The "ageing population of Europe" is a broad and ill-defined segment of the population. The issues appear to be deteriorating health conditions among the 75+ aged citizens and how a modern society should cope with them, i.e. the aim and the vision is to neutralize and/or compensate for the effects of deteriorating health. The reality is that this needs to be carried out with cost-effective, tax-funded programs. As the proportion of ageing citizens is growing in most EU countries – relatively seen fastest in Germany, Finland and Italy – there is growing political pressure to find trade-offs between the costs of the care programs and their substance as the tax-paying part of the population may not be able to afford the programs from the year 2030 onwards.
We created the concept "the young elderly" for the age group 60-75 years; this group represents 18-23% of the population in most EU countries. It is a large segment of the population that according to recent statistical estimates will be about 97 million EU citizens by 2020. It turned out that this concept is very useful for building the focus of a program we call the Bewell.
The choice of wellness is motivated by the fact that wellness services will not be dependent on health or social care data that is strictly regulated in most EU countries, with country-wise differences, and with confidentiality and privacy limitations.
We are working on building programs to tackle the challenges brought by the ageing population using digital services. The first step is to focus on pro-active prevention, i.e. to find measures that will reduce the growth in the numbers of 75+ aged citizens that will need the health and social care support of the society; proactive prevention puts focus on the "young elderly" and develops programs that will keep them healthy, active and independent when they reach the 75+ age group.
In the second step we develop tools that can be used for intervention in the daily routines of the young elderly. Applications for mobile smartphones are now becoming and will be general purpose instruments by 2020 (the mobile connection subscriptions are more than 100% of the population in most EU countries; the proportion of smart phones have passed 60% in most EU countries; approximately 60% of the phones sold in 2015 in the EU countries were smart phones; thus most of the phones in use by 2020 will be smart phones).
There is a growing market for digital health technology that we are aware of but that we are not goingto use for the young elderly; the approach is to collect data, either from medical databases or from individual users and then to offer health advice, which is strongly regulated as the advice giver is responsible for the correctness and the quality of the advice (and will answer in a court of law if something is wrong with the advice).
Our intervention with digital services for the young elderly builds on collecting data on daily routines that have been shown to promote wellness and to present summary data to the users that will encourage them to expand and improve on their routines.
The third step develops ecosystems that will maintain and further develop ICT-based tools to support the programs for the young elderly; we have learned that there needs to be a commercial ecosystem to drive the maintenance and further development of sustainable digital wellness services – research projects are not enough, the services will not be sustained unless they are commercially viable. We use an approach called Business Scrum for developing business models and ecosystems; this approach was developed by our research partners at the Delft University of Technology in The Netherlands. In our overall vision, the wellness services need to be produced, distributed and used for several years before we can start to follow (and measure) impacts on the young elderly age group and study changed/improved levels of health, activity and independence.
Functional impairment covers cognitive, physical, social and emotional impairment. Our work with young elderly groups, we have carried out more than 100 semi-structured workshops, shows that functional impairment is (i) multi-dimensional, (ii) compensatory and (iii) non-static. Physical impairment is an unnecessarily narrow focus as there are many more aspects to the well-being of the young elderly, and most (or all) of them have impacts on the future need for health and social care. On an individual level it is probably fair to say that wellness is subjective and that the motivation for physical exercise may not be high as it has not been part of daily routines for most of an individual’s adult life; on the other hand, intellectual exercises may be part of daily routines and contribute to individual overall wellness; then physical and intellectual wellness may be compensatory (and we will not make any judgement on what is a proper balance). Functional impairment is non-static; i.e., it is a dynamic process that changes in its multiple dimensions – some parts being mutually supportive, some parts being compensatory – and the dynamics has some relations to the daily routines of the young elderly.
If digital wellness services become interventions in the daily routines we will get support for the forming of daily wellness routines. Over time this will have a measurable impact on the health and social care costs – if in Finland more than 50% of 1 200 000 young elderly citizens will have better health for 10 years or more, the savings in health and social care costs should be more than 1 B€ annually.
In Bewell the wellness routines are designed to work out in the following way: (i) young elderly will develop individual daily wellness routines supported by wellness services on an omnivore platform (Wellmo) over mobile smartphones; (ii) the wellness routines will be tailored by/for the users from 100+ smartphone applications; (iii) cloud services will support the wellness routines and collect and analyse user data for further and continuous development of wellness services (Tieto, SMEs and research partners).
The Bewell program for young elderly was triggered by the reactions from service developers and providers when we asked them why there were no mobile services developed for the young elderly: "they give us the wrong image", "it will take too much effort to develop services in such a way that elderly people can use them" and "for what purpose would the elderly use mobile services?". As the young elderly represent up to 23% of the consumer market in most EU countries it appears that some strategic mistakes were made.
