The paper tries to analysis the current scenario of technological supports in the health service of the developed countries to assess their replicability in the developing regions. Secondary data have been used for the analysis and a framework has been developed to reach the objectives. The analysis has yielded important insights into the necessity of technological intervention to the health services in the developing countries in the form of mobile health services, tele-nursing and IPTV solution for e-learning to face the challenges of ageing people in the future. The paper ends with a future direction of specifying on implementinge-health in the health service sector of the developing countries.
We are living in a time of profound changes in economic, social, and political environment which bring both challenges and opportunities for us. When health service systems come into consideration, the most challenge of these changes is the impact of population ageing on social life.
According to the report of the Ageing Societies Working Group, in 2012, people
aged 60 years and more was 0.8 billion and made up 11% of the world’s population.
By 2030, they will be 1.4 billion and make up 17% of the world’s population. By
2050, they will be 2 billion and make up 22% of the population. In 2047, for the first
time in human history, a higher proportion of people in the world will be aged 60 and
over (21.0%) than aged below 15 (20.8%). The age distribution of the population is
shifting towards older ages across most countries, due to a combination of declining
mortality and falling fertility rates [
In the more developed regions, 22% of population is already aged 60 years or over
and that proportion is projected to reach 32% in 2050; whereas just 9% of the
population is today aged 60 years or over but that proportion will more than double by
2050 in developing countries [
Though the majority of the world’s elderly resided in more developed regions,
recent statistics shows that 59% (more than 248 million of the roughly 418 million
persons age sixty-five and older in the world) of them now live in developing
countries. In future, the distribution of the world’s elderly will continue to shift
significantly to the developing countries (67% in 2020) [27] . When examining the
projected increase in the global elderly population over the next half century three
patterns appears: relatively small increases in most of Europe which is below 50%;
large increases in countries with high immigration in recent times like 135% in
Canada; and the highest percentage increases in developing countries e.g., 200% in
Bangladesh [
It implies that the population ageing is occurring fastest in less-developed countries, which have consequently less time than developed countries to build the infrastructure and tools to deal with this major social transition.
Infirmity, dependence, incapability and increasing levels of disability and dementia
are associated with ageing throughout the world. As a result, elderly people make a
new segment of market for health services as they bring new types of needs. These
needs require and motivate investments and funding on innovative technologies that
put up with the predicted needs of an aged population [
Different types of service tools have been developed to help people with physical
and sensory deficits due to old age. Lift-chairs and ergonomic handles are the
examples of such service tools that do not rely on computer technology. On the other
hand, there are service tools that rely on artificial intelligence and other advanced
computer-based technologies like text-to-speech systems, digital programmable
hearing aid [
Hence, this demographic shift has important implications for developing countries
such as Bangladesh, Pakistan, and India as their populations’ age and live longer, the
demand for treatment of non-communicable diseases will increase. Moreover,
longevity is associated with illness such as heart diseases; dementia, arthritis, and
diabetes of ageing that are more complex and expensive for treatment [
Most of the researches conducted on future trend of the demography in developing
countries emphasizing on social issues like education, marital status [
In addition, lack of research on recognition of role of scientific research and
technological innovation result in an obstacle or a barrier in the field of reducing the
diseases for the elderly. Moreover, lack of scientific and technological capacities
brings inequalities in public health between developed and developing countries [
Against this picture, to the best of our knowledge, there is no holistic picture of the role of technology in meeting the needs of the health services of the emerging elderly people in developing countries. This lacking suggests the necessity to conduct a research study that will help to get a deeper understanding through exploring the current scenario relating to technology-based different services to the elderly people in developed nations. The derived lessons, after analyzing the scope of replication, can be used to take the necessary steps for facing the challenges of elderly people for developing countries.
This conceptual paper will try to explore the aspects of technologies that are being used for supporting the elderly people with the aim of responding to the following research questions: How developing countries can deploy technologies for improving the health services of the elderly people? To answer this main research question we tried to explore the current scenario of ageing society in developed countries and how the elderly people are supported by the technology.
