[0:02]Silver Eco Podcast presents Expert Thoughts, a podcast recorded during the Silver Eco International Festival at the Palais de Festivals in Khan. AAL Legacy, 14 years of innovations for aging well. This episode focuses on the European AAL program and the key lessons learned from 14 years of innovation aimed at improving the quality of life for older people. With the participation of Gela Langer Welt, advisor, ambassador, board member, senior and technology expert at AAL, Dominique Rapapi, senior manager of European programs at AAL. Okay, so good afternoon, everyone. My name is Dominic Rapas. I'm the program operations officer at AAL. So we will tell you a bit more about the AAL program. And this is my colleague Krea Angvelt, and we are both here today to present the outcome of a study that has been prepared by our funding program. So we are a European funding program that has spent over 16 years financing and funding projects active in research and innovation for aging well. And so we're here to present the study that is now live on our website and there's been a full report, but the idea today is to give you some key messages of things that we have learned that could be useful for future programs, policies, and potentially, uh, yeah, even project participants. Welcome. Bonjour. So, yes, maybe you can introduce yourself and we can start. Well, thank you, Dominic. I'm Hella Langerfeld. Um, AAL means active and assisted living. I think it's nowhere in the presentation, so maybe it's good to explain it. I don't know if you are familiar with the program or not. As Dominic said, we have been working over 16 years on this program and um well, the read the background, I, I suppose you are all aware of it because you are here and you know about the, the, the topics that are relevant. The average life expectancy is in 2070 88. Uh, the European population will be about 1/3 of um uh in Europe. And the and the ratio of safe of uh the people financing the the taxpayers and the pensionados are kind of balancing the other the other way. A pyramid would be like that and now we have it like that, so, um, the population is changing, but I'm sure you are all aware of that. AAL was a funding program and it had three um objectives from the start that was to improve the quality of life of older adults by using digital, I ICT-based systems and solutions. The other one was uh to uh support the the sustainability of health and care systems. Of course, already in 2008 uh studies were done, projections were done and we knew how the population situation would be by now and also how the projections of the care staff available would be. So that was not really looking very good and we thought we have to do something about it. And then the other the third one was that we should uh support, foster the the the industry in Europe, the companies and also the SMEs and the startups to provide for these solutions. Because otherwise everything, well, will it will get here imported from China, from America everywhere, but it would be good to have a European industry as well. And I think recently that became all the more important, especially with all the AI developments. Well, short overview, the program ran in two parts, AL1, AL2, all uh during 15, 16 years. We had 14 calls launched, uh funding three over 300 projects. We had in the beginning 23 countries participating, some countries with different funding agencies, but that reduced later, but we still had, well, 23 funders being either national funding agencies or regions, especially in countries who have kind of independent uh regions who have their own policies and their own funding for health and health care. Altogether participating in in project were plus 100 more than 100 user organization involving many, many more end users being either older adults or informal carers and professional carers. We had 700 R&D organizations participating and over 2 2000 SMEs and and over time that kind of became more and more. Parallel to the project funding, discovering um what kind of needs the project partners had to really not only develop solutions and and do research, but really bring them to market. Well, we discovered or detected or they told us uh what they needed and we launched a lot of support actions like a market observatory. Uh we did an end-user study to to list all the types of methods that you could use to engage end users, especially older older persons. We did a big one with L2 business, we come back to that later, supporting consortium and companies to really go to market. And altogether national and EU funding and I guess also the the private funding that was mandatory from the participants, we spent over a billion. So that is really a lot of money. That's why it's important to um, well, to to leave, well, some products and the solutions but also the lessons that we learned over all that time. Then we launched a study, it was commissioned to Idea Consult and they used artificial intelligence. A large language model, don't ask me how it works because I don't know, but that was what they, what they used. Analyzing thousands of documents of the projects, of the program, evaluation, reports, impact assessments, support everything. This system generated insights that we for a big part could recognize with our own experience. I worked for more than 15 