The UK population is ageing and it is estimated that by 2034 those over 65 will outnumber those under 16 (at 23% and 18% of the population respectively). As the share of the ‘older’ segment of the population increases, so too will the prevalence of age-related conditions such as dementia and falls. These two conditions are costly both emotionally and socially for the individual themselves and their families, and also in terms of the health and social care. Dementia is currently estimated to cost around £10.2 billion (with £9 billion spent on social care, £1.2 on health care) and is projected to rise to £16.7 billion by 2031. The health and social care costs of falls is currently around £1 billion per year and is predicted rise to £2.2 billion by 2050. The number of residential care places and home care hours would need to expand by around 115% and 103% respectively to keep up, increasing long-term care expenditure by 325% in real terms from 2002-2041.
In the face of these pressures, ‘telecare’ has been presented within policy debates in the UK as a potential solution to some of these issues. Telecare is generally defined as equipment such as alarms and sensor which monitor and manage risks and allow people to live independently. It is argued telecare can help to reduce hospital and residential care admissions, and enable individuals to remain in their own homes for longer, which is often cited as an aim as we age. The cost of installing a typical telecare package is £450; compared with residential care, a body of evidence suggests well-planned support with telecare is highly cost-effective. Telecare has also been argued to reduce the burden on unpaid carers by providing peace of mind and the ability to achieve a better balance between care and other responsibilities, including paid employment.
Though there are examples of positive evidence regarding telecare, there are also issues around the ‘surveillance’ of older people and the impact this would have on their autonomy as well as concern from care professionals who feel technology alone cannot adequately address the care needs of older people, many of whom are isolated and lonely. In addition, the telecare market in the UK is still emerging and the telecare industry still has limited understanding of user requirements, such as socioeconomic factors, gender needs, and income levels that may impede access to telecare, personal attitudes and sensitivities to technology and even of lifestyles.
The AKTIVE research project (Advancing Knowledge of Telecare for Independence and Vitality in later life) therefore aims to explore these issues further by investigating the potential of telecare to support older people diagnosed with dementia or susceptibility to falls and their carers (both paid and unpaid). It is investigating the following topics:
- What are the characteristics of older people who use telecare, and in what context are they doing so?
- How is telecare equipment used in private homes and what is its significance for the users, carers, agencies and workers operating there?
- How, when and in what ways can (unpaid family) carers benefit from the use of telecare in older peoples' homes (and does this affect carers’ capacity to remain in paid employment)?
- What are the barriers to the adoption of telecare for individuals, families, local communities and service providers (and what innovations are needed to overcome them)?
- Does telecare offer opportunities to improve job design and job quality for care workers, providers and commissioners, or for other health and related workers who attend older people at home, and does it improve outcomes for older people and their carers?
- What are the main features of the current / future market for telecare and what can be done to enhance innovation and improve take-up of appropriate technical developments?
The project is funded from June 2011 - May 2014 by the Technology Strategy Board and the ESRC. The project is directed by Professor Sue Yeandle and is being developed and delivered by four partners: CIRCLE, University of Leeds (Lead partner); the Oxford Institute of Population Ageing (University of Oxford); Tunstall Healthcare (UK) Ltd; and Inventya Solutions Ltd. These partners are working with the support of a wider AKTIVE consortium, comprising medical experts; experts in design, risk, disability and ergonomics; telecare commissioners in two local authorities; and a range of agencies representing and supporting older people, carers and care workers.
In exploring the above areas, we will develop a deep and detailed understanding of the context within which telecare is used, the needs and aspirations of the telecare users and of the way their whole caring network operates. At the core of the project is the ‘Everyday Life Analysis’ of telecare use by older people and their carers. The research team will visit these households several times over the course of a year to gain a deep understanding of not only the issues around telecare use, but also ageing and caring for someone more generally. Insight into the everyday lives of older people and their unpaid and paid carers will not only be invaluable in terms of evaluating the benefits and limitations of telecare, it will also enable the project team to explore issues around independence and autonomy versus surveillance and isolation. With a greater knowledge of how older people and their carers interact with telecare in their daily lives, the aim is to cut out avoidable costs and to dramatically reduce the incidence of common hazards which threaten wellbeing, such as falls, accidents and inadequate management of conditions like dementia.The evidence produced will help to will inform the strategies needed to keep older people safe, independent and in control at home. This knowledge will also contribute to improving the way telecare is commissioned, marketed, implemented and adapted to users’ changing needs to improve their quality of life at home.
Kate Hamblin, PhD currently works on the AKTIVE project (Advancing Knowledge of Telecare for Independence and Vitality in later life). She has previously explored employment policy for older workers in Europe; the reconciliation of employment and care for older people and the impact of art programmes on older peoples’ wellbeing. More information on the AKTIVE project can be found here: www.aktive.org.uk
 Office for National Statistics. (2010). Mid-year population estimates, General Register Office for Scotland, Northern Ireland Statistics and Research Agency.
 Fernandez, R.; Leal, J. and Gray, A. (2010). Dementia 2010: The economic burden of dementia and associated research funding in the United Kingdom, produced by the Health Economics Research Centre, University of Oxford for the Alzheimer’s Research Trust.
 Scuffham, P.; Chaplin, S. and Legood, R. (2003). ‘Incidence and costs of unintentional falls in older people in the United Kingdom’, Journal of Epidemiology and Community Health, 57: 740–4.
 British Orthopaedic Association and British Geriatrics Society (2007). The Care of Patients with Fragility Fracture, British Orthopaedic Association: London; Comas-Herrera, A.; Northey, S.; Wittenberg, R.; Knapp, M.; Bhattacharyya, S., & Burns, A. (2011). ‘Future costs of dementia-related long-term care: Exploring future scenarios’, International Psychogeriatrics, 23(1), 20–30.
 Wittenberg, R.; Comas-Herrera, A.; King, D.; Malley, J.; Pickard, L. and Darton R. (2006). Future demand for long-term care, 2002 to 2041: Projections of demand for long-term care for older people in England. PSSRU Discussion Paper 2330. London School of Economics: London.
 Yeandle, S. (2009) Telecare: A crucial opportunity to help save our health and social care system. London: The Bow Group.
 Milligan, C. Roberts, C. and Mort, M. (2010) ‘Cracks in the door? Technology and the shifting topology of care’, pp 19- 37 in M.Schillmeier and M. Domènech (eds) New Technologies and Emerging Spaces of Care. Surrey: Ashgate.
Alaszewski, A and Cappello, R. (2006). Piloting Telecare in Kent County Council: The Key Lessons: Final Report, Canterbury: Kent County Council and University of Kent.