Getting Older, Getting Over: Creating an Age-Friendly Smart City

Growing old is an inevitable part of life. Thanks to modern medicine, people are living longer and healthier lives. According to the World Health Organisation (WHO), one in six people globally will be over the age of 60 by 2030, up from 1 billion in 2020 to 1.4 billion. By 2050, this number is expected to more than double to 2.1 billion.

Life expectancy in Hong Kong has surpassed that of Japan’s to become among the highest in the world. Figures from 2021 showed that Hong Kong men can expect to live an average of 83.2 years, while women’s life expectancy is a whopping 87.9 years, according to the Department of Health at the Centre for Health Protection.

Census data published in 2022 noted that the proportion of persons aged 65 and over in the population has risen to 20 per cent in 2021. For those aged 85 years and above, the proportion has reached 16 per cent, and is expected to surpass 30 per cent by 2066. In other words, almost one in three people will be aged 85 or above then.

While this is good news from a health perspective, from a social governance point of view these developments will pose significant challenges regarding how to help the elderly live better and increase their quality of life following retirement.

Blueprint for a Better City
In 2017, the Hong Kong government rolled out a Smart City Blueprint for Hong Kong that aimed to develop digital infrastructure to help residents in their daily lives.

In 2020, in the midst of the COVID-19 pandemic, a Smart City Blueprint 2.0 was released with 130 further initiatives to be implemented. The intention was that these initiatives would help support Hong Kong to become a more age-friendly city.

“Simply put, creating an age-friendly city is about creating more opportunities for people of all ages to participate and actively foster their health and wellbeing,” explains Dr Tracy LU Shiyu, Assistant Professor at the Department of Social and Behavioural Sciences at City University of Hong Kong (CityU).

Lu stresses that an age-friendly smart city is really more about being inclusive while emphasising the humanistic spirit and taking a people-centric approach.

“It’s about using smart technology to make the city more inclusive,” she says.

And her peers couldn’t agree more. Dr CHAN Ho-mun, Associate Professor at the Department of Public and International Affairs, says that in his view, an age-friendly smart city is really one that is data enabled, digitally connected and uses AI technology to help older people receive their healthcare, social welfare and other necessary services.

“This is particularly important because many older people prefer to stay home instead of in an institution and it is better for them to be supported by a smart system,” he says.

At present Chan is collaborating with CityU’s School of Law on establishing a cross-border medical data exchange framework between Hong Kong and Greater Bay Area (GBA) cities. Many elderly people may prefer to stay in the GBA or travel frequently across the region after they retire; Chan thinks a strong digital connection with Hong Kong is essential to improve the continuity of healthcare wherever they are. For example, extending the coverage of the Electronic Health Record Sharing System (eHealth) in Hong Kong to healthcare providers and professionals in the GBA, so that health records can be accessible by healthcare practitioners across the GBA.

Valuing the Old More
While the above may sound like a straightforward outcome, there are in fact a host of challenges that need to be addressed.

Both Lu and Chan agree that one of the key issues is the prevailing attitude and mindset towards the aged in Hong Kong. “Rather than seeing them as an asset, they are often regarded as objects needing to be cared for, and passive welfare recipients, when that is so often not the case,” Lu adds.

These days, most people in their 60s and early 70s remain healthy, and are educated and experienced. Many have valuable skills and learnings, and what is important is creating a friendly environment so that these people can continue to participate and contribute to society, explains Chan.

“It doesn’t mean we push them back to work, but if we have the capacity, we should facilitate them to make a contribution,” he says.

Building Tech Literacy Among the Elderly
Another major challenge in building an age-friendly smart city is the use of the technology itself. While there are obvious benefits to being connected and being online, if the technology itself creates barriers, then it could further fuel feelings of loneliness and isolation.

In fact, Chan argues that the technology itself can create inequitable solutions. “For example, smartphones—many people cannot buy one or don’t know how to use one properly. Yet if we live in a society that entirely depends on technology, those who don’t have that sort of access will be ignored,” he says.

Another major challenge is the technological literacy of older people.

Dr Dannii YEUNG, Associate Professor of Psychology at the Department of Social and Behavioral Sciences at CityU, observed and witnessed the alienating effects of the technology itself during the COVID pandemic.

“During the pandemic we had social distancing and many of the elderly had to reduce their typical social participation with family members and friends,” she notes. “They couldn’t go to community centres to attend social activities, classes or workshops.”

