Challenging assumptions about technology and ageing

A new inquiry by the Nuffield Council on Bioethics is examining the ethical issues posed using biomedical research and technology in helping people live better in old age.

The context for this new project, The future of ageing, is an increase in overall life expectancy in the UK set against faltering progress in healthy life expectancy and significant variation in life expectancy across the country. Biomedical innovations offer potential to prevent and delay ill-health, improve independence and quality of life for older people, and possibly even delay ageing itself.

However, the Nuffield Council has rightly identified that the use of such innovations poses important ethical questions, and that thinking about these now is necessary to prevent ‘unexamined assumptions and approaches to ageing’ affecting research and development in this area.

The PHG Foundation My healthy future project examined the policy implications of the use of emerging and future developments in science and technology for health across the life course, with a particular focus on personalised prevention. This included specific consideration of both issues related to heathy ageing, and ethical concerns. Our findings informed our consultation response to the current Nuffield Council inquiry.

How can science and technology help?

Harnessing biomedical data generated by remote surveillance and sensors – potentially in the home environment, via telemedicine - could help to extend good health and quality of life for older people. Citizen generated data from digital footprints of activity such as movement or food consumption, and measurement of biomarkers via automated analysis of breath, saliva or urine might take these insights even further, to offer not only monitoring but potentially personalised prediction and prevention of disease.

The Nuffield consultation is also concerned with such opportunities and how they sit with respect to existing health inequalities, and efforts to tackle the wider social and physical determinants of health. These are of course essential areas to examine and address – the more so since vital drivers of a healthier old age are rooted in our early lives. However, alongside broader efforts to lay the foundations of good health for everyone, science and technology could offer further improvements – if used properly.

Attitudes, priorities and risks in ageing research and development

The consultation sought views on how attitudes to ageing could influence research and innovation, including prioritisation. We reflected back findings from a PHG Foundation workshop on healthy ageing that assistive technologies whilst aiming to improve quality of life for older people, nevertheless run the risk of stigmatising this group, especially if they fail to meet people’s real needs or seek to control their behaviours.

Many of these technologies will gather data about the patient. How acceptable the potential loss of privacy and how far patients feel able to trust with whom their data could be shared were just some of the concerns voiced around data collected from, for example, movement sensors. Who would be liable should a digital assistive technology fails to perform as it should, is another area of concern. And there is question as to where high-tech care fits within a system advocating the values of patient-centred care and shared decision-making.

How older people can help (themselves)

The single most important action to mitigate against such risks is to ensure the robust and fully representative involvement of older people at every stage of innovation, from inception to delivery. There is increasing recognition of the value of increased and more influential patient and public involvement (PPI) in innovation, as demonstrated by new moves by NICE and the MHRA to boost involvement in regulatory processes. Similarly, the importance of genuine diverse inclusion is now acknowledged, including hitherto underrepresented groups – which for some purposes includes older people.

There are two important issues to address here. The first is the need for new and more comprehensive initiatives to ensure the involvement of representative groups of older adults in innovation at all stages. Our report Health technologies and social impacts noted that early adopters - who tend to be enthusiasts - typically wield disproportionate influence over the development of new technologies, making them likely to be tailored more to their needs. Later adopters (usually the majority) may therefore be less well served by the final products. Active efforts to bring them into the development process earlier are needed.

Secondly, as our workshop on healthy ageing concluded, the heterogeneity of older people must be properly understood. Not all older people suffer from multiple morbidities or significant, life-limiting physical impairments. Not all older people have equal capacity or willingness to engage with technologies. If barriers such as different educational levels, cultural and language issues, and sensory, cognitive and physical needs are not taken into account, existing health inequalities could be widened by the technologies meant to reduce them.

The bottom line

The PHG Foundation Our healthy future report noted that: ‘Policy-makers have a pivotal role in directing how innovations are developed and used for health to maximise benefits - and minimise harms - for individuals, groups and society’. That’s the aim here, and why the Nuffield Council is right to start examining some of these issues now; and to start productive conversations about where we should go from here.

Technology may be a bad master, but it can also be an excellent servant – provided we are clear as a society about how, when and where it should serve us, and in what ways. To determine how it can best work for older adults, in particular, we very much need to hear from older adults themselves. The job for policy makers and influencers now is to make sure they are heard.