Building an ageing-friendly world empowered by person-centred technologies

A dialogue with Prof. Alex MIHAILIDIS, Associate Vice President for International Partnerships at University of Toronto and Scientific Director of AGE-WELL Network of Centres of Excellence

Building an ageing-friendly world empowered by person-centred technologies

Ageing is a natural process, yet many of us fear the unknown. We all want to grow old healthily and live independently in our homes with dignity. As the world’s population is ageing at a faster pace than ever before, gerontechnology has become an area of growing interest with an enormous market. Scientists are developing new rehabilitative and assistive technologies for older adults and caregivers. While developers and companies are trying to seize a piece of the pie, it is important that these developments are not driven by a “technology-push”, top-down approach.

In this issue, PAIR chats with Prof. Alex MIHAILIDIS, Associate Vice President for International Partnerships and Professor in the Department of Occupational Science and Occupational Therapy at the University of Toronto, about his perspectives on person-centred design in gerontechnology development. Prof. Mihailidis was named in the United Nations’ 2021 “Healthy Ageing 50” initiative, which recognises 50 leaders who are making the world a better place in which to grow old.

Multidisciplinary and holistic approach to elder care

Gerontechnology is at the intersection of engineering, science, technology and social sciences. Why is it important that disciplines work together to bring forth new solutions? At PAIR, how can constituent research units focusing on diverse topics collaborate to develop elder care technologies?

When multiple disciplines work together, we can gain a holistic understanding and approach to the issues we are trying to solve. The field of gerontechnology not only involves developing new technologies, but also understanding the underlying social elements. These include end-user needs (i.e., the needs of older people and their caregivers), service delivery (e.g., ways to make these outputs accessible to older people), as well as related polices and regulations (e.g., how these innovations are adopted and whether their applications are supported by governments and agencies). It is essential to bring together the appropriate experts from various fields to provide a comprehensive view of all these factors.

Different disciplines have much to learn from each other. Advances in elder care should be conveyed and applied to other disciplines. At the same time, we can look at the sensors, wearables or artificial intelligence that are currently in use for certain applications and determine whether they can also be employed for elder care.

PolyU is strong in allied health and engineering. This year, the University informed the Hong Kong government of its plan to launch a technology-oriented medical school and “smart hospital” which will be located in the Northern Metropolis to serve students and users from Hong Kong, Mainland China and beyond. Can you provide any thoughts or advice on the school’s development?

Allied health professionals such as occupational therapists play an increasingly significant role in determining and providing a range of technologies for older adults. Having a medical school and programmes that integrate traditional medicine, allied health and digital health is a very unique and critical advantage.

At the same time, it is essential to involve industry and service providers from the very start of all these developments. Their participation can help overcome challenges in developing the right kinds of technologies and programmes. They can contribute knowledge about the types of technologies and services that are already available on the market as well as the channels through which to reach the targeted market. Thus, we can ensure that the technology solutions and trainings offered align with real-world needs.

Many aspects of the new school, such as education programmes, service delivery, research and development, talent recruitment, scholarly exchange, etc., must go hand in hand with each other. All these aspects should be given equal emphasis. We cannot focus only on research. This is because the technological development needs to be closely aligned with service delivery models as well as policies and regulations.

In healthcare, there seems to be a knowledge gap between researchers and clinicians. At universities, there seems to be a skill divide between professors of practice/clinical professors and research professors. The former focus on practical instruction of students and patients, while the latter focus on research and academic activities. How can universities better bridge this gap?

It comes back to the importance of conducting research, education and training in a multidisciplinary way, which is not easy to achieve. Researchers, clinicians and practitioners need to be provided with the tools, resources, facilities, and time capacity that will foster collaborations. This really points to the need for training and appointments that provide exposure to research and clinical practices.

Union for a brighter future: Connecting community stakeholders for better elder care

You serve as the Scientific Director of the AGE-WELL Network of Centres of Excellence, Canada’s technology and ageing network which brings together a wide range of stakeholders to develop technologies and services for healthy ageing.

In Hong Kong, many universities have already established units dedicated to ageing research. These units have different foci in their studies, covering long-term care policies, interventions, neuroscience, health service management, and so on. What is the value of establishing a formal alliance like AGE-WELL to connect these entities?

PolyU focuses more on research application. By connecting PolyU to other ageing research units in Hong Kong, the universities can achieve stronger outcomes with powerful devices and tools that are accessible to the various communities. Through inter-institutional collaboration, universities can go beyond basic theoretical research, pursuing translational research and achieving practical solutions.

One thing that AGE-WELL is doing very well is that the Network is not funding research projects just for the sake of doing it. The funded projects eventually generate technologies and solutions with a practical impact on the day-to-day lives of older people. AGE-WELL was launched in 2015, and over the past decade we have learnt a lot about how to do research more effectively and how different types of models can be used to bring better research outcomes. This is an area in which AGE-WELL would like to collaborate with PolyU and other partners in Hong Kong. We hope to learn some lessons in terms of how to continue to improve our existing work in Canada.

