matter. The percentage of elderly (two out of three) suffering from at least one chronic disease was the highest in this region. It was followed by the South; the lowest proportions were in the North and North-Western regions of India. Similarly, one out of every five elderly reported suffering from two chronic diseases canvassed in the NSS; from Figure 5, we can see that close to three per cent suffered from three chronic diseases.

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Figure 5

Reported Chronic Diseases in Old Age (Irudaya Rajan, et al., 2003)

Five types of disabilities of the elderly were probed by the NSS: visual impairment, hearing problem, difficulty in walking (locomotor problem), problems in speech and senility. The prevailing disability demography in India (Ibid) is illustrated in Figure 6 and Figure 7.

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Figure 6

Number of Disabled per 1 Lakh Elderly Persons for Different Types of

Disability (Irudaya Rajan, et al., 2003)

Figure 7

Percentage of Differently Abled Old Age Population

(Irudaya Rajan, et al., 2003)

Twenty-five per cent of the elderly in India suffered from visual impairment, followed by hearing difficulties (14%) and locomotor disability and senility (each 11%). The prevalence rates of all the five disabilities were higher in rural than in urban areas (James, 1994). Except in respect of visual impairment, women were ahead of males in respect of the disabilities. Though the elderly in India tend to suffer from many ailments, particularly the old-old and the oldest old, they

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Figure 8

Percentage Distribution of Elderly Men of Various Age Group by State of

Physical Mobility (Ibid)

Figure 9

Per cent of Elderly Women of Various Age Groups by State of Physical

Mobility (Irudaya Rajan, et al., 2003)

do not undergo proper medical treatment due to absence of a compre- hensive health insurance scheme; this is particularly true in the case of the poorer elderly (Gulati and Irudaya Rajan, 1999). One such disability is the lack of physical mobility which affects a large population of India as can be seen from Figure 8 and Figure 9.

Dependency among the elderly population in India is illustrated in Figure 3 which shows high degree of dependence across the rural-urban divide. This dependence is not only of economic origin but is also associated with first-hand care, as can be seen from the demographically differentiated graph in Figure 10.

Daily Life Assistance: An Illustration

Consider a retired octogenarian who is living all by his own in the outskirts of the city. In spite of his age related physical limitations he seems perfectly at ease largely due to a well organised and holistic ICT network which caters to his everyday needs. A system installed in his house provides a proactive environment with a range of intercon- nected sensors, devices and smart appliances working together to provide a safe and secure place to live. These appliances are easy to use due to their customized interfaces and are connected to the neigh- bourhood care centre. This allows, when necessary, remote operation by authorized personnel. As part of the system infrastructure, the smart phones of his children also interact with his home during times

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Figure 10

Percentage of Elderly Persons by State of Economic Independence (Irudaya Rajan, et al., 2003)

of emergency. Several video cameras distributed along the house allow observing his daily routines (by authorized people) and, at the same time, maintain his privacy. The system analyses the situation from the captured images and decides on the best course of assistance, which varies from helping in cooking to interacting with the care-providers. The installed system is also able to react to the most common domestic accidents that are recurrent to people living alone. If it sees him suffering a potential injury, like falling on the floor or cutting himself, the system inquires him to make sure he is well. This interaction is done via spoken natural language. If there is no reply, an alert is immediately sent to his children and the care centre.

Thus with proper application of ICT technology these short- comings which are largely prevalent among the aged community at present, can be successfully curtailed and an overall upliftment is definitely possible.

Existent Organizations In India Supporting Active Ageing

In India, HelpAge and Agewell are organizations working towards creating awareness of the problems and needs of older persons in society and government. But, they do not provide any specific platform for interaction between volunteers or emergency assistance to older people. Heritage Health Care, which is based out of Hyderabad and has 18 years of experience in treating senior citizens has diversified from a geriatric hospital to providing care at home and personalized old age home. But unlike the European and American counterparts, there has been no such noticeable progress in the field of application of ICT for helping the aged population (Knodel and Debavalya, 1997). As a result, there are several areas in the healthcare services which can be developed by using ICT, so as to include old people within the perimeter of advanced telehealth and telecare programmes (as in developed countries), for improved and prompt medicare.

India being a developing country, specific case of telecare may actually work to her advantage. India can use the scientific knowledge and intellectual resources already available due to the extensive R&D investments done by developed countries. In fact, a joint survey by Georgia State University and Apollo Telenet working Foundation

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shows that Indians are quickly becoming conversant with the concept of telecare: 55 per cent of rural and 72 per cent of urban population is aware about and open to using telecare services. In fact the Indian government has recently planned to install 1,00,000 computer centres in rural areas, which will further increase awareness about telecare.

Moreover the “Smart City” plan of the Government of India also includes provisions for use of telecare to create a holistic automated environment. Rs 7,060 crore has already been provisioned as seed money for this project, which is to be utilised for information technology to provide the most efficient and comfortable living standard for the bulging neo-middle class in the Indian society.

Fields of Improvement

Old people value their independence, and thus there is a need of an effective proactive environment which will function remotely and will consist of a group of professionally trained and dedicated volun- teers, who can be available to old people as and when needed during emergency situation. A large section of the aged community of our country is in need of assistance but the present market fails to cater to their needs. Some of the NGOs, in spite of aiming to work for the upliftment of the aged population, largely fail to deliver as per the requirement. Figure 11 and Figure 12 depict the current scenario of Kolkata, one of the major metro cities of our country (Liebig, et al., 2003). So various functioning units of public healthcare need to be

Promoting Active Ageing Through the Use of ICT 279

Figure 11

Need for Support (Liebig, et al., 2003)

integrated to form an efficient network to function effectively in tandem.

One serious problem is obviously, lack of professional caregivers which often proves to be detrimental in this respect.

On the other hand, a user friendly technology is required, in the form of radio-alarms and effective social networking so that old people can connect to the health-centres when they feel the need of any sort of medical assistance. This also helps older people overcome isolation and loneliness, and increases possibilities for keeping in contact with friends and also extending their social involvement (Subrahmanya and Jhabvala, 2000). Thus, a person with movement disability can use an alarm if (s)he has any difficulty in movement, so that a trained caregiver is available for immediate assistance. Obviously it requires prompt service, so efficient management and monitoring of the entire telehealth facility is of immense importance. Technology can assist in normal daily life activities, like tasks at home, mobility, safety, etc. Main developments under this perspective are focused on assistance at home, namely for elderly people living alone, which can be further expanded into developing smart homes. It includes services such as living status monitoring, with connection to care providers in case of any emergency, companion and service robots, integration of intel- ligent home appliances, etc. Support outside home, namely in terms of mobility assistance, shopping assistance, and other daily life activities, is also considered (Schafer, 1999).

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Figure 12

Effectiveness of NGOs (Liebig, et al., 2003)

References

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