March 17, 2007 JEMH van Bronswijk, TUE-NL, Mortality - Morbidity

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From reducing mortality to From reducing mortality to compressing morbiditycompressing morbidity

2007 International Conference on Gerontic Technology and Service Management

Nan Kai Institute of Technology, Taiwan

Keynote speech 4

Mach 27, 2007; 11.00-12.00 H

March 17, 2007 JEMH van Bronswijk, TUE-NL, Mortality - Morbidity

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AgingAging

0

5

10

15

20

25

30

35

40

45

Africa Latin America& the

Caribbean

Asia Oceania NorthernAmerica

Europe World

Region

Med

ian

ag

e o

f th

e p

op

ula

tio

n i

n y

ears

2005 2025

Source: http://esa.un.org/unpp

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Life courseLife course

• Development = Growth = Aging

• Heredity (50%) + Environment (50%)

• Natural environments

• Technology changes environments

March 17, 2007 JEMH van Bronswijk, TUE-NL, Mortality - Morbidity

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(Pre)History by Technology(Pre)History by TechnologyMedicine, Agriculture, IndustryMedicine, Agriculture, Industry

• Stone age: from the wake of humankind to villages

• Bronze age: walled towns come into being

• Iron age: living pace starts to increase

• Industrial age: mechanisation, electrification, ICT

Source: J.E. McClellan III, H. Dorn 2006. Science and technology in world history. 2nd edition. Baltimore: John Hopkins University Press

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Technology generationsTechnology generationsin the Industrial agein the Industrial age

• Mechanical: increased urbanisation

• Electro-mechanical: decreased mortality

• Software: decrease of morbidity wanteddecrease of morbidity wanted

= Gerontechnology= Gerontechnology

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March 17, 2007 JEMH van Bronswijk, TUE-NL, Mortality - Morbidity

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March 17, 2007 JEMH van Bronswijk, TUE-NL, Mortality - Morbidity

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Chronic conditionsChronic conditionsaccelerated aging of certain organs / tissuesaccelerated aging of certain organs / tissues

Examples:Examples:• Lungs: air pollution; indoor, outdoor

• Brains: lack of challenges nor social interaction

• Locomotory system: repetitive forces; work, leisure

• Circulatory system: lack of exercise

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• 950-990x cases of acute Pontiac Fever

• 9-30x surviving Veteran-Disease patients, but with persisting chronic symptoms

• 1-20x fatal cases

Source: JEMH van Bronswijk e.a. 1999. Gezond en Duurzaam Bouwen (GeDuBo). Research Reportfor the Netherlands Ministry of Housing

Fate of 1000 Fate of 1000 LegionellaLegionella infections infectionsafter inhaling infested water dropletsafter inhaling infested water droplets

March 17, 2007 JEMH van Bronswijk, TUE-NL, Mortality - Morbidity

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Allergy: of Mites and ManAllergy: of Mites and Man

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From the NetherlandsFrom the Netherlands

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Improving healthImproving health

• Sustainable society, social cohesion

• Strengthening productivity, vitality

• Prolonging full citizenship

• Diminishing societal costs of care

• through Compressing MorbidityCompressing Morbidityby daily (geron)technology

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Environmental factorsEnvironmental factorsin some chronic inflictionsin some chronic inflictions

• Outdoor and indoor air

• Potable water

• Liquid and solid waste

• Noise, sound, lighting

• Mobility, transport

• Social contacts and interaction

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Environmental engineeringEnvironmental engineering

• = to control environmental stress, by:

• Building construction

• Building services

• Civil / sanitary engineering

• Design of work processes

March 17, 2007 JEMH van Bronswijk, TUE-NL, Mortality - Morbidity

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Preventive part of Preventive part of GerontechnologyGerontechnology

• Delaying chronic conditions

• Robust and feasible approach

• Smart, unobtrusive use of technology

• Acceptable daily technology

• Aimed also at younger age groups

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Ambient assisted livingAmbient assisted living

• Supports– healthy growth, development, aging

• Compensates– Weakening of functions

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TQM of daily technologyTQM of daily technology

• TTotal QQuality MManagement (TQM)• HHazard AAnalysis CCritical CControl PPoint

(HACCP)• Guarantees quality during the whole

working life of a product or service• Originates from the food industry• Applicable to building services

March 17, 2007 JEMH van Bronswijk, TUE-NL, Mortality - Morbidity

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HACCP steps for controlHACCP steps for control

• Base: Process description, end-product defined• 1: Process analysis• 2: CCritical CControl PPoints (CCPs)• 3: Critical limit / CCP• 4: Monitoring procedure / CCP• 5: Intervention at exceeded critical limit / CCP• 6: Verification procedure / CCP• 7: Registration & documentation procedures

(for in-company and out-company certification)

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To reduce morbidity AND mortalityTo reduce morbidity AND mortality= Gerontechnology= Gerontechnology

• Suitable environments– from cradle to grave, HACCP control

• Smart coaching services

• Indoor environmental control– Home automation– Robotics

• Research– Impact, target, intervention site and type– for each single technology and technology system

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010

20304050

60708090%

16-52 53 andover

Age in Yrs

Practical

Comfort

Security

Won't work

No control

Afraid

Expectations for smart housing

n = 42316-83 Yrs old56% female44% male30% home owners70% home renters

Source: S. Meyer, E. Schultz 2001. Vom Otto Normalverbraucher zur Smart Family. Berlin: Berliner Institut für Sozialforschung

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Expected advantages of smart housing

Germany 2001

• Daily living support• Safety & security• Comfort• Management of energy use• Other health issues not yet perceived

Source: S. Meyer, E. Schultz 2001. Vom Otto Normalverbraucher zur Smart Family. Berlin: Berliner Institut für Sozialforschung; http://www.bis-berlin.de/bestell/bestell_01.shtml

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Benefits of telemedicineBenefits of telemedicineA meta-analysis of 66 studies from 1966-2000

Source: D. Hailey, R. Roine, A. Ohinmaa 2002. Systematic review of evidence for the benefits of telemedicine Journal of Telemedicine and Telecare 8(Suppl 1):1-30

0

10

20

30

40

50

60

Advantages Unclear Noadvantages

%

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For Sale: CottageFor Sale: CottageMarch 27, 2027March 27, 2027

• Pleasant neighbourhood• Modern kitchen• Luxury bathroom• A spacious living room• 3 Bedrooms • 103 Built-in butlers for leisure, support

and educationFree after: S. Marzano 2006. Ambient culture. Pp 35-52, in: E.H.L. Aarts, J.L. Encarnaçã0, editors, True visions; the emergence of ambient intelligence. Berlin: Springer

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Thank you for your attentionThank you for your attention