Friday, 8 May 2015

All the time in the world?

She's waiting for her envelope, in which sits a letter, telling her how many years she has left to live. The policy was created in response to overpopulation. So, age is no longer an increasing number, it's a decreasing one.
And her time left has been determined by a slew of tests. Her countdown is predicated on exam results and the duration of her life will be decided on what "the rulers" deem to be her: merits, intelligence, looks and charisma. So far, so contemporary.

This disturbing, dystopian look at society was the basis of a 500 word short story written by a 13 year old girl, Susannah Ames and it was the winning entry for last year's competition. The contest is now in its fifth year and championed by Chris Evans, it's BBC Radio 2's 500 word- short-story-contest. Last year there were over 117,000 entries in the 5-9 and 10-13 age categories. As it surges from strength to strength, I've heard from one of last years judges that there were even more entries this year.

How the scores of librarians, teachers and authors whittle them down to the eventual winners, is a modern day miracle, but they do and brilliantly. So, the wait is on and this years victors will be announced on the 29th of May. But today, almost a year later, I still can't get her story out of my head.

At one point, she explains that she doesn't know who or what to believe from the "rulers " and she's afraid to say anything against them. "....It's not the end of the world, but it could be the end of my world". The parallels to today feel almost prophetic in our world, where younger generations have been taught to fear their own old age.
And that needs re-examined. As it becomes increasingly self evident that we are living longer, we have a solid opportunity to embrace new possibilities instead of believing in a narrative that focuses on limitations. Otherwise, we could effectively squander all this new longevity, potentially an extra 30 years of life. And that would be pretty irresponsible. Age is our most outstanding cultural, scientific and technological achievement. We are at the point where education has become a better predictor of life expectancy, than age.

So what's happening now is that we are re-entering a time that used to be normal, where you remained a productive member of society, for life. That was before it was decided -- for us -- that we had to remove ourselves from the workforce. In case you were wondering, we've got Bismarck to thank for retirement and for making the call that old age begins at 65. In effect, he decided that was when old age began and when governments should plan to start paying people for growing old.

Pensions are a pretty recent invention too. The Old Age Pensions Act in the UK passed in 1908 and in the US with the Sherwood Act but that only applied to veterans. It wasn't until 1935 that a solution to the problem of convincing people to stop working was discovered - you have to pay them. And we all know that formula isn't working because it doesn't make sense anymore.

Unlike the girl in the short story, the greater the age we attain, the less our successes can be linked to what pleases "the rulers." With increasing age, success gets unhinged from merits, intelligence, looks or charisma. There comes a time when career success and degrees matter less and camaraderie matters more. Physical decline can be postponed but not forever and charisma - while seductive- needs to be balanced with authenticity and empathy.
And why would we opt out and ignore this talent, particularly when emotional life improves with age and we get happier! The value in ageing comes through converting accumulated experience and wisdom into new pursuits which are equal to our full potential.

This idea is at the core of a movement for social change called The Age Of No Retirement. and it is not about frogmarching older people into working longer against their will! It's about living fully across the entire life course; changing the negative language that surrounds ageing; co-designing future workplaces and communities and appreciating multiple generations living and working together. Today, we already have four, five and six generation families living at the same time.

Right now, we act like the people this 13 year old described in her 500 words. With 24/7 news and the ubiquity of social media, we have become expert spectators, collectively passive and stumbling into the new longevity. If we cling to old definitions of a future no one can pretend to predict, we are still going to age. But we will have been complicit and ultimately powerless by refusing to choose how we will age in the 21st Century. It's time we all thought about that.

Maybe it would be easier if the choice was taken out of our hands but the reality is stark in its simplicity.

There isn't any envelope.