A qualitative research has been conducted based on the dimensions of health
conditions and technological tools for the elderly people. A broad literature review
has been done for the basis of this paper. Relevant books, research papers, online
materials, relevant reports have been used as secondary data for the analysis. Data
were so collected have been analyzed and presented in a logical order to answer our
research question. Ageing and Health Sustainability Framework [
Ageing and Health Sustainability Framework has been developed by the report of the Ageing Societies Working Group 2012 which consist the key actions and innovations that would help countries assess and enhance the robustness of their health systems. The objective of developing this framework is to create benchmarks for countries to gauge the sustainability of their health and care systems and to target innovations where they will make the most differences by assessing their readiness for the challenges and opportunities of the ageing revolution.
After highlighting the needs for all countries, to make a comprehensive response that addresses the different aspects of an ageing population and health care and enables the various countries to learn from one another, the framework has been developed.
1.Understand the Challenge 2.Create the Vision 3.Assess Performance the 4.Implement new ways of working Do we understand the challenge that an ageing population presents to our health and care system?
Do we have a clear vision about what we want our health and care system to look like in the next 20 years?
Is the financial system right? Are we doing enough to help families to provide informal care? Are we doing enough prevention to reduce demand for care? Are our operational systems working to best effect? Are we getting the best value in the way we supply care at home?
Take actions to implement innovations that build sustainability Review the decisions against the challenge and our
vision
Fig 1: The Ageing and Health Sustainability Framework Fig 1: The Ageing and Health Sustainability Framework
The framework is consists of four steps – to understand the challenges of ageing societies, to create a vision for the health system in 20 years , to assess the present performance and to implement new ways of working i.e. the framework is so developed that help to understand the challenge now and in future, to know the requirement to achieve in improving the health and social care of older people over the next 20 years, to have a comprehensive approach that draws on other countries’ experience and innovation as set out in the Ageing Forum Report, to assess the performance and to implement new ways of working. The sustainability Framework covers four key areas- Getting the financial system right (reconciling growing demand with limited resources), Helping families to care (increasing the supply of informal care), Prevention and Self-Management (reducing the demand for care), and care at home and in the community-and the report showcases innovations in each.
Besides, methodology that was used to develop this framework is very concrete as it includes literature review relevant to the main themes of demographic changes, ageing, health and social care; semi-structured interviews with over 25 experts from different fields ranging from academia to NGOs like WHO, NICE International, HelpAge International, Alzheimar’s Disease International and so on. Moreover, this framework is developed to measure the sustainability of the health system for the elderly people, a modified framework based on this framework may help us to identify whether the existing health services tools of the developed countries are sustainable and replicable for the developing countries.
Hence, we consider this framework as a strong background for evaluating the sustainability of the health system of developing country and construct a new and modified framework based on this for the research. Therefore, a modified framework based on this framework has been used in this research which is shown below (Figure: 1). It is being used in the research for evaluating the current usages of technology for the health care systems in the developed region and the potential of the replication in developing regions. It is expected that this framework will help to measure the effectiveness of the existing technologies and to identify the potentiality of the replication of these in the developing regions.
In order to match with the purpose of our research we use the framework by modifying its area of assessing the performance only into how the technological tools for supporting the elderly people are working to best effect in developed region? Keeping the objective of the research in mind the framework has been modified in the following way.
1. Understand the challenge Present situation of ageing and technological tools for the elderly people in developed countries Create a vision of having such technological tools that will help the developing countries in the next 40 years Assess the performance of the existing technological tools in the developed country
replicate technological tools in the developing country
With this framework the study tries to explore the current scenario of ageing and the technological tools that are used for the elderly people in the health sector of developed country. This scenario is a challenge not only for the developed country, it is also considered as a challenge throughout the world. Then, it tries to create a vision of having such technological tools that would help the developing countries in the next 40 years. Thereafter, the study assesses the performance of the existing technological tools to understand whether these countries are capable enough to face the challenge with the existing technological products for the health services. Finally, it decides on whether it is possible to replicate the technological tools in a developing country or not.
