Development of gerontechnology in Hong Kong
By Biomedical Division
World and local trends - the challenges ahead
Silver tsunami as a local and global challenge
The World Bank predicts that globally by 2030, there will be 1.4 billion people aged 60 and above, and by 2050, there will be a staggering 2.1 billion. In other words, by 2030, 1 in 6 people will be 60 and above, and by 2050 this will increase to 1 in 5 people1. Ageing populations are a pressing concern throughout the world.
The ageing population in Hong Kong has been predicted to grow quickly over the next two decades2. By 2038, nearly 1 in 3 Hong Kong people will be elderly (aged 65 or above) - approximately 31.9% of the population, compared to 17.9% of the population in 2018. In addition, the number of working-age people supporting one elderly person, commonly referred as the elderly support ratio, is expected to decrease substantially from its current level of nearly 4 to 1, to 1.83 to 1 in 2038, and further to 1.48 to 1 in 2066. With less support available for the elderly, the situation places a great burden on the city’s younger generations.
With ageing comes many other issues - financial, social and health. In the face of worldwide population ageing at a rapid rate, there is a growing consensus among welfare organisations and healthcare providers on using novel technology to meet the needs of elderly and their caregivers. The demand for innovative yet accessible technology addressing the challenge of “silver tsunami” is growing.
Gerontechnology?
Gerontechnology is where gerontology and technology meet, and the aim is to create and implement technological products and services that will benefit an ageing population by enhancing their well-being, quality of life and independence, and offer support to their families and healthcare service providers3. In many cases, the problems to be solved in gerontechnology are often interdisciplinary. It may be related to the application of assistive devices, rehabilitation equipment, biosensors and medical devices. So gerontechnology requires collaboration among scholars, engineers and healthcare specialists.
The development of gerontechnology in Hong Kong
“Ageing in place” enabled by gerontechnology
The HKSAR Government’s elderly care policy has been “ageing in place” as the core institutional support. “Ageing in place”, as defined by the US Centres for Disease Control and Prevention, refers to “the ability to live in one’s own home and community safely, independently and comfortably”4. It aims to enable the elderly to remain in their homes and communities and avoid institutional care as long as possible. Gerontechnology is one of the means of ensuring the necessary safety, independence and other essential factors are in place to enable the elderly to do so.
In the light of the potential of gerontechnology, the Social Innovation and Entrepreneurship Development Fund (SIE Fund), which aims to catalyse the social innovation ecosystem5, commissioned the Hong Kong Council of Social Service (HKCSS) in February 2017 to conduct the first landscape study on gerontechnology in Hong Kong. Conducted by Our Hong Kong Foundation in partnership with the HKCSS, the study looked into 72 products and services with the potential of widespread use in Hong Kong and identified 24 gaps and difficulties involving different stakeholders across various stages of the gerontechnology ecosystem.
“Smarter” gerontechnology
Conventionally, assistive devices or mobility are seen as typical examples of gerontechnology. In recent years, “smart” and innovative solutions are taking a growing share in the gerontechnology market and help address the quality of life and independence of the elderly. For example, hospital beds and bed monitoring systems are now shipped with multiple features such as extra-low-adjustable-positions, sensors for human motion detection, distance detection and gross movement detectors. Wireless transmission may also be incorporated, providing stronger monitoring capabilities and transforming equipment into systems of an “internet of things” (IoT).
Another example where “smart” technology is applied is in surveillance and emergency assistance systems. The elderly are at an increased risk of severe consequences from a variety of accidents, including hip fractures, head injuries and even death from falls - especially if there is no immediate emergency assistance. A study shows that 1 in 5 elderly residents falls every year in Hong Kong, with nearly 75% sustaining an injury such as head trauma or broken bones6. With such devastating consequences, surveillance and emergency assistance systems are clearly an integral component in safeguarding the elderly. Advanced equipment has been developed to detect human body, by using infrared sensors. Wireless communication between sensor modules and a computer make it possible for round-the-clock data collection and early detection of behavioural risk patterns of elderly in different areas of the home. In the event of a fall, the system identifies the fall and alerts a caregiver for assistance. Such surveillance systems are commonly installed on beds or wheelchairs using various types of sensor and communication protocols.
Gerontechnology also covers equipment or systems for functional enhancement, education and other purposes for the elderly. The advent of virtual reality (VR) makes possible unprecedented immersion and user experience in elderly cognitive training that help reinforce memory and prevent falls. For example, the United Christian Hospital has developed a “Cooking Assessment and Training Programme”, which adopts immersive VR technology to train patients with memory loss to reduce risk in daily cooking7. The VR kitchen mirrors kitchens in public housing estates with facilities in which patients have to complete tasks. This not only helps them to learn and improve, but also provides a standardised assessment scheme to improve training effectiveness.
