FlyTitle: Finland

Finns turn to technology to help frail old people live at home

芬兰人用科技协助病弱老人在家生活

经济学人双语版-平板处方 Prescribing tablets

IN A GREY office building on the outskirts of Helsinki, a chatty social worker is meeting six elderly people from around town for lunch—via tablets propped on their kitchen tables. For the next half-hour she talks to them about their day and reminds them to have something to drink, because dehydration is particularly dangerous for older people (making them more prone to falls, among other things). Glasses of milk and water are duly raised.

在赫尔辛基郊区一幢灰色的写字楼里,一位健谈的社工正与该市的六位老人共进午餐——通过支在餐桌上的平板电脑。在接下来的半小时里,她和老人聊家常,也提醒他们喝点东西,因为脱水对老人而言尤其危险(比如加大摔跤的风险)。老人会按她的提醒喝水或牛奶。

The virtual lunch group is part of Helsinki’s remote-care programme for its elderly. While many countries with bulging elderly populations are building new care homes, Finland is not planning to do so and, instead, is looking after people in their own homes for longer—even those with dementia who live alone.

这个虚拟午餐小组是赫尔辛基针对老年人设立的远程护理项目的一部分。许多老龄人口庞大的国家正在兴建更多养老院,芬兰却反其道而行,设法协助老人在自己家中生活更长时间,甚至是那些罹患痴呆的独居老人。

The guiding principle in Finland is that for anyone, no matter what their age, “home is best”, says Anna-Liisa Lyytinen from Helsinki’s social-services department. Nurses and care workers drop in, often several times a day, to help with meals, bathing, medication, or just to check that everything is all right.

赫尔辛基社会服务部的安娜-莉莎·莱蒂宁(Anna-Liisa Lyytinen)表示,芬兰的指导原则是,无论什么年纪,对每个人而言“家都是最好的”。护士和护工往往每天家访多次,帮助需要照顾的人用餐、洗浴、用药,或者只是来看看是否一切正常。

Such a painstaking service will be harder to provide as Finland ages. In the next ten years the number of residents older than 75 is expected to increase by around half, as people live longer and the baby-boomers become octogenarians.

但随着芬兰社会日益老龄化,提供这种耗时耗力的上门服务会变得越来越难。人们的寿命更长了,加上婴儿潮一代成为耄耋老人,预计未来十年芬兰75岁以上的居民人数将增加一半左右。

Finland’s answer to this challenge is technology—unsurprising in a country that claims to have the biggest number of digital health startups per person. At a recent international health-tech fair in Helsinki many, if not most, of the offerings at the Finnish pavilion had to do with helping frail elderly people to live independently. That involves two challenges: making sure that care workers know immediately when something goes wrong (an old person falls over, for example) and slowing the decline of elderly minds and bodies.

面对这种挑战,芬兰的对策是科技。这不足为奇,既然这个国家声称人均拥有最多数字健康创业公司。在赫尔辛基近期举行的一场国际健康科技展上,芬兰展馆的许多(如果不是大部分)产品都与协助衰弱老人独立生活相关。其中涉及两大挑战:确保发生问题时(如老人摔倒)护理人员能即刻收到通知;减缓老人的身心衰退。

In Helsinki’s municipal home-care programme, about 4,000 frail people are equipped with various safety gadgets. These include wristbands with GPS, a fall detector, an alarm button and a phone line linked to care workers, who monitor the wearer’s location on their computer screens. Some people who have dementia have sensors on their front doors, which send alerts to the care team if they go out. Most of them are too infirm to walk about much, so they rarely leave their homes, says Hanna Hamalainen, a former manager at the programme. When they do go out, she says, it is usually to drop in on friends nearby. But if they venture out in the middle of the night or stray too far from home, care workers are dispatched to find them.

赫尔辛基市政府的家庭护理项目为约4000名病弱人士配备了各种安全小设备,包括GPS手环、摔倒检测器、报警按钮、护理人员电话专线。护理人员在电脑屏幕上监控佩戴这些仪器的人所在的位置。一些痴呆症患者的房屋大门上装有传感器,在探测到他们出门时会向护理小组发送警报。该项目的前主管汉娜·哈马莱宁(Hanna Hamalainen)表示,这些老人多数身体虚弱,不能多走动,所以很少离家。她说,他们外出通常就是到附近的朋友家里坐坐。但如果他们半夜出门或离家太远,系统会派护理人员去找人。

Technology cannot replace care workers, but it can help. The most common reason for a home visit by a social worker in Helsinki is to check that Grandma is taking her medicine. A pill-dispensing robot in her home can do that. Each holds a two-week supply of multiple drugs, chimes a reminder when it is time to take them and dispenses the right combination. For one in five people who try them the robots don’t work, usually because Grandma is reluctant to take lots of pills or has advanced dementia. But for the rest, they have cut medication-related visits by nurses from 30 to just four a month.

