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Americans over the age of 75 years are expected to account for more than 50 percent of the anticipated 19 million population increase in the country over the coming decade. This is according to a March 2024 report by Wells Fargo that goes on to warn, “Assuming the share of the population that has difficulty with self-care remains constant … an additional 1.7 million seniors will require care a decade from now.” There is a price to be paid in terms of health, as well as a societal and economic one, particularly for women who represent 59 percent of unpaid caregivers.
Other nations are also struggling to find solutions. Japan has the highest life-expectancy in the world, which is certainly enviable, but it comes with a cost. It’s now commonplace to find children aged 80 or older taking care of their parents, who are 100 years or older. With Japan expected to soon have more than 100,000 people over the age of 100, a care solution is urgently needed.
In the U.K., with its public-funded National Health Service (NHS), there are 8.7 million care contacts provided by community care services every month, with 70 percent of these services face-to-face, which means these services are highly resource intensive.
How wearables can help
What is universal among the elderly demographic globally is a desire to live independently, in their own home or in an assisted living situation. Wearables, though not a panacea for this crisis, have the potential to contribute to a solution by allowing the elderly to be health monitored remotely using sensors to check heart rate, temperature, respiration and other vital signs.
Technological advances and better integration, coupled with a firm grasp of the importance of human-centered design, are propelling innovation in the sector. Also of significance, the long-standing issue regarding privacy and data ownership remains, and is proving to be more challenging to resolve.
The very early stages in the development of wearables focused on performance, or more accurately, just getting the technology to work reliably. Largely funded by the military, human-centred design was not a priority. As the technology has come to the consumer it has become apparent that to gain acceptance and to ensure that it is worn—and worn correctly—wearables need to put the human at the center of the design. Comfort, flexibility, haptics and aesthetics are important considerations, but when considering elderly users, additional factors, such as reduced mobility, visual limitations and cognitive impairment, have to be taken into account. The impetus is moving towards invisible wearables: indistinguishable from a regular item of clothing, no more difficult to put on or take off, just as comfortable, and also flexible.
Advances are being made with technology integration as a first step. That advances involve several partners indicate that this is not a simple task. Funded by the German government, researchers at the Technical University of Dresden with partners that include WarmX, a company specializing in heated knit garments, and Dresden Elektronik, custom electronics specialists, are developing wearables to monitor and analyze human movement.
Specially designed applications include gloves that offer the tracking of finger movement and pressure, and leggings that monitor the angle of the knee and leg movement, both for medical continuous assessment and rehabilitation such as analyzing gait. The sensor design and positioning is dictated by the intended application and is directed towards a fully-fashioned and integrated manufacturing process for the wearable.
Lymphatic drainage can be a debilitating condition involving the poor drainage of fluids through the lymphatic system brought about by surgery or another medical condition. Most commonly affecting the arms, hands and legs, it can become exacerbated with age causing pain and poor movement. Currently available compression sleeves, which are typically used to ameliorate this condition, are by design tight and difficult to put on or take off, so a new design is clearly needed for patients whose mobility is compromised.
Fortunately, researchers in Portugal at CeNTI (Center for Nanotechnology and Smart Materials) and their partners are developing a smart sleeve under the country’s Health Portugal Agenda HfPT. Their approach is to combine sensors and actuators and an inflatable sleeve that can apply pressure where needed and as it is needed. Comfort is considered with moisture management properties and breathability, as the inflatable cells mimic manual lymphatic drainage (achieved by hand massage) with an app that’s also used to monitor the limb.
Managing digital data
The digital health market is projected to be worth $171.9 billion in 2024, predicted to rise at an annual CAGR of 8.49 percent, to $258.3 billion by 2029 with the aging population one of the key drivers, according to a report by German data management firm Statista. America is expected to hold its position as the lead region, followed by China, Japan and the U.K. The British government already has an Ageing Society challenge policy in place, with the NHS having a long-term plan for a “digital first” treatment within the next ten years, that aims for 90 percent of NHS Trusts to adopt electronic records.
This gives the important issue of privacy and data ownership a new urgency. As wearables are, by design, frequently used in the patient’s everyday life, as opposed to confined to a healthcare facility, the attention to security in shared data is no small matter, and could, in fact, be complicated by growth in sensing garments usage and availability.
Alex “Sandy” Pentland has served as a professor at MIT and the Digital Economy Lab at Stanford HAI. He is especially concerned with data use, misuse ownership and protection over many years. One of his many achievements is the launch of openPDS/SafeAnswers, PDS being a personal data store, with the research and development of the legal and software code made openly available for public access and re-use. What is offered is a platform where people can securely store, manage and choose to share their data, based on the principles of old English Common Law, whereby data ownership is defined as the right of possession, use and disposal as opposed to a literal ownership.
It is designed to be a reference point for national and international policies and legal frameworks, such as the National Strategy for Trust Identities in Cyberspace (NSTIC) in America, and in Europe it is aligned with the European Commission’s 2012 reform of data protection rules. Leading by example, Pentland’s group has developed, with the Gates Foundation’s support, a digital health system for rural health workers in developing countries that guides health service for 400 million people.
The Advanced Research Projects Agency for Health (ARPA-H) launched a request for information in July of this year aimed at potential procurements for real world health care data and related services. The specifications listed in the online call (open until August 23) indicates the complexity of the challenge ahead.
The agency has identified three specific need areas: real-world healthcare data, data curation and integration, and, finally, real-world data as a “public utility.” The first need, real-world health care data, includes electronic health records (EHR) and diagnostic testing alongside social determinants of health (SDOH) and environmental factors.
In the second request pertaining to data curation and integration, the agency acknowledges that in the gathering of potentially disparate data there is a need to ensure that in the creation of linkages across data sets, individual data is protected through the use of privacy preserving record linkage (PPRL) methodologies. Real-world data as a “public utility” is aimed at making data available to the research community seeking ways to reconcile “a public utility model, enabling research by lowering barriers to data access while fairly compensating vendors for their investments.”
These are all big asks, but crucial for society and industry that they be addressed. To move forward technologically without having an ethical framework in place around data would be to the detriment of all.
Dr. Marie O’Mahony is an industry consultant, author and academic based in London. She is a regular contributor to Textile Technology Source.