EUROPEAN PAPERS ON THE NEW WELFARE

4. A look into the (near) future

Many technologies that are already available now or could be available in the near future will lead to a more integrated approach where tele-health care will develop into ‘personal wellness management’, where complete sets of wearable sensors managed by pervasive computing tools will result in a sort of ‘guardian angel’: the physiological signals will be evaluated in real time by wearable intelligent systems, that will decide which procedures to follow in response to changes in the systems.
A first component of this ‘guardian angel’ approach is the presence of wearable biomedical sensors:
• piezoelectric pressure sensors in the form of watches are available for measuring heart and respiration rates, blood pressure;
• smart textiles are developed, where electrodes, temperature and other sensors are an integral part of the textile fabric, allowing the measurement of ECG signals, body temperature and other physiological signals. A full development of inexpensive smart textiles technologies could be a dramatic step forward towards the complete usability of telemedicine by elderly citizens: diagnostics tests will be performed just by wearing the underwear;
• wearable computing systems, with the computational capabilities to analyse vital signals and detect dangerous patterns, activating communication procedures;
• full integration with GPS technologies allow the instantaneous activation of tracking procedures in case of need of localisation when the patient is not able to communicate;
• full integration with wireless communication technology, integrating GSM or UMTS communication capabilities in the wearable sensors;
• voice recognition and automated call centre response systems will allow the inexpensive integration of biomedical data with the storage of the patient description of their state of wellness/disease.
A second element would be the full deployment of the domotics approach in the houses of the patients – here are some examples:
• bed monitoring systems, monitoring the circadian rhythm and detecting changes in sleep habits, that may be linked to wrong eating habits or negative side effects of drug therapies;
• sensors embedded in furniture, that allow the monitoring of the elderly person’s activities, delivering important information to caregivers about physical impairments or other disabilities with respect to normal habits;
• smart cameras, with the computational capabilities to analyse directly movement patterns of the elderly persons at home and identify danger situation or even the onset of mental and physical disabilities: onset of dementia or other neurodegenerative diseases can be detected through changes in the pattern of daily activities;
• smart pill boxes, that can be programmed to remind users about their therapies, avoiding adverse drug combinations and communicating directly to caregivers about the end of medication supplies;
• smart tv sets will serve as an interface for delivering reminders about social life and wellness management, such as personalised diet planning, or instructing patients with memory loss, dementia or other neurodegenerative diseases about their daily activities: if the sensors embedded in the furniture and the smart cameras detect a difficulty in a normal activity, such as preparing some hot tea, the smart tv set will start to interact with the patient, asking if help is needed and presenting a complete description on how to perform a specific activities like preparing a cup of tea.
Great expectations are connected with the development of micro and nanotechnologies: from non-invasive blood analysis to all sorts of implantable devices that can monitor and support in real time our body functions; now pacemakers can already be programmed and can communicate to external systems. The external and implanted sensors will become an integral part of the wearable and home sensor networks.
The other revolution underway is the development of personal medicine, based on the increasing knowledge in the field of molecular biology: knowing how the ‘molecular engine’ of each individual works will allow the definition of a personal risk profile based on that person’s genetic structure and therefore the design of a prevention strategy that reduces the risk of actually developing a disease. Moreover, the pharmaceutical therapy will be tailored to the molecular responsiveness to drugs: it is expected that drug development will result in molecules which are beneficial only to persons with specific genetic characteristics. This will result in a great role of ICT, which will inform all healthcare operators on the molecular characteristics of the patients: of course older patients will also benefit from this approach, since their molecular profiles will be available within the e-health framework.

5. Conclusions

The important question is: why are these tele-care services not developing at a fast rate in all ageing societies? The main issue is organisational: different organisations are following the health and social problems of elderly persons, investments in technologies are usually flowing to hospitals and there is an ever increasing pressure to control the cost of healthcare; the burden of supporting elderly citizens rests with the family. Those who invest in tele-home care are not necessarily part of the same organisation that reaps the benefits of a technological investment. Public authorities will have to tackle this complex issue, finding the real costs of the ageing society, including those resulting from family care: these numbers should serve as a basis to develop public-private partnership models together with insurance companies, where insurance policies offering tele-care services should be jointly financed by the public sector and from out-of-pocket payments by the citizens. A common ‘ageing in place’ table, where political authorities, insurance companies, social and healthcare services providers and technology companies sit together, could be an important step toward the solution: these organisations should propose care models at the regional level, which represent in most developed countries the proper dimension for healthcare organisation and planning. The efficacy of telecare models should be monitored scientifically as all other healthcare procedures: keeping a specific model or changing it will have to depend only on the outcome and the related costs.

References
Braun, A. (VDI), Boden, M. and Zappacosta, M. (JRC-IPTS) (2003): Healthcare Technologies Roadmapping: The Effective Delivery of Healthcare in the Context of an Ageing Society (HCTRM), JRC/IPTS-ESTO Study, Sevilla, Spain, European commission, August.

Center for Aging Services Technologies (2003): Progress and Possibilities: State of Technology and Aging Services, American Association of Homes and Services for the Aging, Washington, D.C.,