Deborah Gale

Originally posted in the Huffington Post on 8/5/15:
She's waiting for her envelope, in which sits a letter, telling her how many years she has left to live. The policy was created in response to overpopulation. So, age is no longer an increasing number, it's a decreasing one.
And her time left has been determined by a slew of tests. Her countdown is predicated on exam results and the duration of her life will be decided on what "the rulers" deem to be her: merits, intelligence, looks and charisma. So far, so contemporary.
This disturbing, dystopian look at society was the basis of a 500 word short story written by a 13 year old girl, Susannah Ames and it was the winning entry for last year's competition. The contest is now in its fifth year and championed by Chris Evans, it's BBC Radio 2's 500 word- short-story-contest. Last year there were over 117,000 entries in the 5-9 and 10-13 age categories. As it surges from strength to strength, I've heard from one of last years judges that there were even more entries this year.
How the scores of librarians, teachers and authors whittle them down to the eventual winners, is a modern day miracle, but they do and brilliantly. So, the wait is on and this years victors will be announced on the 29th of May. But today, almost a year later, I still can't get her story out of my head.
At one point, she explains that she doesn't know who or what to believe from the "rulers " and she's afraid to say anything against them. "....It's not the end of the world, but it could be the end of my world". The parallels to today feel almost prophetic in our world, where younger generations have been taught to fear their own old age.
And that needs re-examined. As it becomes increasingly self evident that we are living longer, we have a solid opportunity to embrace new possibilities instead of believing in a narrative that focuses on limitations. Otherwise, we could effectively squander all this new longevity, potentially an extra 30 years of life. And that would be pretty irresponsible. Age is our most outstanding cultural, scientific and technological achievement. We are at the point where education has become a better predictor of life expectancy, than age.
So what's happening now is that we are re-entering a time that used to be normal, where you remained a productive member of society, for life. That was before it was decided -- for us -- that we had to remove ourselves from the workforce. In case you were wondering, we've got Bismarck to thank for retirement and for making the call that old age begins at 65. In effect, he decided that was when old age began and when governments should plan to start paying people for growing old.
Pensions are a pretty recent invention too. The Old Age Pensions Act in the UK passed in 1908 and in the US with the Sherwood Act but that only applied to veterans. It wasn't until 1935 that a solution to the problem of convincing people to stop working was discovered - you have to pay them. And we all know that formula isn't working because it doesn't make sense anymore.
Unlike the girl in the short story, the greater the age we attain, the less our successes can be linked to what pleases "the rulers." With increasing age, success gets unhinged from merits, intelligence, looks or charisma. There comes a time when career success and degrees matter less and camaraderie matters more. Physical decline can be postponed but not forever and charisma - while seductive- needs to be balanced with authenticity and empathy.
And why would we opt out and ignore this talent, particularly when emotional life improves with age and we get happier! The value in ageing comes through converting accumulated experience and wisdom into new pursuits which are equal to our full potential.
This idea is at the core of a movement for social change called The Age Of No Retirement. and it is not about frogmarching older people into working longer against their will! It's about living fully across the entire life course; changing the negative language that surrounds ageing; co-designing future workplaces and communities and appreciating multiple generations living and working together. Today, we already have four, five and six generation families living at the same time.
Right now, we act like the people this 13 year old described in her 500 words. With 24/7 news and the ubiquity of social media, we have become expert spectators, collectively passive and stumbling into the new longevity. If we cling to old definitions of a future no one can pretend to predict, we are still going to age. But we will have been complicit and ultimately powerless by refusing to choose how we will age in the 21st Century. It's time we all thought about that.
Maybe it would be easier if the choice was taken out of our hands but the reality is stark in its simplicity.