The lack of ICT knowledge means that many among the elderly do not know how to use the internet or social media to connect with others, while some might not even have a data plan to get access to timely information about COVID-19 restrictions. Added to that, the introduction of the LeaveHomeSafe app also posed many challenges to the elderly in Hong Kong.

“Their limited knowledge of ICT was one thing, and then there was the issue that many of them don’t even have a smartphone and/or a data plan,” says Yeung, noting that when the LeaveHomeSafe app was introduced, many elderly were completely helpless.

“They were standing outside the wet market trying to get help from people to teach them how to install apps and operate the smartphone,” she notes. “That sort of measure when implemented within society has limited consensus. The government isn’t necessarily aware that the potentially poor technological knowledge of older people—especially among those with lower educational levels, or who live in poverty, or don’t have smartphones—can put them in a helpless situation.”

For this reason, both Chan and Yeung advocate more education around ICT knowledge as a start. And in fact, Chan argues that it’s important that everyone in society plays a part in this.

“We need to press all the right buttons, the University, healthcare providers, the welfare associations and different stakeholders. They should all open themselves up for adopting new technology,” he says.

Motivation to Stay Connected
During the pandemic, Yeung’s team noted an appreciable rise in elderly people feeling excluded and isolated. For this reason, she feels that there is still a long way to go before Hong Kong can claim to have developed an age-friendly smart city.

On the upside, there are currently many supportive groups, such as the Social Welfare Department and NGOs who have been providing active community care and support services to the elderly. Researchers are also playing a part in developing intervention programmes that help the elderly prepare for a more technologically driven society.

Yeung’s team and her collaborators have developed intervention programmes that cover mindfulness, behavioural activation and befriending programmes for reducing loneliness of elderly living alone, which are conducted over the phone so the elderly can stay home and still get support from trained volunteers. Yeung believes this is really the way to go.

“If we can develop intervention programmes on technology use that are not just focused on new knowledge acquisition, such as to frame them as learning these skills for having a better opportunity to get updates about their family members and friends, or even their grandchildren, through Facebook or having an Instagram account. This will motivate them more,” she says.

Indeed, looking after mental health and keeping the elderly motivated with social activities is important in old age and promoting emotionally meaningful goals is the key. Yeung explains why: “When we get older, we want to maximise our experiences and feel more rewarded and satisfied in our activities, contrasting that with knowledge acquisition goals when we are young.”

Lu adds that emotional meaningfulness is a crucial way to encourage older adults to engage in social participation which is important for creating a sense of belonging and self-importance, which are all important for social capital.

And technology can play a huge part in this endeavour. In fact, Lu is an active researcher of the time bank model, a system that encourages older adults to do more volunteering and peer-to-peer interaction with a focus on rewards.

A reward can be time credits from volunteer hours that they can exchange for a service, or use to buy products from a social enterprise. But the critical component within the social capital framework is that it co-opts older adults to be co-producers of community development, which leads to inclusiveness, a caring economy and a more equitable society, explains Lu.

And technology today can play a key part in building this. Lu and her team use an app to promote volunteering opportunities and information relating to the opportunities and rewards gained from the social exchange time banking programme. While the app itself sometimes poses its own challenges, Lu believes this is the best way to actually scale up time banks.

“To overcome our challenges, therefore, we need to make sure the elderly are co-producers and are key stakeholders when we improve the design of the technology,” she says. “That’s why we always ask for their feedback and seek to understand their needs before we improve the technology.”

Aside from co-producing the technology, Chan also believes that to turn Hong Kong into an age-friendly smart city, tech development needs to be even more targeted at the elderly.

“This is particularly important because many older people need better support through a SMART system,” he says, citing examples such as technology for rehabilitation, using robotics to solve any manpower problems or even having sufficient hospital beds and equipment to improve the quality of care services provided by institutions.

“If we can keep them in a data-enabled and digitally connected system, it would even allow them to pass away more peacefully and with dignity,” comments Chan when addressing end of life issues.

As such, there are clear benefits for Hong Kong to make use of technology to improve the well-being of older adults. And the three professors are optimistic about the city transitioning into an age-friendly city in the future.

“Although we still cannot see large-scale mutual help happening in the community level, different sectors are making efforts on their own,” says Lu. “A mechanism to allow for cross-sector collaboration is needed to scale up mutual help in our society—and this is the direction we should all move towards.”