years, oh, I didn't even introduce myself, I think. I worked for more than 15 years in the Netherlands at the Dutch funding agency as the AAL coordinator or program manager. We had a group of experts that that went through the reports and signaled strange things that we couldn't recognize. So, expert validation was used to to improve so so to say the findings from the AI uh system. Um, well, I said already we used endless numbers of documents, uh to answer 17 evaluation questions. I'm not going to list them all to you, you will see the results throughout the presentations. And still, although we really, I think we went three times scrutinizing the document, I think we kind of kept out the the AI hallucinations, but you never know if some inaccurac accuracy still remains in the full report. This is to say that if you feel like reading the 135 pages report and you see something strange, it might it might happen, but it shouldn't and you can contact us, of course. Yeah. Um, well, one big element in um in AAL projects and that was mandatory from the very first call was the engagement of end users. Being at first, uh older adults, and we made it mandatory in a sense that one of the eligibility criteria in projects was that they had an end-user organization involved.
[8:28]They were usually, well, responsible for involving individual people. Over the whole period, more than 60,000 older adults participated in different stages of these project. Over 14,000 caregivers were involved that were either informal caregivers or professional carers. Uh in the beginning, well, there were surveys, so that was uh accountable for a lot of end users, you can spread them out uh widely. Uh there were focus groups uh held and there was long-term pilot testing involved over over time. So we really tried to uh generate inclusive and practice oriented innovation, so not only well, research but really practice oriented so that you could come up with solutions that were usable, useful. And you see that over time, very clearly, from the analysis, it started with brief consultations. Then there became more collaborations with end users and in the last few calls, there was really long-term like, like half a year or sometimes even year-long testing and evaluating of the solution in practice situation. Well, at at the last calls over 50% of the project practice really codesigned methods. Not only service, not only focus group but really iterating uh different uh in different loops, um the uh the solutions that were developed. Please come and join us. Following development was that over time the public sector was more and more included. Municipalities were in some in some countries responsible for for care for older people were involved already in in early stage, in early phase of the program, but many more were engaged over time. And it sometimes were also housing bodies or residences for seniors uh and insurers who are often responsible for um funding not so much of projects but much more of the uh well, the day-to-day using of the of the solutions. So the they were really the user engagement were really cornerstones for success. Continuous, structured, well organized, repeated uh feedback loops, embedded testing that really uh led to stronger outcomes and later uh late stage changes. I mean, if you, if you start a product and it's almost finalized and then you discover that it's not really working, then you spend a lot of time and money without uh much success. And the long-term testing also created higher trust and we can even see that when these factors were missing that even very promising solutions just couldn't get any further. They just stuck at the end of the project because there was no system around it that could could take it up. Then we have the the the challenges, every year we launched a call with a well, a theme or a topic. Topics like the one call was about promoting social interaction, the other one was about supporting mobility, the other one was, well, like that. That was what we did in the first calls and later on it, when AL2 started in 2014, we changed that into more what we call challenge-based calls. Like living well with dementia or uh managing better managing uh chronic conditions. And what you see uh when you define it as a challenge and that corresponds very much of course with daily life of people. If people are, uh, mentally, uh, declining, you don't need support in only one topic. You, you, you have some day structure needs to live independently, you might have some navigation support to be able to to move around in the environment. So these challenges made it possible to really integrate different components from different life domains into more integrated solutions. Number of times such a challenge was addressed. It's not that they are adding up to 100% because many solutions addressed, well as I said different topics and then social isolation and loneliness was a very important one as well as daily living and independence. Because that is where the real challenges are when people get older are, well, starting to suffer from some deterioration and still want to live independently. So, uh, well, promoting social connection and emotional wellbeing was um supported by communication technology, uh community creation, um, uh calling people, uh to to share the activities via digital