The other application that VR and other smart interactive technologies may come into play is to help elderly counteract social isolation and achieve psychological well-being. For instance, by means of VR “virtual travel”, elderly may feel like they are out of the home, thereby easing their anxiety and loneliness.
Elderly visitors experiencing fun of travel and sport through an experimental demo of VR technology in the Hong Kong Gerontech and Innovation Expo cum Summit
Local efforts to foster gerontechnology development
To create a suitable environment for innovation development, the HKSAR Government has driven certain measures supporting and promoting gerontechnology in Hong Kong8. Following an initiative announced in the Chief Executive’s 2017 Policy Address, a HK$1 billion “Innovation and Technology Fund for Application in Elderly and Rehabilitation Care” (I&T Fund)9, managed by the Social Welfare Department, was established in 2018 to subsidise elderly and rehabilitation service units in the procurement, rental and trial use of technology products. Organisations covering elderly-service and rehabilitation service NGOs for community care, support services and residential care services were invited to apply for the fund to obtain innovative equipment. The reference list of “Recognised Technology Application Products”10 cited some typical examples of gerontechnology for supporting elderly care.
Riding on the findings from the gerontechnology landscape study, the SIE Fund decided to establish an inclusive platform to link up different stakeholders on the supply side and connect them with the demand side so as to foster the development and application of gerontechnology and facilitate the development of the gerontechnology ecosystem in Hong Kong. The SIE Fund has financially backed different projects and research aimed at supporting the elderly in Hong Kong11. Positioned as a second flagship project of the SIE fund, the gerontechnoloy platform is envisioned to include a knowledge repository of different available resources relating to gerontechnology, to support and nurture gerontechnology start-ups, to support development and testing of gerontechnology products, and ultimately to enhance public awareness and appreciation of the use of technology to address the challenges brought by the ageing population.
In early 2019, the Hong Kong Productivity Council (HKPC) launched the “GeronTech Cluster” (GLink)12. This scheme brings together industry practitioners and fosters knowledge exchange between professionals. With the ultimate goal of promoting gerontechnology development and smart ageing in Hong Kong, the scheme has achieved breakthroughs in utilising IoT technology for remote monitoring of the elderly. As of now, over 100 organisations/ companies have joined the GLink. The HKPC has developed an all-in-one solution to set up a comprehensive tracking and health monitoring system for an elderly home in Tseung Kwan O by linking various types of sensors. Equipped with fall detection and anti-wandering functions, alarms or safety alerts are triggered under emergency situations. The health data of patients is also tracked. The design of the system benefits caregivers, in addition to creating a safer and more caring environment13.
To foster innovation and technology (I&T) development in gerontechnology, the HKSAR Government and the HKCSS have hosted the “Gerontech and Innovation Expo cum Summit” (GIES) since 201714. This is by far the only gerontech fair in Hong Kong providing a platform for different solution providers, local and overseas, to share and showcase their innovative products and ideas in gerontechnology. The GIES also allowed visitors, including elderly and caregivers, to experience and appreciate the options and opportunities brought about by gerontechnology.
Event photo of the GIES
Insight from I&T development
Platform for I&T collaboration
I&T development has been top on the HKSAR Government’s policy agenda in recent years. While on the one hand the Government is determined to adopt new policies that promote procurement and application of I&T in government services, on the other, there remains a critical challenge faced by start-up and universities - the lack of trial opportunities. To address the needs of government departments and the I&T sector, the Electrical and Mechanical Services Department (EMSD) launched the E&M InnoPortal (https://inno.emsd.gov.hk) in 201815. This is an online platform to facilitate collaboration between government departments and I&T solution providers, including academic institutions, start-ups and established companies. The platform
consolidates the technological development needs and matches related solutions as a means of encouraging the implementation of innovative technology to a range of services.
The platform achieves the match by posting wish proposals with technological challenges from different government departments, and then invites solution proposals from I&T solution providers. Successfully matched solutions would put to pilot trials in the EMSD Headquarters or in government facilities. The EMSD reviews the performance of the solutions, with the trial results publicly for consideration by other government departments. Through this arrangement, I&T solution providers, particularly start-ups can obtain valuable test data and user feedback for continuous improvement of their solutions. In addition, the impartial validation by the government also facilitates wider adoption of technology in the community and the industry.
