Words by Stephen McGrath
Society is ageing fast. Can better, smarter buildings and cities help us to survive the demographic timebomb?
You are old. You wake up, in your own bed, and look up at the camera on the ceiling, which has been looking down at you all night. You find its presence reassuring. Another day begins. While your smartphone takes your blood pressure, a companion robot brings in breakfast, together with your various meds. You know you should get up. You have physiotherapy exercises to do on your games console. And you know the clinic will be analyzing your every move …
A scene from 2050? Perhaps, but it could also be much sooner. Care for older people is evolving rapidly, in response to an impending crisis in demand. The good news is that for the first time in history, most people alive now can expect to be around well into their sixties. The challenge is that increasing longevity coupled with lower birth rates means a smaller global workforce will have to support a much larger elderly population. Health and social care will be on the frontline. As the World Health Organization (WHO) has pointed out, older people have complex health needs, often with multiple chronic conditions and geriatric syndromes, and most health services are ill-prepared to cope.
This poses tough questions for governments and healthcare providers across the globe, especially as rising expectations coincide with pressure on funding and fewer resources to go round. The answers promise to challenge not only established models of healthcare provision but the way in which cities are planned and, perhaps most fundamentally, the distinction between care environments and our own homes.
Forever young: the rise of the over-60s
In 2016, the post-war babyboomer generation began to turn 70. In the longer term, the WHO estimates that the number of over-60s will more than double between 2015 and 2050, to 22% of the global population. In all major areas, apart from Africa, at least a quarter of the population will be in this age group. Advanced economies such as Japan and Germany are worst affected — by 2060, one-third of Germans will be over 65, while Japan’s population is set to drop from 127 million to 87 million, of whom almost 40% will be 65 or older. China too is on the edge of a demographic cliff, with its working-age population set to peak in 2020.
The WHO points out that this collective ageing is also happening much faster than in the past: France had almost 150 years to adapt as its proportion of over-60s rose from 10% to 20%, but countries such as Brazil, China and India will have little more than 20. And there is little evidence that older people today are any healthier than their parents: over the last 30 years, there has been a slight decline in the proportion of older people in high-income countries who need help with basic activities, but little change in the prevalence of less severe limitations in functioning.
An obvious first step is to improve the efficiency of hospital operations, so that a smaller workforce can look after a larger number of patients, while lowering costs. Minimizing walking distances, maximizing patient visibility and reducing energy use are already important considerations for the designers of healthcare buildings. But advances in information technology could remove the need for staff to walk between departments at all, while enabling much more detailed patient monitoring and cutting energy bills dramatically.
One of the most exciting developments in hospital design is all but invisible to patients, but it is set to revolutionise care over the coming decades. Healthcare buildings contain many systems, spanning everything from light control and fire alarms to hospital administration, nurse call and heart monitoring, but they are typically separate and unable to communicate with each other. So, what if there was a single communications platform that united all of these systems? Medical staff and facilities managers would be able to extract the information they needed far more quickly, while other tasks could be automated completely. The data harvested from such a system could also be used to improve everything from user experience to waiting times to buildings’ energy efficiency.
“You’d go to the hospital but you wouldn’t have to go to the admin desk — your smartphone would tell them you’re in the building”Rick Rome, WSP
“You’d go to the hospital but you wouldn’t have to go to the admin desk because your smartphone would tell them that you’re in the building,” says Rick Rome, mechanical engineer and executive vice president at WSP’s specialist healthcare division in Dallas. “They would send you a message to tell you that you’re going to be in room 502 on the fifth floor. So you go straight to your room and the nurse meets you. On a screen in your room, it will list all of your caregivers and all of your procedures for the next three days. They’ll already know your blood pressure because it’s been on your Fitbit prior to your arrival. So you’ve just eliminated two or three steps in the process.” Meanwhile, the thermostat in room 502 has been automatically adjusted when you entered the building so that it’s a comfortable temperature: “That’s improving the energy efficiency of the hospital too because you’re not air-conditioning rooms that aren’t occupied yet.”