The mobile internet: what it means for future markets in ageing and changing societies
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Maintaining independence and physical activity is vitally important in successful ageing management, states Kerstin Wessig. Digital technology can provide a platform for doing so.
As societies become older, the proportion of employed people in them declines. There are three potential solutions: immigration, a drastic rise in the retirement age, or an increase in work productivity through operational automation. None of these are feasible or socially acceptable solutions to deteriorating dependency ratios.
One alternative can be found in maintaining the independence, mental and physical activity, and self-determination in ageing people through the use of socially integrated mobile, internet applications and systems.
That is one reason why the market for the use and aggregation of mobile, structured data, applications and localised information in mobile applications is growing rapidly, in particular in areas related to personal use, health and services. In the future, data that can be generated from the linking of informational content, especially from the use of mobile sensor and actuator systems, will make a substantial contribution to economic growth. With given demographic trends, they will most likely have a particular impact on the healthcare, real estate and insurance industries; as well as leading to healthcare cost savings.
The aim is to employ mobile pervasive assistance functions to enhance the economic power of companies; to improve the interaction between buildings and people; and to allow ageing people to keep actively participating in social life. This will allow the optimal use of the existing professional care and medical resources and contribute to economic growth.
In 2020, 20% of the world's population will be older than 65 , , , . This represents more than 200 million people in China alone , , . As societies become older, the proportion of employed people in them will decline. With the average life expectancy also rising, there is also an increased risk of care being required for those of advanced age . With a drastic decline in the formal care resources available (inpatient and outpatient care for the sick and elderly), the extra time and expense needed for care and nursing will negatively affect the professional potential of younger generations. It will further impact the female employment rate, as unstable familial care arrangements must be made due to the lack of professional staff , .
In the Western world's rural regions in particular, the population is now clearly thinning, while the relative proportion of elderly people is increasing. This means that economic growth – including healthcare – will fall, as the number of culturally and structurally integrated professionals in rural areas declines , .
There are three potential solutions: immigration, a drastic rise in the retirement age, or an increase in work productivity through operational automation. None of these are feasible or socially acceptable solutions to deteriorating dependency ratio .
Growing demand for mobile technologies for the elderly
One possible approach to maintaining independence, mental and physical activity, and self-determination in ageing people in their living environment, is through the use of mobile, technological internet applications and systems that are socially integrated . In these systems, the focus is always on people.
In this way, socially responsible family structures, human resources and economic prosperity can be maintained. It can lead to greater value creation potential for companies that provide such solutions in the form of products, services and complex, socio-technical systems .
It is not only in the younger generation that digital natives are to be found, but also, increasingly, in the highly heterogeneous group constituted by the elderly. Thinking of the elderly one-dimensionally as digital immigrants, simply on the basis of their age, is out of date. Instead, there is a greater awareness that technological affinity is not solely dependent on age, but tends, on the contrary, to be oriented around education and gender factors.
Many older people are now managing a range of blogs and wikis, while also developing their own Web 3.0 applications. The market for the use and aggregation of mobile, structured data, applications and localised information in mobile applications is therefore growing rapidly, in particular in areas related to personal use, health and services , ,.
Through the networking and integration of existing technological knowledge, along with manual skills and established corporate structures, mobile product-service systems can be offered in order to help ageing people. These help maintain independence in their normal environment and keep participating in family life, society and even work (by working at home, for example) despite declining physical and cognitive abilities , ,  ,, , .
Mobile, sensor-based information and communication systems offer support through the provision of technical service functions that are individually adapted to the needs and limitations of each user, while also helping to save energy.
Examples include mobile "smart home" applications, as well as health-related applications and mobile purchasing, logistics and work systems that make it possible to work from home. These must be evaluated by means of empirical investigations, user studies, usability tests and living environment studies .
In particular, there is already rising demand for technologies and products for use in the home environment. These range from emergency call systems through telemonitoring systems and mobile-controlled systems for energy and household appliances, socio-technical services and technologies. They further include system solutions for goods provision in daily life; technologies for maintaining social contacts and communication; the development of social organisations; the maintenance of care communities; simplified interactions with authorities; and the enhancement of participation in cultural life.