There isn't any envelope.
Deborah Gale

Friday, 13 March 2015

Walk this way

Fat -- good :)
Sugar -- poison :(
Dry January
Limiting for lent
Decluttered yet?
Digitally detoxed?
Embraced mindfulness?
And while you're at it , don't forget to THRIVE!
Three months into 2015 and it's a wellness-overload-loop.
But, here's something dead simple to start up and keep up. It's for anyone who plans on ageing. So, if you're thinking about stayin' alive, you're in. It's non-toxic and most of us do it already, but lots of us take it for granted.
Walking. Simply speaking, Walking Works Wonders.
If you're a typical office worker, you spend more time sitting at your desk than you do sleeping. If you're sitting, you're not moving let alone breathing right and if that's for over 10 hours a day -- expect consequences.
Researchers at Loughborough University's Working Health Research Centre are looking at ways to improve health and well being in the workplace. This becomes more and more important as conventional retirement disappears in the Age Of No Retirement and people choose to work later.
But real change in behavior and sustaining change is notoriously difficult. Changing a behavior is only achieved by knowing how to reverse it. This is more likely if people feel that that they are doing something they can control, as well as choose. When these conditions are met, the likelihood of sticking to it is greater.
In trials with over 1,000 British Telecom employees, sustained behavioural change via the introduction of short walking breaks and walking lunches has changed attitudes, concentrated focus and helped people take personal responsibility. Along with increased self-awareness, employee enjoyment was widely reported. Exercising was no longer something that they might or might not do, it became part of their daily routine. Wearing pedometers, which provided instant feedback, proved highly motivating and they loved the sense that they were in control.
Improvements were recorded across all markers including BMI, work performance, attitude to jobs and lifestyle behaviors. Changes to healthier food choices, reduction in alcohol consumption and improved well being were also reported.
So, if walking works wonders, footwear choice becomes even more important, a particularly painful problem for working women. A reported 44 percent of women is prepared to wear uncomfortable shoes compared with less than 20 percent of men! Perversely, while high heels with narrow toe boxes can hardly be justified as sensible shoes, researchers have concluded that wearing high heels is significantly correlated to general good health. Despite middle aged women's reporting of foot pain, high heels make a women feel prettier! In a 20 year study of 1000 women with a median age of 61, 84 percent of the participants were wearing over two-inch heels at year 10 and this only dropped to 53 percent by year 20. Now that we are all expected to live longer, it looks like the market for female footwear can also be expected to expand.
At London Fashion Week, Irish designer Orla Kiely's preview show was predictably populated with beautiful, young models. But for anyone who has ever witnessed catwalk shows where the shoes have literally let the girls down, the Kiely footwear collection was refreshingly safer, sophisticated and savvy.
Orla Kiely's collaboration with Clarks, the venerated, seven-generation strong, British shoe purveyor, has delivered some refreshing solutions to the stylish footwear problem.
Now is the time to extend "health span" in tandem with life span. Best foot forward, particularly relevant advice to the "experienced economy," workers over 50.
So, put the"slippers and cocoa" image of the boomers to bed, particularly when this "new-old" demographic represents a $15T market.

And while we're at it, we are learning more and more about the plasticity of our brains. Like our bodies, it's a use it or lose it organ and more likely to shrivel from underuse than overuse.
If walking works wonders, then, moving means miracles.
Get on up now.

This blog originally appeared on HuffingtonPost Live Blog 13/3/15     http://www.huffingtonpost.com/deborah-gale/walk-this-way_1_b_6739570.html

Sunday, 9 November 2014

Time to rethink ageing. It equals living.

There are many lightbulb moments in life but its not as if a switch gets thrown one day and "OMG, I'm 50, what now?"


And so, last month in London, interest and passion for ageing came together to get some joined up thinking going. The object of this exercise was to probe the edges of The Age Of No Retirement (AONR). Undeniable yet broadly ignored, this age is already upon us.
That the world is getting older and that we are living longer is generally accepted - to a point. That the entire notion and nature of "retirement" is in need of an overhaul, is less generally accepted.

27 provocateurs, 200+ debaters and a sold-out invited audience gathered to address this collective blind spot.

Distorted reality clearly exists. Retirement remains a highly prized while strongly incentivized finale to a lifetime of employment. Meanwhile, how long were going to live is gradually increasing, while expectations for retirement have remained constant.

This is a prickly disconnect. In the same way that the benefits of conventional retirement have been exaggerated, our understanding of what it means to reach 50 years of age - with the potential to live another 40 - has not been taken on board.

If we expect to accrue benefits from the AONR, ageing needs to be repositioned as synonymous with living.  Such thinking challenges every preconceived notion about ageing that we possess.

The debates encouraged no holds barred thinking. How is an ageing work force honestly perceived? How flexible and adaptable can these people be and are the skills acquired over a lifetime actually transferable? What about ageism, degree of digital exclusion and the limits of physical and cognitive functioning?  If the answers to all these questions is  negative then, how do we turn these into positive outcomes?  How do we objectively tap into this fallow, talent pool? Where is it stated that innovation is the exclusive purview of the young?

The fact remains that the only natural resource we have not depleted and is actually increasing is the human capital of our ageing population. We need to tap into these plentiful reserves but the reserves need to ready themselves for this new period of life.
Its clear that unless we can shift attitudes about our ageing selves and bodies, we cannot ascribe value to living over an extended period of time.

If we are serious about making retirement obsolete, public consensus including ownership of life long learning will be necessary.

Jonathan Collie of Trading Times and George Lee of Commonland, are preparing an impact report; we await its publication and its actionable outcomes. In the interim, the Age of No Retirement continues its unrelenting advance...

