Older people

Challenges faced and needs to be addressed

Older people are becoming an increasing part of European population. In 2060, those aged 65 and over will become a much larger share (rising from 17% to 30% of the population), and those aged 80 and over (rising from 5% to 12%) will almost become as numerous as the young population. The number of people aged 80 years and above is projected to almost triple from 23.7 million in 2010 to 62.4 million in 2060 (Ageing Report 2012). As the general population is ageing, many chronic diseases become more prevalent. Patients with chronic diseases developed at a younger age are living longer, thanks to modern medical treatments. As persons with chronic diseases age and older people acquire chronic diseases and co-morbidities, they develop specific needs and are confronted with unique difficulties in addition to facing obstacles common to patients of all age.

Key issues when living and ageing with chronic diseases include the loss of independence or/and autonomy, and social isolation, together with other concerns that can be aggravating factors: financial insecurity, guilt, and fear of death. Moreover, older patients with chronic diseases often have comorbidities, which often go unrecognised and untreated. Other barriers when dealing with the healthcare system include loss of cognitive function for many old people.

In addition to medical and psycho-social issues, patients can face social stigma and discrimination. There is already stigma attached to growing old, which is even stronger for older women; and people living with certain diseases, for example hepatitis, HIV/AIDS, Parkinson’s, Alzheimer’s, mental illness or chronic pain can be more vulnerable. Discrimination in healthcare provision for older people may include the rationing or limitation of services based on age.

It is of paramount importance to move away from a negative perception of older people. An older person is a person with rights and capabilities. Older patients have a wealth of expertise that is a potential untapped resource in our societies; they are a source of knowledge and sometimes know more than even healthcare professionals about managing their disease. They can pass on knowledge and experience of navigating the healthcare system, and share coping strategies. Informed patients who are willing to support others and develop networks, help themselves by helping others. Older patients need to be treated with dignity and respect, and their needs should be met taking into account the heterogeneity of this group and the diversity of this population. People as they age want to keep on living an independent life and keep control over their life even when/if they need care. Just like anyone, they want to keep life opportunities opened and live independently without being considered as a ‘burden’ for society.

However, older persons suffer from negative prejudices associated with old age. Because of their age, older persons may encounter difficulties in accessing specific goods and services, or in getting the same quality of service than other age groups. It is also more difficult for persons aged 60+ to access employment and training opportunities. European societies are still organized by age groups.

Older persons in need of care are particularly challenged in today’s societies. While families cannot always take over care needs, older persons have to increasingly rely on professional care options that may not be adapted to their needs (financial, social, etc.). The lack of information on available care options, together with the reduction of public funding on care services and the lack of coordination between social and health services make access to care a challenge to older persons.

In many cases and especially in rural areas, local solidarity and cooperation and social support are very important to enable older persons in need of care to ‘tackle’ as much as possible these challenges. It is important to note that 80% of care is provided by informal carers (partner, family, neighbours, etc.).

Older persons are more at risk of social exclusion and are more exposed than any other age group to depression and suicide. These dramatic situations are particularly true in rural areas, where the lack of local services and of social activities makes it more difficult for older persons to stay socially stimulated in their daily life. However, social stimulation and possibilities opened for exercising creativity are key in maintaining or improving anyone’s autonomy, in which access and training to new technologies play a great role.

These aspects also affect informal carers, who are often older persons themselves: they have to accept the disease of the loved one they care for; they may feel exhausted, fear the loss of independence and experience social isolation and financial insecurity. As a result, they may develop health problems themselves. For patients still of working age, and their informal carers, loss of employment can lead to insecurity and social isolation.

How SmartCare helps addressing these needs

Fragmented organisation and delivery of care form major barriers to good quality care. In our current health and social care systems older patients encounter many obstacles and often report they feel they need to ‘fight the system’ to get the care they need. On the other hand, professionals still sometimes tend to look after their individual specialities rather than the patient as a whole, and overall quality of life issues can be overlooked. Furthermore, healthcare and social services, which are both crucial for the health and wellbeing of old people, are often not well coordinated.

Integrated care solutions are paramount to meet the needs of older patients. Patients indicated as one of their essential demands the wish to remain independent/autonomous for as long as possible, which can only be achieved with adequate support from primary and secondary care and seamless integration of health and social care at delivery level.

In so doing ICTs have a major role to play, as they can enable effecting sharing – in compliance with rules on data protection and privacy issues and within ethical controls - of key information to effectively enable better coordination between health and social care services.

Integrated care services means a lot to older persons in need of care. Integrated care means that the care they receive is continuous (i.e. that there will be no gaps in the service provision, notion of seamless services), comprehensive (i.e. that they are considered from a holistic approach, that the service provision takes into account their ‘big picture’ of needs, expectations and life stories) and flexible (i.e. that the service will adapt to changing needs and expectations, and will be ready and reactive to change).

Integrated care services means especially for the person that information is gathered in one single point and that a care coordinator ensures a good information exchange between the different services. Finally, integrated care services should aim at improving the person’s autonomy and wellbeing, should primarily aim at preventive and rehabilitative measures to support it, i.e. outcome oriented.

Health and social care need the involvement of the patient to ensure adherence to treatments and effective self-management. Older patients should be enabled and empowered to become equal partners in their care to the extent that they are able and willing to do so. To enable shared decision making, communication between patient and their health professional, as well as with social care workers, is an important aspect of management of chronic disease.

SmartCare is without any doubt innovative in terms of scale of population reached and it has therefore huge potential to produce much needed evidence on how ICT can enable seamless integration of health and social care services tailored them to individual needs of the patients.

Older users would benefit from SmartCare integrated eCare services if it contributes to the needs described above, i.e.

  • Better communication and information flow between different services
  • A single entry point to access the services
  • A quick reaction to changing needs

Integrated eCare services could also help a lot in supporting the person’s autonomy, like ‘emergency’ and safety devices, eHealth monitoring and advices, serious games supporting brain stimulation and creativity, access to videoconferences and social media.