To satisfy these requirements and meet these needs, it is necessary for older people to remain in their home environment, thus also supporting the development of their communities. If it proves possible to meet these needs from within a given region, this will also lead to new employment effects in the region, boosting regional development. If, in addition, some of the necessary (technical) innovation can be generated in the region itself, this increases the development stimulus it generates , .
Intelligent mobile data that is linked and structured
The semantic web can be used both in the healthcare market and in a "smart home", for example, to generate more meaningful, personalised and entirely new links to a range of information. This will be in the first instance for individual users, such as information on the monitoring of health behaviours or energy consumption in the home. In addition, many data sources can be monitored and collected, including:
Energy consumption and requirement data
Mobility and daily routine data (related to weather, age, locality, time of day, etc)
Safety and security-related data
Together with relevant data on user behaviour; these can be used to create meaningful smart applications that change user behaviour with the help of the semantic web including:
the use of energy and alternative energy sources
health behaviour data
the dissemination of new "smart home" applications
the automation of "smart home" application safety and secuirty (automatic neighbour alert systems, etc)
volunteering and neighbourhood assistance
services domain (mobile shopping, transport mobility)
In 2030, there will be around 7 million fewer employed people in the Federal Republic of Germany. This will lead to a 16% reduction in the gross national product. Assuming production processes remain the same, this will also mean an enormous loss of knowledge resulting from the retirement of experienced experts, particularly in core industries such as German medical technology and healthcare , , , .
In the future, data that can be generated from the linking of information content, especially from the use of mobile sensor and actuator systems, will make a substantial contribution to economic growth. Given demographic trends, this data will most likely have a particular impact on the healthcare, real estate and insurance industries, through the use of innovative applications, while also leading to healthcare cost savings.
The aim is to employ mobile, pervasive assistance functions to enhance the economic power of companies, to improve the interaction between buildings and people, and to enable people, as they get older, to maintain activities of daily living (ADLs). A further part of the aim is to make optimal use of the existing professional care and medical resources, thus reducing any burdens on their family members.
In addition, the demography problem has so far focused on the group of older people with functional restrictions, particularly with regard to illness and the need for care. Demographers have largely neglected the fact that the majority of older people suffer practically no restriction in their abilities, and therefore offer great potential in terms of work and skills , , . For this reason, older people should be able to remain independently employed – in so far as they wish to be and are able to be – through the provision of appropriate mobile, technology-based systems .
Gampe, J. (member of the MPIDR Rostock) demonstrates that life expectancy is steadily increasing, with physical and mental deficiencies occurring only in advanced old age. Our society, despite its ageing population, is nonetheless becoming younger in the sense that today's younger elderly have many healthy years of life ahead of them before they will need care, particularly if they have remained physically and, above all, mentally active throughout their lives , , . Large-scale studies in Japan, in Silver Human Resource Centers built up over decades, have shown that social participation, quality of life and mental and physical health can be positively influenced up through advanced old age. This can be achieved by involving the elderly in meaningful work tasks carried out in a coordinated, guided and active manner .
The targeted use of mobile applications can compensate for declining cognitive and physical abilities during the ageing process; and the work performance of older people, based on their professional experience and special skills, can be enhanced by the provision of mobile, internet-based technologies , , .
In underdeveloped areas in particular, mobile information is being intelligently interpreted to play a part in improving the regional infrastructure. This information can be used to enhance care provision and mobility through improvements to care and medical systems and better access to them. The development of hybrid business models for mobile socio-technical systems therefore generates economic benefits. In addition to this potential, it also contributes to the research on user benefits through the investigation of various fields of applications , , , .
Creation of hybrid business models
Successful business models for mobile applications that are found to be useful by digital natives and digital immigrants alike must be designed to establish optimal benefits (in the form of a "value proposition", ie the value added to a product or system by the business model) and optimisation on a sustainable basis. This can be achieved by means of the value chain implemented in the business model, which has a substantial impact on the production value of applications , , .