Deborah Gale

This blog was originally printed on Gransnet 30/10/14
http://www.gransnet.com/forums/blogs/1211384-We-need-to-rethink-ageing?pg=2


















http://www.gransnet.com/forums/blogs/1211384-We-need-to-rethink-ageing?pg=2

Tuesday, 4 November 2014

Who can really retire?




LIVING IN THE AGE OF NO RETIREMENT

The last of the baby boomers turns fifty in 2014. This huge cohort is said to have defined the modern age. Not only have the first teenagers come to an advanced age, they are likewise crossing into a different time to grow old. Unsurprisingly, their retirement experience is also turning out to be very different.

While it is misleading to generalise about anyone over 50, traditional retirement for leading edge boomers (born 1946-1955) was broadly accepted as the norm. The situation is markedly different for trailing edge boomers (born 1956-1964), where any expectations of retirement at 65, have been systematically dismantled.

At the same time, longevity estimates have gradually been increasing. The mismatch between retirement expectations and the realities of living an additional 30-40 years; potentially more than half of an adult life, has not been seriously acknowledged

This was the challenge laid down by the organisers of The Age of NO Retirementn which ran from October 1-2, 2014. Over the course of two days:  27 provocations, 120 provocateurs, 200 plus debaters and a sold out audience came together to address the requirements and 21st C complexities, of the Age of No Retirement.

We're talkin' about a revolution but while the assembled revolutionaries attacked the retirement conundrum with gusto, there is a limit to what can change, at present. Dr Ros Altmann, newly appointed government champion for older workers, opened the conference with a call to rethink later life and recognise this group as the economic engine of the future. Similarly, Baroness Sally Greengross, of the International Longevity Centre, commented  that businesses face serious shortages of labor in the near future and new ways to engage older workers who want to work later alongside those who have to work later will be necessary in order to build an inter-generationally connected society. Lord Geoffrey Filkin of the £50M lottery funded Centre for Ageing Better, spoke of the overarching need to prepare for retirement, potentially a time of no income, by focusing on: personal health, building on existing capabilities and new abilities, while simultaneously maximising the psycho-social dimensions that will support a better, later life. There was no denying that poor health, poverty and mental frailty are key factors that will "ruin" ageing, for many. But, leaving these issues aside, unless companies come up with concrete opportunities to retain, retrain and reinvent these would-be-retirees and until these changes are demanded by the cohort itself, nothing much will really change.

In the meantime, reconfiguring jobs and reconsidering employment options is hard work, for everyone. And as attractive as the so called "portfolio career" might sound, that kind of  flexibility assumes a great deal of choice; something else that is in short supply as this cohort ages. In the same way that ageing is not a homogeneous process, ageing is very unequal and social inequality starts very early in life.

This is a big nut to crack but it's time to give it a go. Conventional wisdom suggests that the older you get, the less you have to lose. That thinking is untenable starting immediately. Value must be ascribed to every phase of life, from natural  beginning to natural end. Conventional retirement has already been retired and the transition between midlife and serious old age is growing in importance.  It represents an extension of the same subtle interplay between continuity and change that accompanied every other transition in life. The Age of No Retirement deserves careful consideration.

Conference organisers, Dr Jonathan Collie of Trading Times and George Lee of Commonland plan to publish their impact report in mid-November. Watch this space for actionable outcomes inspired by this incisive, dispassionate review of the no retirement megatrend.


Deborah Gale
This blog originally appeared on The Work Foundation blog http://www.theworkfoundation.com/blog/2342/Living-in-the-age-of-no-retirement
 The Work Foundation transforms people’s experience of work and the labour market through high quality applied research that empowers individuals and influences public policies and organisational practices.

Tuesday, 22 July 2014

Say What?

