How robot seals and intelligent toilets are transforming care for older people

30 Nov 2017 Nick Garbutt    Last updated: 30 Nov 2017

Paro the seal. Pic courtesy of Sense Medical Ltd

Our oldest people are suffering the most as the health service falters in the face of overwhelming demand. 

Yet in the latest in our series on innovation Scope looks at how one country is dealing with the problem of an ageing population and creating a booming industry out of what it calls the “welfare economy.”

Japan has the oldest population on earth, and is also one of the most technologically advanced. Currently 25% of the population is over 65 and it is on course to reach 40%

Life expectancy is the world’s highest at just under 83.4, fertility rates are low and there is an aversion in the country to fill the gaps in the economy through immigration.

It has left Japan with only one option: to invest heavily in new technology to prevent the collapse of its health system. If anyone wants to know what the future holds for older people some of the answers are to be found here.

The Japanese are not just thinking about using robots to help care for older people – they are already using them.

The best-known example of this is Paro the robot seal which was invented by Takanori Shibata, the chief senior research scientist at Tsukuba's National Institute of Advanced Industrial Science and Technology. It is used to reduce anxiety, stress, depression and even patients' perception of pain during chemotherapy treatments. Dr Shibata says the seal is especially useful for calming dementia patients and stops them from wandering around. It has often replaced heavy doses of psychotropic drugs. Why a seal? Apparently because dog lovers don’t like robotic cats and cat lovers don’t like robotic dogs.

A humanoid robot – called TwendyOne has been developed at Wasedi University which can help people out of bed, retrieve food from fridges and even deliver trays of food. It currently exists in prototype form only and is yet to be mass produced. The same applies to a robotic suit developed by Cyberdyne Inc, which promises wearers help in their daily tasks, allowing them to lift more than they could unaided.

Big business is powering most of the new products designed for older people in Japan. Panasonic has launched a bed that converts into a motorised wheelchair so that users can get out of bed without help.

In Japan the move towards driverless cars is being powered by demand from older people. Toyota is creating intelligent cars that monitor brain activity in the elderly. The idea is the car will learn the driving patterns of the user, then curb any unusual and dangerous activity. For example, it would automatically slow the car if it senses the driver is hitting the accelerator for no reason.

Even the toilet manufacturer Toto is getting in on the act. It has designed loos with medical sensors that measure blood-sugar levels based on the urine, and the blood pressure body fat of the user. The data is emailed to the local GP through a built-in internet device.

Remote care is an emerging theme in Japan with sessions with GPs increasingly held online – although older Japanese people apparently prefer to do this using TV remotes rather than keyboards. There are even devices to help relatives monitor their older relatives – like the kettles that are connected to the internet, so children can be reassured when their parents make their morning tea.

All this is powering a huge new industry in Japan which has a series of bio-medical research hubs, the most famous of which is on a man-made island in Kobe.

In Japan there appears to be no option but to supplement traditional care with automated solutions. This is likely to accelerate. The average age of doctors in the country is 58, so a shortage of medical professionals is also looming. We can therefore expect Japan to be on the forefront of using Artificial Intelligence for diagnoses and introduce robotics into operating theatres.

In many respects this sort of change is both necessary and inevitable. Health services have not seen the kind of increases in productivity evident in industry – productivity today, across Europe is still roughly the same as it was in the 1990s.

Japan may have the oldest society on the planet, but all western countries are on the same trajectory – an ageing population bringing with it an increase in chronic conditions, supported by health systems which are no longer fit for purpose.

Technology will provide some of the answers – lives are already being saved in Rwanda, for example, thanks to a world-leading drone project for transporting blood to remote hospitals. Elsewhere work is underway to refine technology that already exists, to remotely monitor peoples’ health through so-called smart clothing and devices similar to modern sports watches.

In the USA there is currently considerable research going on into how Artificial Intelligence can help palliative care. For example an alogrythm has been developed by researchers at Stanford that can help doctors’ to develop care packages by predicting when patients are going to die.

In Boston 360 patients who have been told they have less than a year to live have been issued with tablets which have been preloaded with a chatbot which they can talk to about their concerns and the levels of pain they are experiencing. This will test whether or not AI programmes are actually better than humans in helping to care for the dying. The thinking behind this is that humans are actually more honest and open with machines than with fellow humans.

 Change will require a courageous and bold approach from government which will involve difficult choices. Japan has excellent services for older people, but the high standard of care for older people is funded via an insurance scheme which was introduced to supplement the state health care system in 2000. The dwindling number of tax payers would not provide enough revenue without it

However there will be a further price to pay. As we adopt more automation, and treatments become more remote, we cut people off from human contact. Conventional wisdom suggests that this will mean loneliness and isolation will grow. Loneliness is in itself a major factor in poor physical and mental health. The Boston experiment into the experience of dying will test whether humans truly are better than machines at empathy.  

Our current crisis in domiciliary care and the growing shortage of nurses could all be helped through the adoption of technology already available.

What we need is a debate about how this should be used. Health care professionals and those Third Sector organisations who work with older people need to be at the forefront of this. These changes are happening right now not in some distant future – and if we are not careful we will be not so much helping to shape a better future as raging against the machines.



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