In this context, the value chain depends on the preliminary work performed, the effort invested in production, and the marketing of a mobile application.
Sensor-based mobile applications that support future-oriented self-responsibility and organisation, while also providing high-quality data worthy of protection, must be further researched and developed. In particular, the individual- and social-ethical requirements of sensor systems must be incorporated through technological development in a user-oriented manner in order to ensure marketability , , .
If the variety of contextual data, such as that from "smart home" applications, yields additional, intelligent added value, this automatically creates further meaningful links with present and future sensors. This contextual data should also be accessible to users anywhere, in a simple, mobile manner, subject to valid interpretation. The successful dissemination of the new systems and sensor concepts created by this process requires close coordination with the energy, construction, healthcare and service industries; as well as local communities. Communities can offer their assessment both before and during the detailed development process .
For the success of hybrid business models for such applications, and in order to actively design requirements in light of demographic change, it is necessary to interweave and integrate technological development and application designs that have been researched in ethical and socio-economic terms. This will ensure the sustainable activation of autonomy and user-oriented control options, as well as integrated, personalised and lasting systems with high economic potential to support the provision of vital services .
Use of structured data to strengthen the future healthcare market
The innovation boost in mobile healthcare provision is huge at the moment, and continues to grow unchecked, particularly in Asian countries and the USA, despite increasing safety and ethical questions posed in Europe ,.
Today, over 1 million gateways are already in use in the "telehealth" area. Forecasts predict that more than 3.6 million gateways will be used in 2018 (InMedica, IMS Research). At present, it is estimated that there is already a market of USD 1.7 billion for mobile applications related to healthcare. By 2016, according to forecasts, 100 million portable sensors will be in use , , , , .
Sensor-based mobile applications that support self-responsibility in the promotion of health and the prevention of illness, while also providing high-quality data worthy of protection, must be researched and developed. In particular, the ethical requirements of sensor systems must be incorporated in technological development in a user-oriented manner in order to ensure marketability.
For marketability purposes, healthcare research methods should be applied when assessing the benefits of developed sensors and actuators from a medical, ethical, economic and user-based perspective.
If the dissemination of mobile applications to ensure access to the healthcare system is to succeed - for self-diagnosis, innovative treatment concepts, self-management, and the strengthening and intensification of doctor-patient relationships, as well as improved compliance and the use of socio-technical systems and mobile sensor concepts (such as those used in medical technology on the healthcare market) - close coordination with the healthcare industry will be required. The healthcare industry already assesses these aspects before the detailed development stage through major cost centres and service providers in the healthcare domain , , .
Use of mobile data to improve health behaviours
In both industrialised and developing countries, millions of people continue to die from preventable illnesses such as cardiovascular diseases and diabetes, as a result of preventable poor health behaviours. In the USA alone, 120 million people are highly overweight. In the transitioning countries Brazil, Mexico, India and China, in particular, a rapid increase in the body mass index and diabetes rate has been reported.
Although past efforts aimed at health awareness and education have created a tendency towards health-promoting behaviour, particularly in older people, governments and healthcare providers still need better and more appropriate strategies. The potential and success of these strategies is based on the consistent use of mobile communication technologies.
With the help of the semantic web, the aggregation of structured data, applications and environmental information in mobile applications can be used to obtain powerful and entirely new information , , . The use of a similar approach for a variety of groups - individual mobile device users who feature similar health behaviours; the aggregation of structured data from the living environment of individual users; and from group-tailored interventions that reach individuals through the use of mobile information - can lead to positive changes in the daily health behaviours of peer groups.
By directly addressing many various users and the communications among them, the use of mobile, structured information can lead to economically measurable, health-promoting behavioural changes in users. These can improve the health behaviours of the society as a whole in the long term , , , .
Mobile data in personalised medicine
In personalised medicine, the insights and results of treatment interventions can be utilised by employing the added value of structured data in pharmacological applications customised for patients , . Today, for instance, it is already possible to quickly recognise the impact and scope of individual side effects and interactions resulting from a drug, eg to combat high blood pressure. This is achieved through the interpretation of structured data, making it possible to respond immediately and administer new, personalised doses.