There's a tricky condition called "mother deafness". This normally occurs when teenaged and dare I mention "Boomerang Kids", appear incapable of hearing anything their parents and usually their mothers, say to them. This is usually interpreted by the recipient as seriously annoying. The condition is closely related to another ailment called selective hearing and documented evidence indicates that males, particularly husbands and fathers, may be carriers.
Jokes aside, there's actually a bigger hearing problem bearing down on all of us, yet no one seems to be listening. It's a collective sound barrier and it comes loaded with shrill implications as the boomer population ages and gradually tunes out. Hearing loss is largely ignored and early detection, in adults, just isn't happening.
In the UK, an estimated 4 million people have unaddressed hearing loss. It takes most people at least 10 years, before they do anything about it. What a waste. During this time, they miss out on 10 years worth of good hearing, at the same time as making themselves less likely to accept and adapt to wearing assistive devices. Not hearing seems innocuous but its stealth is isolating. Hearing aids, however, are not a fashion accessory and to many users and viewers, they scream old. Worryingly, this is happening in a country with a National Health Service (NHS), where you can roll up and get free, state-of-the-art, digital hearing aids. Meanwhile, in the USA, where, if you can't hear, you'll pay dearly for the pleasure; even people who have been fitted with hearing aids, don't always wear them.
So what gives? The fact is, we really are nowhere near a full understanding of the interaction between cognition and hearing aids . This represents a public health issue with far reaching consequences. because this unaddressed problem is correlated to other physical and mental health issues. Meaning that this kind of head in the sand behaviour translates to greater costs, worsened health outcomes and the emergence of related and more complicated health issues, further down the line.
Early detection is key. Neonatal screening is enjoying success with positive effect but it is the accumulation of people with unaddressed hearing loss that is worthy of closer attention. Unchecked, this will impact a larger number of the ageing work force, year on year. Keeping people in productive employment has demonstrated health benefits and could help lessen the load on pensions and ultimately on health and social care provision. This can only be achieved by keeping hearing impaired people employed, by removing barriers like telephone only based interviews and then making adjustments in the workplace that support people with hearing loss. To pre-empt problems, younger people and those working in at-risk employment settings need to be educated on ear protection. Taking advantage of noise cancelling technology is better than turning up the volume and risking further damage.
Not being able to hear isn't like other sensory deprivation. If you can't see you can get glasses, contacts or sign up for some lasik or radial keratotomy. If you can't taste, smell or touch, it's clearly a problem but these only affect your personal sensory experience and not the specific experience of those around you. Hearing is different. Normal communication relies on hearing. Mishearing can be funny and embarrassing so it makes perfect fodder for annual compilations and comedians like Peter Kay. On the flip side, mishearing is also very disempowering.
The International Longevity Centre in London has recently chaired a two part commission on hearing loss in the House of Lords. The evidence from the commission was overwhelming. Hearing loss, like ageing, is well below the radar on the agenda. A quarter of people with compromised hearing leave their GP's without understanding what their doctor has told them or the treatments they need. The situation in the US is also dire, national funding is at an historic low and even the recent formation of a research consortium of the six largest hearing aid manufacturers, has shown only token success in two minimally funded proposals. Patient advocacy in this area is seriously wanting.
The truth is, sometimes we don't even realize and perhaps don't want to realize that our hearing is going. We need to normalize this loss. Cilla Black, now 70, the English chanteuse and media personality is believed to have had cochlear implants inserted. Observant family and friends need to be more proactive. Society has to recognize that the majority demographic is struggling. Hearing loss is very democratic and if you live, it's likely to happen to you.
Time to hear ye, hear ye not come again?

A version of this post originally appeared on the Huffington Post - The Blog and is republished with permission.