In the semi-structured workshops with the young elderly we found that they are experienced, not easily impressed by new technology and confident with their daily routines, i.e. building interventions to form wellness routines may have some challenges. On the other hand, there is an important difference from other user groups that we have studied – the young elderly have time to spend on what they find worthwhile, they do not have the time pressure of work life and obligations to adjust to the routines of a work environment.
We carried out an in-depth enquiry with 101 participants in Mariehamn, which gave a number of insights. Young elderly that are active with full- or part-time work, or with voluntary work, are also active with mobile applications and find them useful for the tasks they carry out. Young elderly closer to 60 than 75 are more used to mobile applications, have the necessary knowledge and find it easier to learn how to use them. Active young elderly find intellectual stimulation in their everyday life, they find it important, which is also the case with people with higher education. Regarding wellness, young elderly with higher income is more positive to the status of their physical health and their possibilities to resist illness. These observations make sense and are supported by the literature; thus they can be used as advice on what groups of young elderly could be the first users ("early movers") of digital wellness services.
The ISS researchers developed in D2I further a framework – which they initially had created for SITRA for analysing the viability of wellness services – into a practical tool which is called the Viability Radar, which is designed to assess the innovation potential of transformative service ideas. Based on service research and innovation literature it highlights the importance of novel simplifying technologies, supporting value networks, cost-effective business models, and regulatory environments that enable the renewal of prevailing market practices. The Viability Radar is operationalised with a set of questions to assess the innovation potential of wellness services.
In the context of wellness services the challenges in business model innovation are found to be the following:
Furthermore as the wellness services get more integrated and virtualized, it gets harder for the users of the services to understand the service content, delivery and consequences. Therefore, it is crucial to "reify", to make it easy for young elderly users to understand how to order a service in a manner that corresponds to and fits with their everyday life, i.e., how to launch a service and what it means to allow service providers to use data for feedback, research and further development of the services. One tentative solution to this problem was developed during the project, where the use of an individual's calendar was worked out as a baseline of activities to be performed and connected with augmenting and ancillary activities and sensors in an interactively guiding manner. It was found that this approach also could show deviations from the planned activities to serve as an indicator of emerging memory problems and offer a basis for solving them in relation to real life events (i.e., scheduled activities on the calendar).
In the D2I project BeWell participants developed an idea for an agile service development approach, a "business scrum", which consists of interactive cycles of technical development, user involvement through Life-based Design and business modelling. It recognises the importance of including business model development, user acceptance and feedback as part of service creation in parallel with technical development (Heikkilä et al, 2015).
Digital wellness services for the young elderly has the potential to become a disruptive intervention in the common wisdom on how to tackle the problems with an ageing population: it will be a pro-active, preventive program, it will promote wellness routines and change daily routines, it will improve health scenarios for elderly people and reduce public health and social care costs.
From the simple fact of numbers it can be seen that the Finnish society faces some challenges in terms of health and social care if more than 1.2 million citizens need care when they get older. The cost of health care for the ageing population in Finland was 3.8 B€ in 2014; as a rule of thumb it is said that a Finnish citizen spends 80% of the health care costs (s)he spends during a lifetime during the last 10 years of his/her life. Thus much can be gained if the young elderly build up good wellness routines and stay active and healthy with them also as seniors and elderly.
There are some benefits in operating with wellness in a four dimension construct: (i) intellectual wellness, (ii) physical wellness, (iii) social wellness, and (iv) emotional wellness, which mirror functional impairment dimensions. In our work with young elderly groups we have learned a few things about wellness. Even if it is accepted that building physical wellness is beneficial there is assumed to be a "reasonable" level which does not require daily exhortations. It is reasoned that an "overall wellness" can be maximized by compensating some missing level of physical wellness with improved intellectual wellness, or with improved social wellness, or with improved emotional wellness or with any combination of these. It will of course be a challenge to find some good trade-off, mapping relations between the wellness dimensions, and then to create digital wellness services to support and sustain them.
Digital business is opening markets for innovative solutions to digital services, business models and ecosystems. This is where digital wellness services for young elderly should/will be heading – aiming for winning (mobile) platforms, using innovative business models and creating ecosystems of companies with high levels of productivity and cost effective operations.
