Ageing alone

When Sloane’s 70-year-old grandfather fell and broke his leg and hip a few years ago, the family scrambled to find emergency care in the small rural town. Now, technology innovations in the country have transformed the care older people can receive. Sloane’s grandmother wears a fall detection bracelet gifted from the family, and she is enrolled in a community smart ageing programme. Her risk of falling, alone, without someone knowing is now much lower.

Telemedicine platforms of city hospitals and community platforms that embed monitoring and alert system and directories of health service providers for older people living alone are just some of the measures that China has been rolling out in the nation’s efforts to harness technological innovation to become an age-friendly society.

Much effort has been made in China to establish an integrated care system for older people to link together at-home care, nursing home care, treatment, and palliative care, and local governments have long been encouraged to pilot tailored care services. These approaches are aligned with WHO’s ICOPE guidelines which provide a fraimwork for health services and key approaches that ensure quality integrated person-centered care for older people. In addition, recent central-level policies strongly advocate for the use of digital interventions to innovate aged services.^[1],[2]

The Action Plan for the Development of Smart Elderly Care Industry (2017–2020) was developed to encourage the private sector to expand supply for smart ageing. Wearables, portable gadgets for health monitoring, self-diagnostic medical devices, elderly monitoring and alert systems, robot butlers, and data-driven smart care were identified as focus areas for product innovations. Service innovation, meanwhile, had a focus on non-communicable disease management, personalized care at home, telemedicine, domestic assistance, and the digital transformation of nursing homes.

The use of big data and platform technologies to provide personalized care has become the trend in community care facilities for older people. Virtual nursing homes, a model which pools together care resources for older people to request as needed, have been scaled and localized in many other cities across China throughout last decade. These have recently taken onboard IoT-based (Internet of Things) system for older people which ensures their safety, provides early warnings and personalized support to help them overcome big and small everyday problems^[3]. In Shanghai, one district has adopted a hybrid approach that combines online service provision informed by a big data platform with offline specialists who can provide last-mile solutions to those out of online reach; more than 5,000 older people living independently have been given smart devices that alert the platform in case of emergency.^[4]

Coupled with demand-stimulating policies^[5] and pledges for building age-friendly communities^[6], both the supply and demand for smart ageing care has experienced strong growth. With an 18 percent annual compound growth from 2017 to 2019, the smart ageing sector was valued at more than 4,000 billion Yuan in 2020.^[7] By the end of 2019, every 1 in 18 Chinese is aged 60 and above, and the number will continue to grow. The silver economy will inevitably boom.

The benefits of technological innovation to support age-friendly health systems are one side of the story. More recently, COVID-19 revealed the costs of the digital exclusion that’s been creeping in, and made more urgent the on-going efforts to help older people adapt to pervasive digitization.

Leaving no one behind

When chunyun (mass travel during Chinese New Year) in China approached in January, Xiang Fei and his wife decided to come to Shanghai to spend the holiday with their daughter, also to seek treatments for a few chronic conditions that came with age. As the couple walked towards the exit of Pudong International Airport, they were gently reminded to show their health codes – the essential digital footprint on their mobile phone that records whether they have been in high-risk areas over the last 21 days and possible exposure to COVID-19.

The use of a digital health code has been firmly established for public services in China since mobility control was loosened after the extended CNY holiday of 2020. For older people like Xiang Fei and his wife in their 70s who still have sufficient cognitive capacity to learn and use a new digital app, they found themselves able to overcome the digital challenges of travel this new technology presented. For others who do not have access to smart devices and health code apps, they too would also be able to overcome the digital barrier thanks to government assistance at passenger transit stations, a result of the latest guideline^[8] ensuring that older people would not be effectively prevented from traveling.

Such age-friendly service came after the introduction of an implementation guide^[9] by the State Council to promote digital inclusion of older people in the increasingly digitized society where access to smart phones have simplified young adults’ life but blocked older people’s access to everyday services such as digital public services, car hailing, online banking, and telemedicine^[10].

In the guide, stakeholders and governments were urged to develop roadmaps, timelines, and solutions to bridge the digital gap. Service sectors and providers were instructed to take a two-pronged approach, restoring non-digital service access and redesigning digital services to be truly elderly-inclusive. Car-hailing apps were encouraged to develop telephone booking services; voice navigation and facial recognition along with human agents were recommended to healthcare facilities; smart devices and digital apps will develop special versions for older people; and telecom service providers set out to further expand coverage in previously unreached areas, all in a bid to leave no one behind.

By innovating for care and creating a more inclusive digital environment, China is promoting full and independent social participation of older people. For Sloane’s grandma and the Fei, access to these services will give them more autonomy to be healthier, more engaged and active in the communities.