Friday, 25 April 2014

Keeping up with the Jetsons - Compact version


If you’ve been around the block a few times, you’ll remember the Jetsons.  If you haven't, here's your primer.   The Jetsons was a cartoon series set in 2062. It debuted  in 1962 and Rosie was the Jetsons’ robot-maid. She controlled the chaos in George, Jane, Judy, Elroy and even the family dog’s orbit.  A reject from U-Rent A Maid, Rosie was a humanoid robot, an assistive device with a frilly apron and a huge heart. Rewind to 2014 and we’re already living in an assisted world – far earlier than the Jetsons predicted. From remotes and smart phones all the way to driverless cars, the robo-genie is out of the bottle. 
The question is, will this robo-boost benefit our older generations? Will it make the next generation of older people independent or isolated? In the UK over 50% of over 75 year olds who live alone say their TV is their main company. A further 17% reported they have contact with another person less than once a week. It’s hardly surprising that neuroscientists have found higher levels of epinephrine, the stress hormone, in the morning urine of  “lonely people”. Rent-a-Maid Rosie had a heart… it begs the question, could a relationship with a machine be better than nothing, or no one, at all?
It’s not a huge concern at this juncture – but it ought to be. 
There are concerns: fears about inauthentic relationships, particularly with respect to end of life care.  Our acceptance of introducing human-like but not actually human helpers might qualify as an infringement on personal dignity. So, the next step should be targeted attention on specialized ‘bots that will be able to assist and care for older adults.  They are already successfully aiding the medical industry and this could be a logical next step.
The business of robotic engineering and the business of caring do represent two distinct cultures needing to comfortably co-exist. Since 2000, pioneering surgical procedures using robotic arms and a surgeon operating from a console have allowed dexterity beyond what’s humanly possible. A recent study showed that trained physicians were outperformed in diagnostic accuracy when pitted against artificial intelligence algorithms by a staggering 41.9%. Add to this the dual bonus of tremor reduction and faster recovery times for patients – there’s not much to dislike about these robots!  Plus, it’s common knowledge that most people never do any rehab exercises after they leave the hospital or physio appointment. But wait… this won’t be a problem anymore. We can have virtual avatars carrying out routine checks on patients, as well as advising them on proper technique! Even better, these "relational agents" are at the forefront of medication management, "watching" patients take the right meds. 
Fifteen years ago, an entertainment robot pet, AIBO, was brought to market by Sony. Research was conducted in Japan on its use in a care home for dementia patients. AIBO was regarded as a total success in terms of increased communication with patients, as well as performing duties better than a real animal with respect to… ahem… cleanliness issues. Success notwithstanding, AIBO was discontinued in 2006 and customer support ended last year. Hmmm. Now, Toyota is working on a full range of HSR, Human Support Robots. There is a Robot Era project in full swing in Tuscany and Sweden. All three projects support independent living for older people. 
Older people without cognitive decline have high demands for a high quality of life. They need help with basic functions including cleaning and shopping, which robots of the future will be able to perform, but human intervention will continue to be fundamental. The extent to which robotic innovations will assist or replace humans in the future remains unknown – as are the long term costs, but will the reduction in human labour be seen as a worth the expense?  After all, what if a robot IS capable of caring behaviour: are they so different from a well-trained carer, a taught actor who expresses compassion and concern as part of their job? How comparatively artificial is empathy imbued by human designers in a dutiful robot?
In the meantime, no one can predict their own ageing fate. Ageing is not a homogeneous process and care needs are highly personal and fluctuating. Normal function is lost unevenly and inequitably, not suddenly and over the course of a lifetime. Sophisticated assistive care is, at present, available to the few: the deep pocketed and participants in optimum conditions, in controlled settings. Until sufficient interest, improved access and affordability gaps are closed, solutions loom just out of reach. Boomers, like me, are watching their own ageing parents and wondering. The boundaries of what is achievable to enable independent living are being pushed and we all want that.
Get a move on Rosie.

For more information, the BioCentre on Ethics held a teleconference on the Use Of Robotics and the Care of Older Persons on April 11, 2014, Deborah was a panelist. Link to the audio and full report: http://www.bioethics.ac.uk/news/Teleconference-on-robotics-and-the-older-person-
Deborah Gale

Thursday, 17 April 2014

Keeping up with the Jetsons - Long Version


Last week, the BioCentre on Ethics hosted a teleconference on the Use of Robotics in the Care of Older People. I was on a panel with Dr Walter Greenleaf from Stanford University and Dr Amanda Sharkey from the University of Sheffield.

We teamed up to discuss whether robotic assistive devices are more likely to empower independent living or intensify isolation. We barely scratched the surface. Dr Greenleaf opened the conversation reminding us that at the same time as we are facing the acute problems of caring for ageing populations, we are already living in an assisted world. He advocated for immediate action in the form of targeted, solution oriented efforts and user-led ie older person involvement in the design process. Unless actual users can be involved in all elements of design, we will be unable to stay far enough ahead of the predicted, large-scale physical and neurodegenerative inevitability's. Dr Sharkey also acknowledged the predictable expansion of robotic options, in all domains of care, but cautioned against the inherent risks, particularly with respect to end of life care.  Our overenthusiastic acceptance of introducing human-like but not actually human helpers could qualify as an infringement of personal dignity, in our older years. The subtext to our exchange of viewpoints, as academics observing these developments, was on ethical isolation amidst this burgeoning robotic innovation. Worthy of note, the concept of robo-ethics is a mere 13 years old.