The design of digital wellness services works with data that is multi-dimensional and covers the four wellness aspects. Part of the data needs to be in real time; part of it can be daily and weekly summaries and some of the data could be imported through interfaces with data sets (or databases) that have been collected for various purposes. In our work with young elderly user groups it was proposed that results from the use of digital wellness services should be used to update user profiles in health care systems (makes sense, a personal physician could get access to wellness data). All of it should be summarized and offered in an understandable – most probably tailorable – form for young elderly users over smart mobile phones (operating in Android, iOS and Windows to make sure that the services are not monopolized as they become wanted and successful in large user groups). The summaries and follow-up reports should be produced in forms that are adaptive to the users' contexts, to the data collected with various sensor systems, to various types of apps and to the cognitive profiles of the users. This sounds reasonable but requires advanced and innovative designs. These requirements are our present understanding of how the digital wellness services should be made operational.
A more far-reaching issue was also identified, while thinking through the use of the developed sensor technology for households: the technology changes the cost structure of service production substantially by increasing the investments in infrastructure, software and data analysis as a basis for service planning and production. First, this means that there is a need to develop housing environments in a more versatile direction. There should be modular designs to allow alterations to the new surveillance and feedback technology in new houses, and add-on designs to existing houses. In the short term this would need subsidies, which leads to an additional remark: what should we consider as basic services to which all citizens are entitled? What are additional and extra services the costs of which citizens will have to cover?
A digital wellness services program for the young elderly can be expected to quickly get hundreds of users (the Bewell program is backed up by SPF and EKL with a total membership of more than 100 000 members), soon turning into thousands of users and then scaling up to tens or hundreds of thousands of users in fairly short time. The technology infrastructure needs to be planned for very large groups of users; technology developers and providers clearly want the user groups to grow to millions of users in all EU countries.
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The D2I BeWell Happy-project focused on developing new models, services and solutions, which enable meaningful daily activities, wellbeing and quality of life for older people living in their own homes. The perspective was on future orientated, proactive operations, based on multiprofessional cooperation and co-creation with all stakeholders. A pilot study was completed during the Proof-of-concept phase in 2014–2015.
A number of technologies enhance seniors' feelings of safety and independence, but cover and report only on limited aspects of daily performance. Some are not even designed for seniors; for example, some activity level monitoring bracelets do not take into account whether the person uses a walking aid. The BeWell Happy-project highlighted the value of collecting objective and comprehensive data about older people's daily activities and routines over a long-term period within the context of his/her individual life situation and environmental impact.
The Happy-project looked at seniors' daily living from a broad perspective. Instead of focusing solely on the possibilities technology has to offer, the project developed technology-supported concepts of service from the human perspective. During the pilot study, home tracking systems were installed in the homes of 16 volunteer participants aged between 74 and 91. The tracking systems consisted of three motion sensors and two door sensors placed in locations that were significant in the participants' usual routines.
The "forms of life" of a cohort of volunteer end users were analyzed in order to identify the daily activities and routines they typically carry out. It was also clarified why participants do these activities, what value is associated with them and how they are structured, guided by the principles of human-technology interaction design as set out by Life Based Design method. The model used here also referenced the World Health Organization's Classification of Functioning, Disability and Health (ICF).
The project was carried out by four companies (Benete Oy, BLC Protie Oy, Capcon Oy and Mediconsult Oy), two research organisations (VTT Oy and the University of Jyväskylä) and the Miina Sillanpää Foundation as a non-profit organisation. The Happy-project was based on human-centred multidisciplinary co-design. All partners contributed unique expertise to creation and production of services. The perspectives of all stakeholders, including seniors and their significant ones, were brought into design discussions. Needs, attitudes and experiences concerning technology were derived and understood via participatory means, such as interviews and workshops.
A theoretical framework combining Life Based Design with the International Classification of Functioning, Disability and Health (ICF, WHO) was created. These models complement each other and form a structured framework that enables the design of comprehensive technologies that bring genuine value to people's lives.
From the technological point of view, important work on integration and user interface planning and implementation was carried out. During the pilot the activity data collected by home tracing system was transferred into safe servers of service providers. Each participant was offered a secure digital service (Medinet) with web-service interface which allows the data to be stored and displayed in structured and controlled way. The feedback on the usability of the digital service was collected from the participants for the future development.
The usage of big data technologies creates new insights into the prospects of monitoring the wellbeing of older people. Yet it also requires innovation in design practices. By introducing a model for the ubiquitous detection of human functioning and performance, we also sought to start a discussion about the necessity of well-grounded methods and tools for designing the human dimension of human-technology interaction design. In this kind of innovation, involving all stakeholders – ranging from service providers to older people and their significant ones – is a prerequisite for a successful outcome. The framework was developed based on the extensive and highly professional work of all such stakeholders. The important creative next step in applying the framework to technology design is turning the explicit and implicit research embedded in them into technology and technical requirements. This step presupposes a working discourse between human research paradigms and technology development.
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