It is not just about health management: Supporting the diverse needs of elders

At PAIR, you are the Chairman of the International Advisory Committee of the Research Institute for Smart Ageing (RISA). To date, RISA and several other PAIR constituent research units have developed a number of technologies and solutions for older adults. These include an ultrasound imaging technique for liver fibrosis diagnosis; psychological and cognitive interventions that combine music, artificial reality and motion sensors; robotic arms for stroke rehabilitation; microclimate maps for preventing heatstroke in specific neighbourhoods; and a biofeedback system to address freezing of gait in persons with Parkinson’s disease.

In addition to our existing work on imaging, interventions and mobility, what other areas could PAIR researchers explore?

Elder care technologies are meant to monitor and support older people. Many other aspects such as socialisation, leisure activities, and civic participation also have a significant impact on the health and wellness of elders. However, few technologies have been developed to address these areas, as compared to the management of disease and health conditions. Hence, more efforts could be directed toward the social needs of elders in addition to the classical focus on health management.

In Hong Kong, the number of suicide cases among the elderly has reached a record high, and there seem to be more cases of family tragedies, i.e., elders being abused by caregivers and attempts of homicide-suicide in older persons. What implications does this situation have for elder care technology?

Technology can be used not only for supporting older adults and their health conditions, but also to address the needs of caregivers including mental health and wellness. Caregivers are often considered as one of the primary groups of customers and end-users of the elder care technologies developed. Hence, developers may also consider technologies addressing caregivers’ needs. These can be tools that support their mental health, help them schedule and manage time better, or guide their decision-making.

We are now seeing more technologies being developed to support doctors, nurses and healthcare providers in making clinical decisions in hospitals or other formal settings. Similar technologies should be developed to support decision-making by family caregivers, helping them to make the “best” or the most “sensible” caregiving decisions that take into consideration their own needs as well as the needs of the persons being cared for (based on schedules or lifestyles, for example).

Breaking down the barriers to senior care tech

The global trend to “go digital” is influencing the development of smart elder care technologies which may require end-users to perform certain actions on phones or tablets. To use these technologies, seniors and their caregivers must be digitally literate and have access to smart devices. At the same time, technological development is a profit-making business, and new technologies can be pricey for consumers. In addition, families and senior care organisations may be conservative and resistant to using new technologies. How can developers make sure that their innovations are user-friendly, affordable and trusted by potential users?

One important consideration in development is to keep user friendliness in view during the research process. In other words, developers should try their best to take a user-centred approach and apply a “design thinking” mindset during the process. They should involve older adults and caregivers in the entire development process. Developers need to understand the needs of seniors and caregivers and their workflows in routine care. We should not develop a technology for the sake of developing, but rather a technology that addresses real-world problems. Therefore, the development should follow a bottom-up approach as opposed to the top-down, technology-push approach.

On the other hand, governments play an important role in ensuring that new products reach their beneficiaries. Governments represent a major stakeholder group, and they benefit from elder care technologies because these innovations can help reduce public spending on healthcare. Hence, governments should provide subsidies and make elder care technology a sector that is attractive to companies. Currently, governments around the world are providing incentives to the automotive industry and other sectors, and they need to do the same with elder care technology.

Another point to note is the provision of education and training on elder care technology. Our society needs to be aware of, understand and embrace the use of technologies in elder care. This requires educating the public from an early stage. For example, providing university and training programmes during which students are taught how technologies can be used in their future fields of work. As a result, when the trained individuals begin their careers, they will already have developed a readiness to employ elder care technologies.

When the researcher becomes the patient: A rehab journey that spurs empathy and motivation

In 2019, you had a serious accident, falling 30 feet from off a cliff. You experienced the rehabilitation system first-hand after a devastating spinal cord injury. Looking back, how would you say this journey has influenced you as a researcher?

It has given me a stronger appreciation for the whole process of technology translation and working more directly with professional healthcare workers and caregivers so that they can understand the role of technology in providing better care.

When I was a patient in the hospital where I am also a scientist, it became very clear to me that the service delivery could be improved, because many of the caregivers in the facility did not even realise that technology was an option for use. This has motivated me to ensure that knowledge translation, knowledge exchange and education are valued equally in any project. They are just as important as the research and development of the technology itself.

Can you share some advice for researchers seeking to excel in the field?

One key piece of advice is to remember not to do development driven by the technology push. It is crucial to understand the needs of the people for whom we are designing. To ensure that the research can achieve impactful outcomes, it is essential to include these users in the research and development process. Also, knowledge exchange is as critical as knowledge translation and should also be incorporated into any project.