STATE OF PLAY
The fact is, the robo-genie is way out of the bottle and robotic intervention is already occurring in every dimension of modern life. What's needed is targeted attention on the actual application of robots to provide assistance and care for older adults. Despite the robotic inventing taking place in specialized, well-funded labs and the growing awareness that the planet is ageing, a serious lack of consumer ready solutions remains. Robotics for older people isn’t core to any business plans of the relevant players in this market. This is relevant because we live in a commercially driven world.
Clearly, the business of robotic engineering and the business of caring represent two distinct cultures that need to comfortably coexist and these cultures are already intersecting.  Since 2000, amazingly complex surgical procedures using robotic arms and a surgeon operating from a console have allowed for enhanced dexterity and more refined movements than were ever humanly possible . Add to this the dual bonus of tremor reduction and faster recovery times for patients and there is not much not to like about these robots!  Next, it is well documented that most people never do any rehab exercises after they leave the hospital or physio appointment. There are now virtual avatars carrying out routine checks to see that patients are actually doing their exercises and advising them on proper technique. 
These "relational agents" are also at the forefront of medication management, "watching" patients take the right meds, at the right time. This is hugely beneficial, given that 50% of the people to whom 146M are dispensed in the US daily are never taken, at a cost of some $2.9B annually. In addition, diagnostic and pharmaceutical errors result in 700K drug emergencies every year. This translates to sunk costs to the pharmaceutical industry of £180B. Big Pharma flag bearer or not, this is material. Another recent study shows that AI, artificial intelligence algorithms, outperform trained physicians in terms of diagnostic accuracy by 41.9%. In these examples, there is proven synergy when artificial intelligence and robotic engineering are combined with humans and we leverage all the new technological tools at our disposal. The nagging question, then, is will these interactions alter the users: surgeons, carers and the cared for's basic understanding of themselves and if so, at what cost?

INAUTHENTIC RELATIONSHIPS
There is something called the Turing Test that robots can take. It's a test for intelligence which requires that a human being should be able to distinguish the machine from another human being by using the replies to the questions put to both. Many studies have shown a natural disposition of people (especially, older people and children) to accept life-like robots readily as peers, despite the fact that they are machines. This opens up the debate to concerns over inauthentic relationships.
Over ten years ago, research was conducted on an entertainment robot animal. AIBO was being used for treating severely demented people in a care home in Japan (Tamura et al., 2004).  The conclusion was that the AIBO was an effective rehabilitation tool, providing positive outcomes to patients. In addition, AIBO was observed to avoid any potential danger or injury to the patient and because it was not a real animal, cleanliness was more easily maintained. AIBO was also attributed with the most positive outcomes, when the AIBO was dressed. Apparently, the introduction of humanoid characteristics and demonstrating their usefulness in predictable environments, not situations requiring intuition or spontaneity, is the implicit driver of good tech for older persons.
Similarly, a "welfare robot", in the form of a robotic seal called Paro has also shown beneficial effects on people with dementia. A landmark Danish study aims to professionalise the use of Paro by certifying professional caretakers in their use of the robotic seal. The objective is to determine the extent to which new technology can support care home residents’ independence, communication and needs for stimulation. So does the robotic seal give care staff more time for social contacts with other residents, thereby enhance the well-being of both parties or  is this actually a clever distraction, further limiting personal contact?

LONELINESS
And what about loneliness? In the UK, it is estimated that over 50% of over 75 year olds who report living alone, say their TV is their main company and 17% report that they only have contact with a person, less than once a week. If you are being cared for by social services, your carer may not even speak the same language as you do and can only spend, on average, about 15 minutes, per day, per visit.
This makes it hardly surprising that neuroscientists have found higher levels of epinephrine, the stress hormone, in the morning urine of  “lonely people”.  Their research also showed that “loneliness” – subjective social isolation – alters the basic process of DNA transcription. We know that gene expression also disrupts perception, behavior and physiology. Loneliness burrows deep and can become a trap that reinforces isolation. On the positive side, loneliness and possibly depression have both been observed to be relieved using AIBO or Paro and in much the same way as a communication technology such as Skype works to create connectedness in people without cognitive deficiencies.
The bottom line is this, when you introduce a robotic assistive device into the mix you need user led design. Because older people respond differently to any technology than do designers or technology saturated children, they need to be included in any R&D effort. Worthy of mention, the prototypical designer of anything from F1 to a toilet seat is a 38 -year-old-white-male. What do you suppose they would rather be working on?

