Innovating for the elderly
With our rapidly-ageing populations, innovations in health technology are becoming increasingly crucial.
With our rapidly-ageing populations, innovations in health technology are becoming increasingly crucial.
IT took France 115 years to move from being an ageing society to an aged one; it is projected that Malaysia will take only 25.
This is according to the United Nations (UN) Economic and Social Commission for Asia and the Pacific’s 2016 population data sheet.
An ageing society is defined as having a minimum 7% of its population aged 65 and older, while an aged nation has 14% or more of its population in that age group.
As of last year, Malaysians aged 60 and above comprised 9.5% of the population, according to the commission. This is projected to increase to 14.4% in 13 years’ time and nearly one-quarter of the population (23.5%) by 2050.
Said UN Population Fund Asia Pacific regional director Yoriko Yasukawa: “At the moment, in Asia as a whole, 11.6% of the population are 60 years and above, and by 2100, it will be over 30%.
“And in Asia, (ageing of the population) is happening much more quickly than it did in the developed countries in the West.”
She noted that the ageing of populations is not a spontaneous occurrence.
“It’s a result of policies taken with the intention of benefitting people, and therefore, it signifies a moral and ethical advancement for humankind.”
Ageing today, she said, is not the same as it was in the past.
“We’re looking at the fact that life expectancy is getting longer and longer.
“Here, we’re looking at life expectancy at age 65 and that increased by almost five years since the 1970s, and it will be increasing further in the future.
“So we need to rethink when old age begins, what we mean by old age.”
Elderly challenges
Yosukawa was speaking at the “Transforming Ageing With Health Innovation” forum organised by the National University of Singapore (NUS), NUS Enterprise and pharmaceutical company Bayer in Singapore recently.
QuintilesIMS Institute Asia director Dr Xavier Chan, who also spoke at the forum, noted that among the innovations currently trending in medicine are improvements to increase patient adherence to medications, and in drug efficacy and administration; addressing unmet needs in rare diseases; and in prevention of diseases and their complications.
However, he said that there are still a few key challenges when it comes to health innovations for the elderly.
One is in terms of research and development. According to him, a systematic review of all the clinical trials done across all therapies in 2012 found that only 7% had specifically included elderly patients.
“Which means that in some countries or in some cases, you have limited options in which clinicians would have to make choices using medications that may or may not have been tested specifically for the elderly patient,” he said.
However, consultant oncologist-haematologist and NUS Isabel Chan professor in Medical Sciences Dr John Wong Eu-Li observed that one of their biggest challenges is to get people to participate in clinical trials.
Speaking as one of the panellists on the current affairs talk show Perspectives, which was recorded during the forum, he said: “The only reason why we have 1,000 great drugs is because people went on clinical trials.
“We can only make advancements if people step forward and take part in clinical trials.”
Another challenge when it comes to innovating for the elderly is their complex needs.
Dr Chan noted that the effects of ageing can cause the body to respond differently to therapies.
In addition, there is the issue of polypharmacy, caused by the tendency of elderly patients, especially in this region, to seek out multiple medical opinions, as well as the advice of informal health providers like traditional medicine practitioners, and pharmacists.
“There is a real high risk in which patients are being exposed to polypharmacy, and this is something we need to be careful of,” he said.
Elderly patients also have a different perspective on what they value while being treated.
Said Dr Chan: “Speaking to doctors in particular, most of the time we think about the success of the treatment based on clinical outcomes, which is important, but at the same time, when you think of older patients, the value which they place on quality of life is sometimes not as emphasised as it should be.”
Another area that needs to be looked into is the design of medications and their methods of delivery that usually do not take into account the needs of the elderly.
He said: “We’re already getting down into the level in which some of these medicines and therapies are being used by older patients, and that in order to really maximise the outcomes you want from the therapy, some of these things need to be considered.”
Another panellist, Bayer Pharmaceutical Division Asia Pacific Medical Affairs head Dr Foo Chuan Kit, agreed.
He said that from the perspective of a pharmaceutical company, new products that are friendly, more convenient and easier for the elderly to use, as well as safe with less side effects, need to continue to be developed.
Holistic health system innovations
Fellow panellist and Singapore’s Integrated Health Information Systems Planning Group director Chua Chee Yong said: “Aside from drugs, health systems themselves could potentially benefit from technological innovations.
“As we see the population ageing, there’s the element of the patient that’s getting older.
“And statistically, in Singapore at least, we have seen that such patients are five times more likely to be hospitalised, and when they are hospitalised, they tend to stay longer – almost 1.6 months longer.
“So that creates a huge burden to our ecosystem, and if you look at it holistically, it means that we have to do a lot more, serve a lot more patients, with less resources.”
He added that we need to remember that while our populations are ageing, so are our healthcare workers.
“So we absolutely have to start to use, leverage and harvest technologies, so that our healthcare workers can serve more with less, be more productive, and even use those technologies in a meaningful way to better serve our patients.”
He said that this kind of healthcare ecosystem requires a lot of data exchange that needs to be converted into insights that can help healthcare professionals proactively reach out to patients.
Prof Wong added: “We have to put a system in place because otherwise we’re tackling only parts of the elephant – so, really constructing a system from what we call end-to-end, everything from prevention to end of life.
“Once we have a system in place, we need to ensure that patients can seamlessly flow up and down that system, with the ability to sustain that system both in terms of finances, as well as in terms of manpower.
“And this is where innovation can come all the way down that food chain.”
He gave the example of innovation playing a role in identifying people at higher risk of developing a particular disease, so that the limited healthcare resources can be used to focus on them for prevention and monitoring purposes.
Macular Disease Foundation Australia CEO and patient advocate Julie Heraghty agreed.
“We need to be responsive in terms of prevention and early detection, and education, and that brings in technology,” she said.
She shared how mobile phones are a new invention to her 88-yearold father, and how text messaging is his form of communicating through it.
This example was used to illustrate her point that different age groups within the aged population will require different forms of technology to engage them.
“The second part is the referral process,” she said.
“We need a smooth transition for the referral process for the patient.
“That’s from the GP to the specialist for implementation.”
Heraghty pointed out that while many technologies like e-health, telemedicine and data collection, form the foundation of such a system, patients are really not interested in them.
“What they are interested in is that speedy referral process, and that is important to ensure that they get the treatment,” she said.
“And most importantly, we need to remove barriers to treatment.
“Because if we invest all this money upfront to get people into early detection and prevention, then there are barriers to treatment like cost of transport, it means we’ve got issues.”
In our own hands
However, while health systems are important, the most important element of staying healthy is the individual himself.
Said Prof Wong: “Well, I think that ageing well, like all worthy causes, requires an investment.
“One does not age without challenges and I think that it is very important that we actually take our future in our hands and invest in all the issues that will line us up for a healthy or as-functional-as-possible silver generation.”
He noted that this would require education, prevention and doing all the health-related things we are advised to do, like eating healthily, exercising, not smoking and knowing our blood sugar, blood pressure and cholesterol levels.
He added that it is also important to act on health information.
“One of our challenges is that when people find that they have an elevated blood pressure or their sugars are a little bit high, they tend to attribute it to many different factors, rather than acting on it.
“So, acting on information, seeking treatment, and when treatment is given, actually following it to minimise the complications – there are several things we can do to minimise the infirmities associated with ageing,” he said.
“It’s not destiny that getting old is getting sick. Yes, we all have to pass away, but there’s no reason why we can’t have a healthy ageing process.”