To supplement the E&M InnoPortal, the EMSD also established the E&M InnoZone in its headquarters as an offline platform to physically showcase the latest development and application of innovative technologies to other government departments and the E&M trades, thereby further promoting adoption of I&T in Hong Kong.
With the E&M InnoPortal and the E&M InnoZone continuously creating new connections between different industries and companies, this facilitation is anticipated to further promote new development of innovative solutions, especially in technology domains like IoT, artificial intelligence (AI) and robotics. These are exciting areas bound to bring positive impact to the I&T sector - including gerontechnology.
I&T solutions for the new normal
In the wake of COVID-19 outbreak, the I&T sector sees new opportunities, and gerontechnology is no exception. Elderly are particularly prone to infectious diseases, so equipment supporting healthcare service providers has become one of the important factors in the fight against COVID-19 in elderly homes. Medical experts have raised the need for infection-control measures in nursing homes16, where the implementation of anti-epidemic solutions could ease the workload stress on healthcare providers.
The first line in safeguarding the elderly and staff is screening the body temperature of visitors or residents. The method usually adopted by nursing homes is screening by thermal scanners, or thermal guns. To further relieve the workload caused by manual procedures and the inaccuracy of thermal scanners, thermal cameras with AI for human detection17 can be employed in nursing homes to continuously and automatically monitor body temperature.
Prototype of mobile thermal imaging system
A second line of anti-epidemic application is mitigating the risk of infection through indirect transmission, for example, touching contaminated objects or surfaces18. Door handles, lift buttons or other frequently touched surfaces are where the virus spread is high. Advanced self-disinfection coating19, proven to have no toxicity to the human body, can be sprayed or applied to these surfaces to eliminate virus or microbial retention and sustain cleanliness. Such coating is durable and can be applied to most surfaces in the nursing home environment, including wood, plastic or metal. Disinfection robots are an alternative for minimising crossinfection. They are capable of carrying out automatic patrol and disinfection using ultraviolet radiation or disinfectant spraying, which may be deployed in nursing homes to help reduce cleansing workload of cleaners and caregivers.
Developing gerontech solutions - oversea experience
In order to the meet the demands of rapidly ageing populations, many countries have initiatives facilitating the development and innovation of gerontechnology. One such example is Canada.
The Baycrest Hospital of Canada is known for its extensive development in geriatric residential living, healthcare, research, innovation and education with a particular focus on brain health and ageing20. Baycrest has established many dedicated centres for research and development (R&D) of which the Centre for Ageing and Brain Health Innovation (CABHI) focuses on innovation in the ageing and brain health sector21. Innovations being developed fall under the areas of ageing in place, care co-ordination (and navigation), caregiver support, cognitive health, emergency room avoidance and falls prevention. Through partnership with healthcare institutes, different types of products and services have been developed for trial use across North America.
In addition, the CABHI also runs several solution acceleration programmes, through which innovative solutions from startups and established companies can be put to trial and subsequently funded for wider adoption to address the challenges faced by the elderly care sector. The ecosystem provides a systematic platform for gerontechnology solutions to be developed in a sustainable and scalable manner, from conceptualisation, trial, validation and roll-out, which allows resources to be allocated to address prominent pain points in elderly care.
A Hong Kong delegation, including Dr Lam Ching-choi, Chairman of Elderly Commission, as well as representatives from the HKCSS, the Hong Kong Jockey Club and the EMSD, visited the Baycrest Hospital and relevant health institutions in Canada in 2019, to appreciate overseas gerontechnology development
Engineering opportunities
Engineering in the silver economy
In the engineering context, the key to “age in place” is to leverage technology to make a difference between living at home or in care. Assisted living solutions and smart homes are still under development, but are now used by an increasing number of people. These systems use advanced sensors to monitor activities such as time in bed, time between movements within the home, as well as fall and vital signs. Communication with a remote carer via live conversation and advice giving should also become a standard feature.
Likewise, the key to achieve “healthy ageing” would be to enable elderly to monitor their own health - both physical and psychological. A wide range of feedback equipment is readily available in the market to promote healthy living and ageing. This currently includes sophisticated weighing machines and user-friendly blood pressure monitors, which together with algorithm, or even AI, allow accurate assessment of health status. With these coupling with the advent of 5G mobile network and novel sensors, one may anticipate more advanced, predictive health conditioning monitoring.
With the advancement in IoT, AI, 5G, robotics and new materials, there are numerous opportunities for engineers of various disciplines such as biomedical engineering, electronic engineering, information technology, electrical and mechanical engineering, building services engineering, etc to work in collaboration with fellow healthcare and gerontology professionals to co-create novel engineering solutions to overcome challenges in elderly care, thereby enabling the elderly to live with dignity and independence.