ANWERS
Is there an answer? In the case of people with dementia or other psychopathologies, are we deceiving them? If a robot is capable of impressive caring behaviour, is that wrong? Are carers who are good actors and exhibit impressive caring behaviour any different? In the same way that the carer may die, the robot may fail. Is one disappointment bigger than the other, in the mind of the cared for? Is there a distinction? Is artificial empathy, imbued by human designers fundamentally wrong? For that matter, is first person subjective experience or at best, realistic conscious like behaviour, necessary for caring? I think not. However, human intervention in terms of monitoring will for the foreseeable future, continue to be important.
Meanwhile, in all of the popular and stunningly poignant TED talks by Henry Evans and Hugh Herr or other equally important personal technology news, we see enthusiastic people fully dedicated to reengaging with the human race. These are the fortunate survivors, all living new lives and au fait with their biomechanically engineered prosthesis and body surrogate robots. Some of these come with $400K price tags, clearly out of reach for most, but they also inspire great hope. These are  authentic but they should not be confused or compared with the radically different experience of ageing.
With ageing, function is lost unevenly and inequitably, not suddenly and over the course of a lifetime. The application of robots in care of older adults is uncharted territory. The needs of an ageing citizenry are no less immediate or urgent but are unlikely to be perceived in the same way as the otherwise disabled group. The extent to which robotic innovations will assist or replace humans is yet unknown and the long term costs of such care are also unknowable.
The ultimate goal of human-robot interaction in the care of older people is to enable communication with real users in real-world environments. We need to start training a new generation, combining specialists from both ends of the age spectrum with specialist knowledge about technology and of actual ageing. Currently, there are serious gaps in the linkages between product and the population they are intended to serve (Hudson, 2014).
At present, the boomers are watching their own ageing parents and worrying. We see the centenarians, clutching their birthday greetings from the Queen and delight  to see them being adequately celebrated, obviously cared for. There is no hint of fear, no whiff of loss of control, no suggestion of isolation, loneliness or neglect.  They also illuminate that the benefits of ageing are far from equitably distributed. This has further philosophical and spiritual implications for the broad definition of caring and even categories of the notion of “elder abuse”, be it inflicted by man or machine.
By definition, these issues are intricate, vital, and incalculable. This is as true today as it was for the 1962 Jetsons and their indefatigible robot house-maid, when Rosie the Robot got burned into our boomer memory banks. She was a reject, an outdated model from U-Rent A Maid. The Jetson's only ran for 24 episodes but in that brief time, it fired our imaginations. Despite the fact that Rosie was past her sell by date, she ran the house while simultaneously dispensing wisdom, parental advice and discipline. If having a robot like Rosie, who understands where the older person is located in the home, provide them with whatever help they want or need and provide companionship, can this be so wrong?
Ageing is not a homogeneous process, care needs are highly personal and fluctuating, while eventual decline is undeniable. This debate only serves to underscore the first world nature of this problem. Older people without cognitive decline have high demands for a high quality of life. They need help with basic functions including cleaning, washing and shopping that robots of the future will be able to perform. Integrating technology with existing health and social care services makes intuitive sense but it represents such an ambitious undertaking it is barely conceivable. Meanwhile, sophisticated assistive care is, at present, available to the few: the deep pocketed and participants in optimum conditions, in controlled settings. Until sufficient interest, improved access and affordability gaps are closed, solutions loom just out of reach (Hudson, 2014).  But this also represents a yawning ethical issue and it's racing to the fore. As such, it is rightly under exploration. 
Get a move on Rosie.

Deborah Gale

For more information, the BioCentre on Ethics held a teleconference on the Use Of Robotics and the Care of Older Persons on April 11, 2014, Deborah was a panelist. Link to the audio and full report: http://www.bioethics.ac.uk/news/Teleconference-on-robotics-and-the-older-person-

HUDSON, R. B. 2014. Aging and Technology: The Promise and the Paradox. Public Policy & Aging Report, 24, 3-5.

JOHNSTON, S. 2014, Aging2.0 Flipboard. Accessed: 23 March 2014. http://flip.it/dDQpo 

TAMURA, T., YONEMITSU, S., ITOH, A., OIKAWA, D., KAWAKAMI, A., HIGASHI, Y., FUJIMOOTO, T. & NAKAJIMA, K. 2004. Is an Entertainment Robot Useful in the Care of Elderly People With Severe Dementia? The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59, M83-M85.