Health is considered as the most important parameter for ensuring quality of life and health is very significant for active ageing. Nonetheless, diseases are associated with ageing. Though both chronic and degenerative diseases are associated with age, degenerative diseases are more closely related to old age. In all countries, the most common diseases of the elderly people are related to sight and hearing disorders, frailty, dementia, cardio vascular diseases, fear of falling, mobility problem and so on. Yet, the scale of severity is different in developed and developing countries.
Among the developed countries, 5-10% of older people who live in community
settings are categorized as frail and around 20-40% exhibits some signs of frailty in
Finland. In the UK, 20% of the older people living in the community experience
urinary in continence. Dementia is primarily associated with older people. About 35.6
million people around the world live with dementia and it is projected that it will
reach at 115.4 million in 2050 [30]. In the developed country, among people over 60
years and above, Alzheimer’s and other dementias account for 9% of lost healthy
years due to pre mature death and disability [
In developing countries, the scale of sight and hearing disorders is much larger
than in developed countries. Vision, hearing and mobility are considered as the
biggest challenge arising from ageing for India [
Fear of falling is an alarming issue when the body ages. A survey on the
Norwegian elderly people found that around 25% of the respondents had experienced
a fall in the preceding six months of the survey time. Of those, more than one-half
reported that their most recent fall had led to an injury and roughly 15% said it had
resulted in a fracture. Similar data have been found in other research reports on same
issue in Europe. In the US, according to the CDC, falls are the leading cause of
injury-associated deaths among the over-65s, and are the leading cause of non-fatal
injuries and hospital admissions for trauma among the same group. It is also found
that the fear of falling can in itself place great restrictions on mobility and causes
social isolation which leads to further negative outcomes [
However, no data have been found relating to the fear of falling for the developing countries.
Science and technology are central to the lived experiences and normative
definitions of health and illness for ageing people. From pharmaceuticals, to walking
aids, to cell phones, old people interact with technologies and science on a daily basis.
Everyday technologies as well as biomedical interventions can be part of the way
older adults pursue, maintain, and negotiate life [
A growing range of technologies and information systems are now available that are used to promote health, safety and social connectedness as the basis for healthy longevity. Smart technologies are available to enhance safety, security and surveillance [16].
In the developed country new technologies are now available to help integration
and deliver care at home and communities to the elderly people. In Denmark,
telemedicine is used in standard patient treatments [
Similar to this, in USA “Smart Personal Advisers” are used that use radio
frequency identification and wireless technology to make an individual’s personal diet
information available on a screen based device that offer them in-store guidance while
shopping for food and intelligent cardiopulmonary decision systems that apply
telemedicine to provide early detection of and warning about patients at risk of
congestive heart failure [
However, most of these technologies are neither available nor easily replicable in
developing countries. There are two reasons behind this; one is the cost of the
technology. Around 75% of the people of developing countries live in rural area and
most of them are poor [
Population ageing is happening in all regions and in countries at various levels of development. It is progressing fastest in developing countries, including in countries with large populations of young people. Although population ageing poses social and economic challenges to individuals, families and societies, with the right policies in place, societies can prepare for an ageing world, address the challenges and take advantage of the opportunities.
The economic and social consequences of aging are considerable, particularly with regard to the increasing burden of dependency. These consequences in the industrialized nations of Europe and North America have been well publicized. However, less is known about the effects in less well developed regions [27].
Sound health is highly correlated with population ageing. Developed countries are ready to face this challenge with adequate latest system of medication and technological tools for providing the sound health to the old people in their daily lives as they are more prone to different old age diseases. Mostly, the elderly people suffer from visionary problem, Alzheimer`s Disease, dementia, cardio vascular disease, diabetes, prostate enlargement, frailty are also common as old age diseases. Technology is being used to provide health services to the older in the form of assistive technology.