科技不能代替护理人员,但可以协助他们的工作。在赫尔辛基,社工家访最常见的原因是检查老人有否遵医嘱服药。在老人家里配备一台配药机器人就可以做到这一点了。每台配药机器人可提供两周用量的多种药物,会按时提醒老人该吃药了,并递给他们正确的药物组合。在对这种机器人的试用中,没有发挥作用的情况占五分之一,通常是因为老人家不愿服用大把药片或患有晚期痴呆症。但对于其他人,机器人把护士为检查服药而登门的次数从每月30次减少到了仅仅四次。

Here’s looking at you

看着你

The idea of frail old folk living alone perhaps worries Finnish people less than many others; Finns pride themselves on their rugged self-reliance. A welcome pack for foreign journalists includes a book of cartoons depicting “Finnish nightmares”, such as having to say “hello” to a neighbour. Social isolation, however, is a big problem for the elderly because it leads to faster cognitive and physical decline. To deal with that, Helsinki runs virtual get-togethers for its homebound elderly that include quizzes, chair exercise classes, sing-alongs, book clubs and a religious discussion led by a priest. These should be regarded as extras, though. A degree of personal interaction, not just the virtual kind, is surely necessary even for Finns.

在让衰弱老人独自生活这一点上,芬兰人不像其他国家的人们那么担心——毕竟芬兰人一向以他们坚定质朴的独立自主精神为荣。来芬兰的外国记者收到的欢迎礼包里就有一本漫画,描绘了诸如不得不和邻居打招呼等“芬兰人的噩梦”。然而,社交孤立对于老人来说是个大问题,因为这会加快认知能力和身体机能的衰退。为应对这个问题,赫尔辛基市政府为不便出门的老人举办虚拟聚会,其中包含益智问答、椅子锻炼课、唱歌、读书会以及由牧师主持的宗教讨论会等。不过这些应被视为辅助性活动。一定程度的面对面社交——而不仅仅是虚拟互动——是绝对必要的,即便对芬兰人也一样。

The biggest challenge for both humans and gadgets is to spot problems early. Some Finnish towns are testing technology to unobtrusively track the daily activity patterns of people who live alone. Local tech companies, including MariCare Oy and Benete, have developed systems that use a network of motion sensors to gather data on things like how much a person moves about, visits the bathroom or opens the fridge. Care workers use dashboard summaries of such data to prioritise whom to visit and what to check for. A jump in bathroom visits, for example, may be a sign of a urinary-tract infection. Not opening the fridge as much is a hint that memory problems may be getting worse.

无论是人还是电子设备,最大的挑战都是要尽早发现问题。一些芬兰城镇正在测试能无声无息地追踪独居老人日常活动模式的技术。包括MariCare Oy和Benete在内的当地科技公司已经开发出系统,利用运动传感器网络收集数据,显示个人在家中移动、上厕所或打开冰箱的频率。护理人员根据这类数据的汇总来确定优先家访的对象和要检查的事项。例如,上厕所次数明显增加可能是尿路感染的迹象。打开冰箱次数减少显示患者记忆力衰退可能加重。

Gizmos sometimes misfire. Wristbands give out the wrong co-ordinates, triggering false alarms. A sensor may fail because Grandpa draped a towel over it. Some elderly folk forget to charge their tablets. Such problems can be fixed. But even so, the share of contacts that home-care workers in Helsinki make virtually is not expected to rise much from its current 8% (out of 250,000 visits a month).

小电子设备有时也会失灵。比如手环会发送错误的位置信息,引发误报。传感器可能因为老爷爷在上面搭了条毛巾而失灵。一些老人会忘记给平板电脑充电。这些问题是可以解决的。但即便如此,预计赫尔辛基的家居护理员虚拟访问老人的比例并不会提升太多——目前占每月25万次家访的8%。

The biggest gain from technology may be that it makes it easier to keep old people fit enough to remain in their own homes for longer. This is much cheaper than an institution, and usually nicer, too.

科技带来的最大好处也许是能更方便地协助老人维持健康,让他们能在自己的家里生活更久。这比入住养老机构便宜得多,而且通常也更舒适。

A 65-year-old Finn can expect to live another 20 years, among the longest life expectancy in Europe. But Finland is in the bottom half of EU countries when it comes tohow many of those years are spent in good health, thanks to a fatty diet and a relative lack of exercise, perhaps because the winters are so long. Not every problem has a technological fix. ■

一名65岁的芬兰人预计还能再活20年——他们的预期寿命在整个欧洲排在最前列。但要统计这其中有多少年是在良好的健康状态下度过的,芬兰又落到了欧盟国家中的后半区。这也许是因为这里的冬季过长,芬兰人饮食中脂肪比重大,又相对缺乏运动。并非每个问题都可以靠科技解决。