The medical concept of photoplethysmography (PPG) is especially well-suited for use in a mobile application for diagnosis and self-management, as well as the mobile monitoring of vital statistics, and this use has already been applied.
The utilisation of such "pervasive sensing" methods in mobile applications can generate substantial added value with regard to the prevention, treatment and monitoring of chronic diseases and age-related illnesses. It can also provide assessment of secondary risks (eg falls, vertigo, sleep and vision impairments), which are frequently medically induced .
The intensification of the doctor-patient relationship through the possibility of more frequent contact using mobile media, together with shared decision-making thanks to the personalisation of therapeutic options, can lead to better treatment, higher quality of life, and added value in terms of cost savings in the healthcare industry , . Examples include the complex treatment of Parkinson's disease; arterial hypertension and its attendant symptoms in old age; stroke prevention and treatment; and the early identification, treatment and monitoring of patients and relatives in the case of dementia diseases , , .
In particular, the monitoring of adherence and compliance - alongside support and motivation to continue treatment and key data from daily life that impacts therapeutic decisions - could be meaningful and valuable for the improvement of individual medical conditions . Meanwhile, all individual-ethical and social-ethical principles should be fully applied when evaluating and interpreting such data.
Many critical situations in epidemiological medicine can be assessed much more quickly and effectively using mobile, structured information based on eHealth technologies. This ensures adequate and customised treatment recommendations that have an economic impact in the healthcare domain (such as the spread and treatment of influenza viruses, etc.).
In the areas of personalised and high-tech medicine, there is great growth potential for mobile, telemedical applications that are already used on a day-to-day basis in emergency medical care. These could also be modified for mobile and expert-assisted self-management.
Risks and challenges
Risks are found in the analysis and interpretation of highly dense, incoherent, multi-modal and multi-local health data. In addition, quality and safety assurances must be provided if this data is used for diagnosis or treatment. This gives a device the properties of a medical product. From a technical perspective, energy efficiency also needs to be taken into account .
Challenges are furthermore found in the acceptance of data for clinical decision-making. To satisfy the data requirements for clinical decision-making processes, the volume of data generated must be reduced and interpreted meaningfully at a higher level. Challenges also arise from the current boundaries of professional care ("primary healthcare market") and the barriers of non-professional care, which need to be lifted. Meanwhile, new mobile technologies promote even closer cooperation in the interfaces between nursing staff and doctors, as well as outpatient and inpatient care facilities with non-professional services. This creates numerous fresh perspectives on new business areas in the healthcare market and the funding of such health-related services.
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Senior Researcher, iHome Lab, Lucerne University of Applied Sciences and Arts
Prof. Dr. med. Kerstin Wessig, is a Senior Researcher in socio–technical systems at Lucerne University of Applied Sciences and Arts – Engineering & Architecture, CEESAR-iHomeLab.
Educated in neurology and psychiatry, she gained her PhD at the Medical Faculty of the University of Frankfurt, Germany, by sensor precisioning for wrist blood measurement devices.
For a decade she served as a Professor and Dean at the faculty of Healthcare and Nursing Science and member of the managing board at the Protestant University of Applied Sciences Darmstadt and served as Founding Director of the Institute for Future Studies of Health and Social Management, IZGS.
Before joining iHomeLab she served the Technical University Munich as Head of the Human Ambient Technologies Lab and headed the working groups Ambient Assisted Living and Demographic Change Design at the Generation Research Program of the Ludwig-Maximilians-University, both in Munich, Germany. She is a member of the advisory board for Ambient Assisted Living and Dementia at the Fraunhofer Society and also a member of the German Federal Government´s Commission for the 7th Report on Ageing.
Her research projects include studies of cognitive and functional competence of humans and their dependence on the social, geographical and political situation and the understanding of the needs and capabilities of humans to develop human adequate technologies to serve optimal healing environments for all generations.