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Watch Dr Shinsuke Muto share at TEDxUTokyo his vision on how technology can empower us to meet the needs of the elderly.

00:20 – “How do I want to live out my life as a doctor?” There is a story behind how I decided on that.

00:28 – During my term at the Tokyo University Hospital, I had a chance to do a home visit for one of my patients.

00:41 – That patient was living in a home that looked like this.

00:48 – I was shocked. For someone like me, who has only dealt with outpatients and inpatients up until that point, seeing that my own patients were living in such environments was a big shock. They stay in bed for more or less the whole day; eating bread and drinking juice from (the juice boxes) around them, and refrain from talking to anyone. They’re surrounded by a mountain of rubbish. This is the reality of an ageing society. I did some research after that, and I found out that my patients were not unique in this respect. In about 10 years from now, the elderly will come to make up (about) 40% of society. And out of that group, 70% of them will either be living alone, or with just their spouses. This is the society we are heading towards. That was what I came to understand through this experience. These elderly are living with extreme degrees of solitude, and I want to do something about it. This happened after I had decided to set that as the theme of my life.

2:04 – “What can I do (for them) as a doctor?” I thought to myself. I put a lot of thought into it, and the answer I came to was a ‘home clinic’. A home clinic is a method of treatment for patients who are unable to leave their homes, or who are suffering from terminal stage cancer and want to live out their final days in the comfort of their homes. Doctors will visit these patients in their abodes and carry out medical treatment and care for them there. Doctors will also be available round the clock to rush over and deal with any unexpected situations that may arise. This was the kind of care (I had in mind).

2:39 – And so, in January 2010, I set up a home clinic centre in Bunkyo Ward. And when I first started out, I genuinely believed that this would help the elderly in tackling their (problem of) loneliness. But when I actually began (operations), (I realised) that the reality was not so simple. Even though we could visit (the elderly), do check-ups and treatments for them, talk to them about their prescriptions and give them dietary recommendations, there were always patients who were unable to take certain drugs, or who would claim that they cannot make or refuse to eat the food we recommend them. The thing that shook me most was that, while the patients would be all smiles and cheerfulness talking to us, their expressions would change to one of intense loneliness once we were about to leave. I felt then, that as a doctor, I wasn’t doing anything effective for these elderly. “What should I do?” I thought to myself. It was during that time that I had a (life-changing) encounter. This (happened in) Ishinomaki City, Miyagi Prefecture.

3:52 – After the Great Tohoku Earthquake, I went to Ishinomaki City located in Miyagi Prefecture, believing that there would be a need for home clinics in the area, set up another centre, and began home consultations. Besides that, I also conducted lessons for the disaster victims. One day, some of the volunteers I was working with told me about an elderly man who was in rather bad physical shape and asked if I could pay him a visit. And so I went.

4:24 – This patient was a 72 year-old man called Abe Shouki. Everything within the vicinity of Shouki-san’s house had been washed away, and he was living in the 2nd floor of his house, which had survived the disaster. When I paid him a visit, with the intention of performing a check-up for him, he said this to me, “I can’t do anything even though I’m alive. I feel sorry for being alive when everyone else has died. I don’t need a doctor.” He would not even let me into his home.

5:01 – I went back, and asked my co-workers about Shouki-san. And when I did, I got a lot of information from them – that (Shouki-san) feels uncomfortable because there is a persistent draft in his house; that he experiences difficulties sleeping at night; that he cries in the middle of the night, thinking of his friends who have passed on; that it is a home that is very lacking in warmth in general; that it’s infested with mould. We then sat down and discussed what we could do to help (Shouki-san). There was a huge hole that had opened up in the wall (of his home), so a male volunteer went down the next day and sealed it up. The day after that, another volunteer went and replaced his mouldy futon with a new one. And after that, a counsellor would pay him regular visits to have chats with him. And so a few months passed like this, and I was finally allowed (into his home) in my capacity as a doctor. I asked him what medicines he had been taking before the disaster, gave him a check-up and new prescriptions. To my surprise, Shouki-san started recovering really quickly. When I asked him what he had done during that time, he told me he had received a bicycle, and had been using it to go around and check up on his friends, who were also victims of the disaster. That was what he told me.

6:36 – I took away many lessons from this experience. One of them is that you should always assess an elderly person’s circumstances from multiple viewpoints. Gather comprehensive information about the person, find people who are able to provide the necessary assistance, analyse the information, and have the parties involved provide help in whichever area they are able to. This is the necessary set-up (to help elderly patients). A common problem among professionals is that we tend to try to solve problems using (only) our own abilities. For example, if a patient is having difficulties sleeping, a quack doctor will simply prescribe (him or her) sleeping pills and leave it at that, when the true crux of the problem may have actually been that (the patient’s sleeping quarters) were too cold. Or that the patient has been feeling troubled by the deaths of the people (around him/her). Or because he/she has been sleeping on a mouldy futon. There could be many other aggravating factors behind the patient’s condition. We must look at these factors holistically in order to come up with the optimal treatment for the patient. This was the first thing I’ve learnt.

7:55 – Another thing I got (from this encounter), is that we tend to think of the elderly as people we must help; as people we must save. But in the case of Shouki-san, to give an example, while his house was in tatters and his health had deteriorated, the reason he got better was actually because he was able to become a guardian (of sorts), or perhaps even a pillar of support for others, in a place he was familiar with. It was only after he had such an experience, such an environment, that he began to recover.

