The country with one of the world’s oldest populations is turning to robots to deal with the elderly. Can new technology be the answer to our social care problem?
A robot stands at the front of a meeting room where 30 elderly people are gathered at the Shintomi care home in Tokyo. Pepper – a white plastic machine with big black eyes, jug ears and a screen on its stomach – is an integral member of staff. It sings and dances, leading the group in a music and movement session while the human carers look on. When the robot starts playing an old Japanese folk song, the residents clap and wave their arms. It is a little creepy but also rather captivating, and the crowd seems to love the performance.
On a table to the side of the hall, a small robotic dog wags its tail and turns its head towards an elderly man who speaks to it. When asked to do so, Aibo sits and offers a paw, then rears up on its hind legs to be patted. It has different “moods”, using artificial intelligence to analyse its environment and interact with humans.
Across the room, an old lady strokes a furry seal that blinks and nods its head in response to her movements. Paro, the world’s most therapeutic robot, has been shown to reduce stress and anxiety among dementia patients. The machine remembers previous actions and learns to personalise its behaviour to calm and comfort often disorientated users.
This residential care home, part of the Silver Wing Social Welfare Corporation, has been pioneering the use of technology for almost a decade. There are exoskeletons that help the elderly to walk, muscle suits that give extra strength to the carers and motion sensors that detect when someone has fallen out of bed. And there are more than 20 types of robot, with functions including communication, empathy and toilet support, which use artificial intelligence to soothe, entertain and stimulate the home’s 40 residents. While human beings tire or become frustrated, the machines are endlessly patient and responsive, working around the clock (as long as they are charged). One person with dementia regained a sense of the passing of time by having a robot that did not mind being repeatedly asked what hour it was.
Kazuo Kaneko, 92, had been in a wheelchair for years but now he can walk again with the help of a robot and his own determination. When I meet him he has the Honda Walking Assist Device, designed by the car manufacturer, strapped around his waist. It is linked to leg braces that support his limbs and propel him along. “The world has changed so much,” he says. “When I was young it was a dream to have a robot. I only ever saw them in cartoons.”
His face lights up in delight as Aibo, the robot dog, wags its tail at him. He used to have a real dog when he was younger and the machine brings back fond memories. “Good boy, Pochi,” he says, using the traditional Japanese dog’s name.
As Japan struggles with its ageing population, the Shintomi home has received a grant to trial all kinds of nursing care robotic equipment. New machines are introduced every six months and staff are able to suggest adaptations and improvements. The programme is popular with residents and their families and there is a waiting list of more than a year.
The robots have also boosted the recruitment and retention of staff. One of the carers, Sinichi Sano, is wearing a muscle suit to help him transfer a frail elderly man from his bed into a chair. The machine adds 30kg to the amount that a user can safely lift. “It’s reduced injuries quite a lot,” he explains. “I used to get terrible back pain and now I don’t.”
Kimiya Ishikawa, the president of the Silver Wing Social Welfare Corporation, says the robots simultaneously improve self-reliance among care-receivers and reduce the physical and mental burden on care-givers. “There are benefits that wouldn’t have been imagined previously,” he says. “We regard the robots as co-workers with the humans.”
The next stage, he thinks, is to move the robots into people’s homes, allowing those who were previously housebound to walk to the shops, or alerting a doctor if someone has a medical problem. Ishikawa predicts that virtual reality will one day become an integral part of social care too. “At the very end of their life when they have no way to leave their bed, people will be able to see all the places around the world that they have always wanted to visit. They will be able to meet their family or see their old pets, bringing them comfort and hope. It’s an exciting thought.”
Japan has long been the world leader in robotics, developing the first humanoid robots in the Seventies. Japanese folklore is full of inanimate objects that come to life and the machines are perceived by some to have a spirit. Ishikawa says the residents at the care home sometimes treat the robots like living beings. “They tell the staff that they are making them work too hard.” A few years ago, in another part of Japan, there was a Buddhist funeral for 62 robot dogs that were beyond repair. Grieving owners offered prayers for their “dead” pets.
It is somehow appropriate that the collaboration between robots and the elderly is taking place in Japan, a country that juxtaposes gleaming modernity and ancient tradition, where bullet trains speed across the country while every meeting begins with a bow. But robot carers could soon be coming to Britain too. Both Steve Barclay, the health secretary, and Michael Gove, the levelling-up secretary, have visited Shintomi looking for fresh ideas to tackle the social-care crisis in this country.
Ishikawa argues that demographic trends make the transition to robotic support for the elderly inevitable around the western world. In Japan, almost a third of the population is over 65 and 15 per cent are over 75. An extra 690,000 care workers will be needed by 2040 to cope with the rapidly rising demand. In Britain, there are already 165,000 vacancies in social care and 2.6 million older people have needs that are not being met.
With one of the highest life expectancies in the world and one of the lowest birth rates, Japan has the greatest proportion of elderly citizens anywhere on the globe. But it is only further down the same track along which Britain is travelling with increasing speed. Almost 1 in 5 of the UK population is over 65. By 2050, it will be 1 in 4. Over the next 25 years, the number of people older than 85 in England will double to 2.6 million.
In many ways this is something to celebrate, but it also creates challenges. Andrew Bailey, the governor of the Bank of England, suggested recently that the ageing population posed a long-term threat to the economy and would ultimately have a greater impact than the war in Ukraine or the pandemic. Public services are not geared up to cope with the demographic shift. Around 10 per cent of hospital beds are currently filled by patients who are medically fit to be discharged but cannot go home, often because of a lack of social care.