Generally assistive technology can assist older people with cognitive impairment in three ways. It provides assurance that the elder is safe and is performing necessary daily activities, and, if not, alerting a caregiver. Assurance system tracks an elder’s behavior and provides up-to-date status reports to a caregiver. It helps elder compensate for his or her impairment, assisting in the performance of daily activities; and it assesses the elder’s cognitive status.
Compensation systems gives direction to people as they carry out their daily activities, reminding them of what they need to do and the way of doing it. Assessment systems attempt to assess the activities i.e. how well a person is doing by comparing what her current cognitive level of functioning of with her performance of routine activities by continuous observations [27].
At present, 7 of the 15 countries with more than 10 million older people are in the
developing world. By 2050, another 15 countries currently classified as 'developing'
are expected to have 10 million or more older people. This generation is growing at a
faster rate than the total population in almost all regions of the world [
A growing range of technologies and information systems are now available that can be used to promote health, safety and social connectedness as the basis for healthy longevity in the developed countries. It ranges from telemedicine to artificial limbs to smart home.
Tele-health for professionals is more developed, with comparatively strong evidence for efficacy for people with chronic conditions such as diabetes, heart disease, arthritis and stroke.
It is very obvious that old people lose their mobility over time; most of the times
they tend to remain at home. However, when the suitable technology, like wheel
chair, for moving around is introduced their scope of mobility can once again
increased [
53% of American adults ages 65 and older use the internet or email. Though these adults are still less likely than all other age groups to use the internet, the latest data represent the first time that half of seniors are going online [41]. If this becomes a trend in all other developed countries, it can be inferred that the online tool which is currently being piloted in UK for families and friends caring for someone with dementia will be very effective in near future.
Inappropriate use of pharmaceutical drugs is a common reason of visits to hospital
and emergency units. Many older people used to take more than four or five different
medications. In Finland, an estimated 40–50% of hospitalizations among older people
results from the improper use of medicines. Hence, device like talking pill bottle : a
single function standalone device that assist visually or cognitively impaired patients
in accessing recorded medication information. Kaiser Permanente has implemented
this technology in over 140 facilities [
As there are number of constraints in replicating the technological support tools for the elderly people in the developing countries, it is required to implement new ways that is compatible with the existing resources with technological intervention.
Technology is playing a vital role in the health service of the developed countries
for the elderly people. However, it is not possible to imitate all of them because of the
poor infrastructural facilities and cost in the developing countries. A healthy condition
of the infrastructure is an important source to thrive innovation. Most of the
developing countries face the problems of insufficiency of these infrastructures [25].
Most of the people of developing countries are poor and those technologies are not
affordable by them [
Mobile companies set up networks throughout developing nations and sales of
inexpensive mobile phones soared into the millions despite the low incomes of their
people. Even in case, when the mobile phones are not available to people, creative
entrepreneurs make them available locally for a per-use fee. Moreover, it is such a
technology that does not require continuous supply of electricity [
Moreover, The Grameenphone Community Information Center is a shared premise
where rural people may access a wide-range of state of art services such as Internet,
voice communications, video conferencing and other information services in
Bangladesh. This initiative by Grameenphone (the leading mobile operator in
Bangladesh) is in line with the company's objective to serve local community needs
by bridging the "digital divide" by providing information access to rural people,
educating the underserved and underprivileged on information-based services. These
centers are a unique business model that has won appreciation from the International
community, such as from the Washington Post, from UNDP, as well as the blessings
of several International bodies like Katalyst and the GSMA. The pilot project started
in February 2006 with 16 CICs in the rural areas of Bangladesh; today the project has
become a massive operation with over 500 CICs operating in nearly 450 sub-districts
[
Besides, nearly 73 per cent of households in developing countries are covered by
television [
Hence, this can be inferred that there exists a vast scope of technology interventions for welfare of elderly people in the developing countries so that the technologies are accessible, affordable and adaptable to the specific needs. Therefore, we need to think for new ways of working for the challenges due to the ageing in future in the health services sector in the developing countries.
Mobile Health Services - Mobile health services could a possible solution to the health services of the ageing people in the near future in developing countries because market penetration is approaching 100% even in the developing countries.