8:34 – How then, can we apply this lesson to the whole of Japan and its rapidly ageing society? This is, again, another difficult question. After mulling over it for a very long time, I found my answer from this. This is a smartphone. This is an undeniable concept for (our) society. What do I mean by that? Well, most of us own a smartphone, right? But the apps on my phone are likely to differ from those on yours quite significantly. So what accounts for the difference? That is because the services I need are different from the ones you do. So what can we say about this in the case of the elderly? Take youths, for instance. They have a lot of variations in the way they think. But for the elderly, these variations, instead, come in the form of their physical conditions. For example, one person may suffer from poor vision; another, from poor hearing. Or they could be suffering from differing degrees of dementia. There could also be variations in their living environments. Because of that, when you want to provide services for people living in such different conditions, you would need to gather many different services (to cater to those varied needs). If we were to use applications as an example of services, this would mean that many different apps would be required. It is also not simply a matter of providing a variety of services (for the elderly). You must also provide a platform that where (the consumer) is able to choose the services that fit his or her needs – essentially something like the iPhone. In other words, an avenue which allows (consumers) to freely select the services they would like to have – that is what we must provide. Until now, most of the measures targeted at the elderly have been singularly formulated and implemented by organisations, such as by NPOs or company departments. Because everyone has been doing things on their own, there has never been a single platform for collaborative effort.

10:51 – Will (providing a platform for collaborative effort) be enough, then? No, of course not. This is because, among the elderly, the majority of them may not understand (their own needs and) the services they require. Which is why we need to have people recommend services in accordance with their needs to them. As people age, their mental and physical capacities will also change. Accordingly, their needs would shift as well. By gathering information (about our patients), and analysing that information, we may then be able to anticipate the kind of services they might need next. This is similar to the product recommendations you would receive after making a purchase on Amazon. For instance, if a person’s reflexes have deteriorated, the risk of them having a severe fall would increase. Then they would be likely to need this equipment. Or perhaps having a certain service would help to reduce their risk of falling. When we gather information comprehensively in this manner, we will then be able to predict (their needs) in the short-term. Accordingly, we may then be able to better prevent their existing conditions from worsening.

12:10 – One more thing. Applications nowadays enable information sharing, right? Facebook and Google, for instance, share a lot of information so you don’t have to register twice. This is an important concept for our platform too. For instance, a patient may suffer from reduced mobility after a minor stroke. When we receive such information, the next thing we do is to change their meals to include foods that are easier to swallow, or alter their rehabilitation programmes. Or even make changes to their support systems (to accommodate their bodily changes) after they’ve been discharged. When we share such information, the service network will then be able to better respond and adjust itself to accommodate the patient’s changing needs.

12:57 – Another thing is that a new community can also be formed through this platform. Currently, the support system for the elderly community is very scattered. It’s limited to regional (assistance). But if (the patients) are allowed to share about the services they are using, or about the ones they like, a new (support) community can be created. More importantly, it also gives them a chance to use their experiences, knowledge and skills to help others. If we are able to match information in this manner, we will then be able to create an additional layer of support for the community, where (patients) are not just recipients of services, but where they are also able to provide support for each other.

13:48 – Last but certainly not the least, interface is also of importance. That is to say, even if we were to create a (comprehensive) e-system such as this, it will be useless if the elderly do not use it. Someone has to get them to use it. Such as the retail assistants at convenience stores, or the delivery personnel, for example. These people would likely have established connections with the elderly living in their area. They would have had the opportunity to ask little questions like “how was your day?” or “what are you doing now?” as they are providing their services (to help them establish relations with their patrons). This (idea) is, in fact, what we are using in our project.

14:34 – I’m sure most of your grandparents have television sets in their homes and often watch it with the volume turned up very high. Television sets are actually a very big deal for the elderly. They have a substitutive effect (for the elderly). And they (TVs) are important because serve as a portal through which the elderly can obtain information about the society at large. If someone sees them talking to the television, for example, he or she may then be able to go up and recommend services they may need to them, or perhaps give them the information they need. In this way, we can take existing services and transform them into a new interface.

15:16 – I get very excited whenever I think about this. By taking advantage of IT innovations, the concept (of an integrated user interface) represented by the iPhone, and modern social infrastructure such as the convenience store, by combining all of these, I believe that we will be able to create a society in which the elderly will be able to not only receive the services they need, but also connect with each other and find greater meaning in life. Looking at it this way, the term “ageing society” seems to produce a rather depressing image. But it actually isn’t (that bad a thing). (I prefer to see it as) a balance that encourages innovation. That is the theme to which I have decided to dedicate my life. And I truly believe that it is a good one.

16:15 – Lastly, I have a request to make of all of you (in the audience). When I was thinking of how to (make my vision) a reality, my first thought was crowd sourcing. That is to say, have individuals gather their resources, start projects based on what they have, and run with it. If we adopt this concept, everyone of you here will be able to become a contributor in providing solutions to (the problems of) an ageing society. Therefore, what I would like you to start doing from now on, is to go to your grandparents, parents, or perhaps any elderly person around you, look at them closely, and listen to them carefully. Understand their troubles, or what makes them happy. Try to see them for who they are and understand those things about them. Then, use the skills you have and come up with new ideas. I would like to take those ideas and, together with all of you, create an “ageing society” where the elderly will be able to live happily. Thank you.

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