An engineering approach to elder care

Elder care is usually a domain associated with soft skills such as communication, compassion, patience and consideration; not engineering.

The truth is, however, that the absence of engineering thinking in elder care is one of the reasons that we do it so badly, and at such a high cost.

Over the last 5 or so years we’ve seen the emergence of a fourth wave of internet technology called “The Internet of Things” or IoT.

  • The first wave of the internet was about people accessing information across the network (which evolved into the World Wide Web).
  • The second wave was about people accessing goods and services – e.g. eCommerce such as Amazon.
  • The third wave was about people communicating with other people – the social media phenomenon exemplified by Facebook and Twitter.
  • The fourth wave is about computing devices communicating with other computing devices. It’s come about because of the emergence of cloud computing, low cost computing devices, ubiquitous wireless communication and cheap sensors.

What is the IoT?

Well it’s a lot to do with sticking sensors and processors into things such as vehicles, plant and equipment, buildings and homes to make them “smart” so that they can send information to other systems which are managing those assets.

That Nest or Hive controlling managing your home heating is an IoT device. Every aircraft has hundreds of sensors embedded in it, sending a stream of information to Boeing or Rolls Royce about the performance and health of the engines. Pumps in the water and sewage systems, electricity substations, drilling platforms, earth moving equipment, street cabinets etc. have all got sensors in them and are connected over fixed or wireless networks to management systems.

The sensors come in all kinds: sound, motion, vibration, temperature, pressure, light, video and what have you. And what is all this data for? Well any engineer (or seamstress) will tell you that a stitch in time saves nine… In other words it’s much cheaper to proactively maintain an expensive asset than it is to wait until it fails completely and then try to repair or replace it.  Some extra noise and vibration in a bearing tells you that it’s starting to wear out. This means you can schedule some maintenance, have the parts ready just in time, and take it out of service for the minimum amount of time and keep it running smoothly. All this is obvious to any engineer – but when it comes to people and health, we usually do the exact opposite.

For example, in the UK we don’t monitor gait and estimate when someone’s risk of having a fall has increased to the point where it would make sense to give them some physiotherapy, a walking frame, some grab rails at the front doorstep and maybe a level entry shower.

No, instead we wait until they fall and get injured. Then we send them to hospital for expensive surgery, where those days in bed cause the loss of so much muscle mass that the person is never properly mobile again. The care system provides the money to modify their home so they can cope with their reduced mobility, and provides domiciliary care visits to help with washing, dressing, eating and medication at great cost to the taxpayer.

Proactive engineering

NHS England analysed the cost of proactive versus reactive for a fictional elderly woman and published a report called Janet’s Story https://www.england.nhs.uk/rightcare/2019/07/12/janets-story-explores-how-a-frailty-care-pathway-could-be-so-much-better/

The conclusion was that pro-active care costs half as much and extended life (and good quality life) for many years. No engineer would be surprised at this. But recognising the superiority of proactive maintenance of people’s health isn’t enough to bring about change. Particularly if the change requires upfront investment in training and technology, and the establishment of new organisations and processes. But sooner, rather than later, we’re going to have to think like engineers when we approach elder care. We’re going to have to make that investment in AgeTech because we simply can’t afford the ever growing costs of a reactive approach.

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