Meanwhile, waiting lists are full of people needing hip replacements or knee operations and the NHS is struggling to cope with the growing number of elderly patients with long-term conditions such as diabetes and heart disease. The Health Foundation predicts that 9 million people will be living with major illnesses by 2040, an increase of 37 per cent. The rise is predominantly to do with the population ageing rather than diseases becoming more prevalent: 80 per cent of the increase is among people over 70. We may be living longer but we are often too sick to enjoy those extra years.
The World Health Organisation analyses both general life expectancy and what it calls healthy life expectancy. In Japan, life expectancy at birth was 84.3 years in 2019, while healthy life expectancy was 74.1 years. In the UK the equivalent figures were 81.4 and 70.1. In other words, we are typically unwell for the last decade of our lives. The average patient spends 23 days in hospital in the last year of life and requires almost £7,500 ($16,000) worth of medical care.
The Japanese have decided that it is healthy life expectancy that really counts, so they are focusing on narrowing this gap. The priority is to improve happiness and wellbeing in old age. There is even a “Restaurant of Mistaken Orders”, which operates pop-up evenings around Japan. It is staffed by people with dementia. “They may or may not get your order right,” its website says. “However… even if your order is mistaken everything on our menu is delicious and one of a kind.” The intention is to spread a feeling of “openness and understanding” of the disease.
I take the commuter train from Shinjuku station in Tokyo to Tama City, a suburb 30 minutes to the west of the capital. Fifty years ago it was a gleaming new town, built to cope with an expanding population during Japan’s economic boom years. In the Seventies its apartment blocks were full of young couples attracted by the green spaces and modern development. But now those bright young things have grown old, their children have moved out and Tama has become a symbol of Japan’s greying society.
In 1989, just 5 per cent of the population in the suburb were over 65; now it is almost a third and in another 20 years it is projected that 40 per cent of the population will be elderly. There has been an exodus of businesses as well as wealth, with many shops boarded up around the crumbling estates. Instead of sinking into decline and despair, however, the local mayor, Hiroyuki Abe, has declared that Tama should become what he calls a “healthy-happy city”. He is now in his fourth term, having seen off a rival AI candidate a few years ago in one of the more bizarre elections in Japanese history. His decades-long project to use the planning system to let people live their long lives “with vitality” and “as they wish” is well under way.
A network of pedestrian walkways, stretching to 40km in total, has been laid to encourage people to walk rather than drive. Specialist exercise equipment has been installed in parks and instructors offer fitness classes that aim to prevent “tripping” and “wobbles”. There is a “brain health class” designed to ward off dementia and an octogenarian football team. The star player, Mutsuhiko Nomura, 83, is a former member of the Japanese national side. He recently declared, “If possible, of course I want to keep playing until I’m 100.”
I join a weekly exercise class for the elderly, run by volunteers wearing bright blue T-shirts who are themselves in their seventies. The average age is 80, the eldest participant is 95, and the room is packed with people doing stretches and strengthening exercises. With loneliness one of the biggest problems among the old, the benefit of such activities is just as much psychological as physical.”I’ve been coming for seven years and I never miss a session,” Mioko Yamamoto, 86, says. “I feel fitter and it’s something I so look forward to every week.”
Tama has more than 1,400 “silver volunteers” who do gardening or cooking for the community in return for a token fee. A hollowed-out shopping street has been turned into a hub for charities offering help with grocery shopping, laundry and using a smartphone. They pay half the rent that the commercial businesses used to pay. In the local café, elderly people, some wearing traditional yukata gowns and slippers, gather for a lunch of homemade fish, rice, miso soup and vegetables. It is delicious and costs 500 yen ($5.80). The septuagenarian chef, Mieko Terada, has lived in Tama since the new town was first built.
Mayor Abe says the aim is to allow more people to live independently at home for as long as possible and it seems to be working. The number of those requiring hospital treatment or social care has dropped and there is a gap of only 18 months between healthy and unhealthy life expectancy. As a result, the social care insurance premiums that the municipality is required to pay have been reduced. “In the end it saves money,” Abe says.
Back in Britain there are some trailblazers who are trying to emulate Japan by emphasising the quality of life, not just longevitiy. Bernie Enright, the energetic executive director of adult social services at Manchester City Council, has managed to balance the books – an extraordinary feat – by reducing demand for care. A “reablement” team works with elderly people to increase their independence with exercises, activities, technology and equipment. More than 60 per cent end up needing no social care at all after a few weeks with the team. Robots are still a way off, but some care homes use Alexa devices to help residents communicate with their families or staff.
The innovators are, however, the exception. Joan Bakewell, the broadcaster, Labour peer and campaigner who at 90 epitomises the idea of ageing well, says older people are too often dismissed or sidelined in a society that idolises youth. “As you get older, you have less and less voice,” she says. “You are judged to be at death’s door. You’re not going to be around so why invest a lot in caring for you?”
Politicians prefer to kiss babies rather than hug the elderly, and social care is still the poor relation to the NHS. Celebrities have facelifts to try to disguise the effect of ageing and billionaires have blood transfusions in search of eternal youth. Too often retirement is seen as the beginning of the end when in fact it is just the end of the beginning. There’s a sense that if we all collectively ignore older age it might never happen.
I leave Japan feeling oddly optimistic about the process of ageing. The care robots may be a bit weird, but for those facing the groundhog day of dementia they could be a salvation. Technology will liberate the elderly, helping them stay independent for longer and shifting the emphasis to the quality as well as the length of life. As in Tama City, it is possible to keep trying new things right to the end, whether that’s joining a football club or a knitting circle or running a café. The horizons do not have to stop expanding. The future may be grey for our ageing population, but it can also be bright.
Written by: Rachel Sylvester
© The Times of London