Mobile phones have many advantages when used as a healthcare tool. It helps to
send text messages and make phone calls at real-time for critical information quickly
and easily. Ultimately people who are living in remote areas can reduce unnecessary
travel to health centers for health services. Smartphones and broadband-enabled
devices can become medical devices/tools, used for monitoring vital signs and body
functions or as videoconferencing equipment, facilitating remote consultations even
in the developing countries. In the developing countries where resources are under
increasing pressure, mobile health service has the potential not only to cut costs but
also to free up badly needed capacity. As we discussed earlier, for developed
countries with aging populations, sensors connected to home alert systems improve
safety and prevent needless deaths through accidents or falls. Similar services can be
provided through mobile technology. Mobile technology can do everything from
checking on patients’ vital signs to sending individuals reminders to take their
medications on time [
Tele-nursing - In many developing countries, like Bangladesh, Pakistan, and India lack sufficient numbers of skilled healthcare workers—physicians, nurses, and specialists—to serve their populations. This situation has been worsening by the migration of healthcare workers over the past three decades to mature markets. In this situation, tele-nursing could another way of providing health services to the elder people in the developing countries. Tele-nursing refers to the use of telecommunications and information technology in order to provide nursing services in health care whenever a large physical distance exists between patient and nurses. As we discussed earlier mobile telecommunication is diffusing in the developing countries in a high rate, therefore, there is a place for tele-nursing for providing health services to the elderly people in the future. Moreover, Community Information Center can also play a significant role in this case by bridging the gap between patients and the nurses. As most elderly people prefer home care to residential care, tele-nursing is essential to allow elderly people to maintain their autonomy by strengthening their emotional, relational and social abilities. As tele-nursing is considered as complement to traditional nursing practices and as the elderly have appreciated the opportunity to use video-telephony to communicate with a nurse about their needs, expectations and feelings, tele-nursing could be another way of supporting the elderly people in the developing countries for their health care.
IPTV Solution - IPTV could be another solution to the health services to the elderly people of the developing countries in future. This could be done through elearning of the health practitioners. IPTV is a nursing communication and management system using IP technology that can be used for both wired and wireless connections. In the developing regions, if training can be provided to the nurses for working on IPTV, they can have a contact with the patients who are in the remote place. The system is comprised of a set of push buttons and wireless sensors which make it possible for nursing staff to keep track at all times of the state of each patient or resident, thereby increasing their safety and comfort. In Australia, IPTV has been used in a pilot survey to measure its effectiveness as a distant health tool. It is considered as a tool that can be used to lower the rate of diabetes and to cut and manage the cost of the treatment [26]. Though the initial cost would be very high, with the increase in volume it could be decreased over time. According to International Telecommunication Union (ITU) coordinator Masahito Kawamori, it is expected that in near future people of developing countries might consult their medical doctors through their television sets at home, by using an IPTV [24].
Such technology can be used for the people who are not very familiar and comfortable with computer as TV is like a very common item in the household. If it is possible to train the nursing staff for IPTV, it may possible to provide necessary information by the trained nurse who interact with people in need and their caregivers and who are able to personalize the information and distribute it, especially to remote and regional areas in the developing countries.
The above analysis has yielded important insights into the necessity and of introducing technology in the health service sectors and showing the way out of the developing countries for meeting the challenges of the time ahead for ageing population. Presence of technological interference as health care tool in the developed countries provides an opportunity of learning lessons and innovation for the developing countries. Developed countries are well prepared for facing the challenge of ageing population as the scenario is approaching to them gradually. Moreover, researches are being conducted for coping up with the situation in a more affluent way in these regions. With the help of mobile technology or Community Information Center (CIC), developing countries would be capable of facing the challenges of health service problem related to ageing in the future. In this regard, exploring potentials for the implementation of e-health in the health service sector in the developing countries is considered as a realistic option for future work. Leveraging innovation to achieve sustainable health service systems that deliver defensible health sector builds the way forward strong for facing the challenges ahead and improving the quality of life in the developing countries.
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