Homes for Healthy Ageing: the role of innovation 

The social and economic impact of COVID-19 across the UK (and indeed the whole world) is truly unprecedented. It has also been hard-hitting demographically, not least for our elderly population, whose vulnerability to the pandemic has been exposed in the starkest terms. Not only are they at greater risk of harm from the coronavirus itself, but they are also more profoundly affected by the stricter social-distancing rules put in place to protect them against it.

The home – once considered an Englishman’s castle – can under the current conditions increasingly feel more like a prison. Whilst the challenges presented by an ageing society have been discussed in the UK for a long time, this pandemic throws into sharp relief the scale, significance and urgency of the challenges we are facing – both now and into any future that might emerge from the lockdown. And given the likely enduring nature and impact of the pandemic, it is that urgency with which we need examine the issues facing our ageing society that is increasing – especially when it comes to thinking about what can be done to make homes feel like safe places of refuge once more.

The scale and significance of the challenges
A recent ONS figure (8th May) shows that nearly 90% of COVID-19- related deaths registered in England and Wales have been among people aged 65 and over1. But this disproportionately high death rate is not simply due to the heightened vulnerability of the elderly to the virus – it is also indicative of the expansion of the UK’s elderly demographic: today, nearly one in five British people are aged 65 years or over, and this proportion is on course to reach one quarter of the population by 2050 2.

As people get older, their health can deteriorate significantly. With
time spent increasingly indoors, the quality of their homes has a pivotal role to play in health and wellbeing. However, the majority of older people are living in mainstream housing, which is often not fit for their needs. Below are just some of the key issues most likely to be exacerbated by the COVID-19 pandemic:

• Lack of care – Based on a study by the Local Government Association, less than 1% of over 65s are living in housing with care3, and many others do not receive the care and support they need for basic living functions. The pandemic has made this situation worse: as well as the higher risks of dying from COVID-19 itself, elderly people are also at increased risk of morbidity and mortality from other acute and chronic diseases due to reduced non-COVID-19 care4. We have all seen the devastating impact of the pandemic on care homes – but even looking beyond the acute phase of the pandemic, the ongoing impact of COVID-19 is likely to exacerbate the current care-related challenges. Future care arrangements will need to accommodate strict hygiene regimes and the threat of regular lockdown will disrupt the ability of suppliers to provide regular in-home care support.

• Digital exclusion – A report from Centre for Ageing Better shows
that people aged over 55 make up 94% of those who have never been
online within the UK5. This digital divide becomes more worrying in
the COVID-19 context as more services such as shopping or interacting
with local authorities move online. The issue is particularly acute
among the poorest who rely on ‘pay as you go’ services and struggle
to afford data6.

• Social isolation – According to Age UK, nearly a third of people
aged 65 and over live alone in the UK, and 1.4 million older people
regard themselves as ‘often lonely’7. Confronted with higher risk of
becoming severely unwell with COVID-19, elderly people are also
required to follow even stricter social-distancing guidance and avoid
gathering with friends and family. Those who have been living alone
are literally forced into a state of social isolation for the duration of
the pandemic. This would inevitably have a very negative impact on
their mental health and may lead to a range of other poor health
outcomes. For example, insufficient exercise due to self isolation
could result in health deterioration with subsequent fragility and
falls, whilst a decrease in cognitive stimulation due to lack of contact
with the outside world could aggravate cognitive and behavioural
symptoms associated with dementia8. In particular, social isolation will
disproportionately affect single seniors whose only usual social contact
is outside their homes, such as at churches, community centres and
day-care facilities9.

Other issues often affecting older people’s quality of life at home
include dementia, a lack of accessibility and safety issues. All these are
challenging enough on their own, but in reality they are usually combined and compounded by other issues such as underlying health conditions and poor-quality housing stock. As is now widely recognised, the UK still has some way to go in enabling its older citizens to live healthily for longer in their own homes.

Innovative approaches to tackling the challenges
Looking again at the three challenges outlined above, a variety of innovative solutions already exist:

• When it comes to the provision of care, there are various
approaches to delivering complementary or alternative care. The most
common are telecare services, which make use of environmental and
personal sensors to monitor the safety and wellbeing of the elderly,
thus enabling rapid response to concerns or incidents. There are also
initiatives exploring how robots could be used to provide preventative
and supportive care for elderly people at home. For instance, in an
Innovate UK-funded project, engineers worked with elderly people
and care providers to develop a prototype robotic system that could
support older people with basic movements at home. The technology
responds to voice, gestures or touchscreen commands, and has the
potential to work with other smart devices to track users’ health and
wellbeing, in order to reassure authorised third parties, e.g. relatives or
carers.