An investment in our future
Fostering an I&T environment to facilitate technological advancement is pivotal to facilitating healthy ageing across all elderly age ranges and realising the “ageing in place” vision. However, the adoption of advanced technology takes years or even decades to become a “common practice”. As the Gerontechnology Landscape Report issued by Our Hong Kong Foundation puts it, “there is an urgent need to address the lack of technological support for the elderly” and as neatly summarised in the report, “integrating technology within the elderly healthcare system should be viewed as an investment and not an expense” 22. Engineers can all support the development of gerontechnology, and improves the quality of life for the elderly in medical, physiological, and social fields. As engineers we all need to embrace innovation to turn the “silver tide”, starting today.
This article was prepared by Miss Azura Y C Choi, Mr Johnny Y F Choi, Mr Sam K Y Shum, Mr Eric K P Yau from Biomedical Division.
A remark on the vision for gerontech development
By Dr The Hon Lam Ching-choi, Chairman of Elderly Commission
Gerontechnology is a combination of elderly care services and technological advancement in response to the issues presented by an ageing population. In recent years, various sectors have been researching and developing technological solutions to improve care for the elderly and enhance their quality of life.
Given there are many innovative solutions and talent available, it is an opportune moment to promote the wide-scale adoption of gerontechnology in Hong Kong. Many of these solutions and products are engineering-related such as robotics, IoT, AI, big data, etc. While care workers and nursing professionals cannot be replaced by technology, georontech products will nevertheless provide much-needed relief for them in caregiving and reduce the risk of injury at work, hence enabling a “high touch, high tech” service environment. The adoption of gerontech products will also modernise the field, professionalise the sector and attract the tech-savvy younger generation to join the eldercare industry.
One of the biggest challenges of adoption of gerontechnology in Hong Kong is that collaboration between different stakeholders is insufficient. On the user end, elderly care service operators and family carers are unaware or unfamiliar with the latest gerontech development; while on the R&D end, developers do not have opportunities to engage users and can only develop prototypes in a lab environment. Developers need to understand the real needs and living environment of users so to create pragmatic and user-friendly designs. Testing of products in real service environments will improve user engagement, allow developers to gain a better understanding of user experiences and usability of their products before entering the market, and encourage the modification of products to effectively address the needs of older adults.
I believe gerontechnology is not only beneficial to elderly care services, but also has a huge potential in R&D as well as the engineering industry. I look forward to seeing more innovative yet down-to-earth solutions in the future to create a positive impact on our community.
References
1. Independent Evaluation Group. World Bank Group. 2019. ‘World Bank Supporting to Ageing Countries’. Retrieved from
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2. SIE Fund. 2020. Gerontechnology Platform in Hong Kong. Retrieved from
https://www.sie.gov.hk/en/what-we-do/gerontech.page
3. Office of the Government Economist. January 2019. ‘Population ageing trend in Hong Kong’. Retrieved from https://www.hkeconomy.gov.hk/en/pdf/el/el-2019-02.pdf
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13. Hong Kong Productivity Council. ‘IoT-Enabled Tracking and Health Monitoring System for Gerontech Elderly Home’. Retrieved from
https://www.hkpc.org/en/our-services/gerontech/success-stories/gerontech-elderly-home
14. Gerontech and Innovation Expo cum Summit. 2020. Retrieved from
https://gies.hk/en
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https://inno.emsd.gov.hk/en/home/
16. South China Morning Post. 2020. ‘Coronvirus: guidelines to keep Hong Kong elderly care home free of disease must be made mandatory, experts say’. Retrieved from
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article/3092571/coronavirus-guidelines-keep-hong-kong-elderly
17. Electrical and Mechanical Services Department. 2018. ‘I&T Solutions: Smart Thermal Crowd Screening System: Prototype and Roll Out Implementation’. Retrieved from
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19. Electrical and Mechanical Services Department. 2020. ‘I&T Solutions: Durable antimicrobial coating for door handles’. Retrieved from https://inno.emsd.gov.hk/en/it-solutions/index_id_584.html
20. Baycrest Hospital. 2020. Retrieved from https://www.baycrest.org/
21. Centre for Ageing and Brain Health Innovation (CABHI). 2020. ‘All Projects’ Retrieved from
https://www.cabhi.com/all-projects/
22. Our Hong Kong Foundation. 2017. ‘Gerontechnology Landscape Report’. Retrieved from
https://www.ourhkfoundation.org.hk/sites/default/files/media/pdf/healthtech_eng_cover_ss.pdf