‘Aging in place’ is about providing the necessary resources for older adults to remain in their own homes and communities safely and independently.  It is generally agreed that Chinese people prefer to continue living in a familiar environment with the support of their families as they age.  Policy makers and professionals have therefore placed great emphasis on conceptualizing aging in place as an attainable and worthwhile goal.  Over the years, an ecological model of aging has been used to conceptualize the policy agenda.  Improving the physical-spatial-technical environment to enable aging in place have been widely studied and publicized.  New partnerships and collaborations required to fund and maintain the aging in place agenda, such as private foundations, research institutes, health services organizations and technology companies are also developing rapidly in recent years.
Yet, various local studies have found that traditional Chinese culture has been sapped, posing challenges to familial care for the elderly people.  Coupled with the lack of adequate support for family caregivers, this has presented a great challenge on realizing the aging in place agenda.  On the other hand, while technological devices and systems hold considerable promise in assisting a growing older population to age in place, there are a number of challenges that must be addressed before such technologies are fully developed, evaluated and disseminated.  These include the limited evidence base, economic barriers and the need to address older people’s sensory, cognitive and ergonomic challenges in the design and operation of such devices.  More importantly, successful use of technology to realize the aging in place agenda has to be backed up by well planned community care co-ordination services, such as home nursing and rehabilitative support programmes.  However, such support services has not been adequately planned and delivered.  More concerted multi-disciplinary efforts in enabling our older people to live with dignity and safety in the place they choose are required.

Ageing in place is not only a policy target of the HKSAR Government, but also the desire of many elderly people. In the recently completed Elderly Services Programme Plan, the government pledged to provide more community support services to elderly people to enable them to live in the community instead of moving into institutions unnecessarily. At the same time, there were new attempts to maintain the health of elderly people and reduce the caring burden of their carers through medical-social collaboration. A recent example was the Dementia Community Support Scheme jointly launched by the Food and Health Bureau, Social Welfare Department and the welfare sector.
This presentation will introduce how technology could be employed to facilitate ageing in place, and illustrate how medical and social sectors can make use of technologies to enhance the effectiveness of their interventions. Some local and overseas examples will be quoted to demonstrate how technology could facilitate health management, early detection and intervention, and self-management, etc. New initiatives of the HKCSS will also be highlighted.

In face of the rapid ageing population, the Hong Kong Government has formulated her policy in its well-stated statement “Ageing in Place as the Core, Institutional Care as the Backup”. Studies has confirmed that senior people in Hong Kong prefer to age at their homes and familiar communities. Even though the government has invested huge resources on the provision of health and welfare services for the implementation of her policy, she is silent on the housing aspect. Hong Kong Housing Society, as a housing laboratory, has piloted various housing schemes to help seniors fulfil their dreams to age at their preferred environment. In the past 20 years, various housing schemes for the lower income groups, middle income groups and higher income groups have been implemented. Studies of the University of Hong Kong have confirmed the positive results of these housing schemes, for example, in its AIP scheme, it effectively achieved reduction in intention for institutional care, falls, use of A&E services and percentage of older people with depressive symptoms, and increase in satisfaction with living environment, utilization of community care services, participation in social activities, and subjective social support and percentage of elders with unimpaired cognitive performance. To convert these effectiveness in monetary term, the AIP scheme and the SEN scheme have generated $4.83 and $5.07 respectively in return for every dollar invested from its SROI assessment.

Diseases affecting the brain is the commonest reason for preventing aging in place. Commonest brain diseases associated with institutionalization are Alzheimer’s and cerebrovascular diseases (stroke, small vessel disease), degenerative (idiopathic Parkinson’s disease) and vascular (small vessel disease) types of parkinsonism. Other important factors affecting aging in place include availability and capacity of caregivers (e.g. spouse, children, domestic helper). 

In this lecture, a clinical road map of enhancing aging in place will be discussed. In brief, the clinical road map includes early detection and early intervention, as well as continuous investment in research for development of simple yet accurate diagnostics and disease modifying therapies. On another front, strategy and support network that can empower informal caregivers in caring for the diseased elderly at home is also important. Achieving longevity with health and dignity requires collaborative effort from the whole society.