• Digital inclusion initiatives for the elderly include nationwide digital
training programmes, such as NHS Widening Digital Participation and
One Digital, both of which provide digital training and support to help
create ‘silver surfers’. There are also initiatives to install smart home
devices or create bespoke applications to demonstrate how digital
technology could support independent living for longer. For example,
in a DCMS funded initiative in West Essex, some digital-savvy elderly
people opened up their homes to be kitted out with new technologies,
and the homeowners themselves were trained as ‘digital boomers’ to
help other older people improve their digital skills. Another Liverpoolbased initiative saw a tech company develop an age-friendly shopping app called ‘Helping Hand’, which connects directly to a major
supermarket via a user-friendly interface, thus enabling elderly people
to shop online more easily.

• Approaches to reducing social isolation include smart
communication technologies that enable elderly people to be better
connected with their family, friends and the wider community. New
living models such as senior co-housing or intergenerational living
allow elderly people to live in self-reliant but socially inclusive and
diverse communities. A good example of this is the Older Women’s
Cohousing Community in North London – a senior community created
and managed by like-minded females, with the aim of reducing
loneliness and enriching later life in a collective way.

Gaps, opportunities and the way forward
As illustrated above, a range of approaches have the potential to help
older people live and thrive in their homes and help mitigate problems
that COVID-19 has exacerbated. Nonetheless, challenges remain. There are various reasons for this.

1. The market for smart home based solutions is nascent and often, the
products have been developed for general-needs rather than
specifically for the elderly. And of course, none of them accounted
for the impact of COVID-19. A user-centred design approach to repurposing these tools would help drive adoption and impact.

2. There are also market co-ordination barriers. Whilst no one
council working in isolation would offer a big enough market for
the development of an ideal solution, collectively the market is huge.
Similarly, the savings that preventative-technology-driven approaches
could deliver to the NHS are substantial – but it remains unclear by
what mechanism the NHS could subsidise such approaches in order
to realise the benefits.

3. In the business to consumer market, the challenge is that the
technology solution alone is often not enough. It would need to be bundled with a service package to be effective – but the big technology companies who can achieve scaled production are typically not interested in the service business. The latent potential in this space is evident. The ageing population represent a large and growing market and the needs they have are clear enough in calmer times, and become ever more pressing in the era of COVID-19 and whatever comes next. To unlock the opportunity, we need to deconstruct the systemic barriers referenced earlier and bring together different parts of the ecosystem to create value propositions that are attractive to all parties. Sometimes all that is needed is for someone to take the difficult first step. After all, the best business to be in is that of the ‘fast follower’.

With this in mind, Connected Places Catapult are bringing together
stakeholders from across relevant sectors to take action and move the
ecosystem forward. We are inviting key players from across industries to
work with us on a series of healthy-ageing housing pilots across different
parts of the UK to test and refine new ideas.

For each pilot, we will:
• Collaborate with relevant stakeholders to deepen our understanding of
the specific challenges facing the local areas.
• Bring together technology suppliers, local authorities, housing
providers and health and care professionals to develop solutions.
• Open up the opportunity space to a wide range of solution providers
through a challenge-based open call process.
• Focus on solutions with the potential to scale and map out next steps to
achieve this.
• Build validated business cases to allow the wider roll out of these
solutions. We are agnostic to the route to market at this stage: there
may be viable business to consumer propositions, but we are also
interested in exploring models which involve a range of stakeholders
from local NHS trusts to large corporates through to smaller community
organisations.

As a neutral party in the ecosystem, part funded by government but
independent from it, and with strong connections to academia, start-ups
and place leaders, Connected Places Catapult is ideally placed to help
overcome the system level challenges which are holding back the wider
uptake of innovation in the healthy ageing space.

If you would like to get involved, then please do get in touch
(email info@cp.catapult.org.uk). We will be focusing on areas of the UK
with large and growing populations of elderly people; where the need is
greatest – we’re ready and waiting to hear from you.

1 Office for National Statistics (2020). Coronavirus (COVID-19) roundup. 2020.
2 Local Government Association (2017). Housing our Ageing Population.
3 Local Government Association (2017). Housing our Ageing Population
4 Steinman MA, Perry L, Perissinotto CM. (2020).Meeting the Care Needs of Older Adults Isolated at Home During
the COVID-19 Pandemic. JAMA Intern Med.
5 Centre for Ageing Better (2018). The digital age: new approaches to supporting people in later life get online
6 The Guardian (2020). Digital divide ‘isolates and endangers’ millions of UK’s poorest.
7 Age UK (2019). Briefing: Health and Care of Older People in England 2019.
8 Steinman, MA., Perry, L., Perissinotto, CM. (2020). Meeting the Care Needs of Older Adults Isolated at Home
During the COVID-19 Pandemic. JAMA Intern Med.
9 Armitage, R. and Nellums, L. (2020). COVID-19 and the consequences of isolating the elderly. Lancet Public
Health.

Erin Walsh is Director of Built Environment and Bin Guan is Built Environment Researcher for the Connected Places Catapult