solutions. So, all um aiming at at, well, engaging people in their social environment. Daily living and independence, well, what I said, day structure, enabling everyday tasks, safely, uh, uh, remaining, uh, providing reminders to things like medication or eating and drinking or appointments or things like that. Then we had uh uh the third one was cognitive decline and mental health. That was actually quite a broad topic because it, on the one hand, is memory loss, well, a general um characteristic when people are aging. But also a lot of people with either starting the starting dementia or cognitive, and that is really a topic where these AAL solutions are there are a lot developed to to support people with um getting, having to deal with memory loss because it's a very, yeah, kind of clear need. But on the other hand, you need very flexible solutions because people become more and more uh affected by that. Also including, well, cognitive stimulation by games or by, uh, exercises, uh, and also therapeutic systems were developed. Have you been on the floor as this floor or the one above? Oh, yeah. Well, there are of course a lot of booths anyway, but there are also five booths from AAL projects or solutions. Well, then of course, a big topic was the physical and functional mobility, rehabilitation, there's one upstairs. 12 fall prevention, fall detection, and there are technologies that are, well, wearables, robotics, there I mean, there is a lot possible to address that that that particular topic. Safety and emergency always uh from the beginning also, well, not in all the projects, but a very clear need to uh to address. Um that also has to do with the detection of falls and health crisis. That's a much more about monitoring uh monitoring systems. And then another big issue is the reduction of the burden of caregivers, especially informal carers but also professional carers. Chronic disease management, also monitoring, early warnings, coaching, um some cases also uh kind of uh early detection of deterioration. Then there were some projects addressing environmental adaptation with smart lighting, sensors, well, which can detect falls. Uh sensory impairments were not many. I remember one project where they tried to develop a smart stick for people with uh vision impairments, but uh there were only few projects addressing those topics. Well, what we saw over time is that we started and that of course is related to this uh these calls from from single purpose from basic sensors, basic systems to really complicated integrated systems with predictive AI incorporated in the solutions. What also helped was that over time more and more uh the standard, the the the interoperability standards were uh developed, respected, in well, deployed or how do you say that, implemented. So that means that also the the island solutions from only facilitating social interaction to to ecosystems where you could plug and play all the different types of solutions that someone might need. You can tailor that to individual needs. And that is really um uh yeah, an improvement and also necessary because otherwise it will be people need like five different interfaces to to deal with the different challenges they meet and that's a challenge in itself, I think. So we we moved from single topic to broader challenges and in the end, we uh ended up with uh more integrated ecosystem level solutions. Then another mandatory aspect of this program, but also objective was develop solutions and bring them to the market. Because if they stay in the research area, well, it's interesting for researchers, but no older adult will benefit from it, uh nor a care system. So we had these commercialization line in the program where we also uh demanded that at least one SME should participate in an um in a consortium, a aiming at bringing the solution to market. And what you said, what you saw was when when user engagement was well organized, when the open system design was okay, so uh the possibility to plug in uh new other solutions, and the structured business support that was also developed and provided by the program. If if that was uh um in place, then they really at the end of the project succeeded in follow-on funding and and deployment. And when some of them were missing, uh a lot of projects kind of, well, died uh after the prototype. Uh you saw also the rise of SMEs. By supporting the the projects, uh training them, workshops, coaching to to develop business models, to to get access to finance, to learn how to pitch for investors, for instance. All that type of support really helped and it also made the the number of SMEs participating really wanting, well, to use a project to bring a product to the market evolved over time. And at the end of the program, 2/3 of the project coordinators were SMEs and in the beginning, I think almost 100% were research organizations. I think we mentioned already isolated pilots. Oh yeah, no, that was that was another aspect. Uh over time, we also realized that we saw a lot of projects developing, say, uh the most projects lasted three years. After two years, two and a half, you actually could see that they they learned a lot, but they were not able to really get further to the market. And we realized we should create new opportunities like small collaborative projects, projects of maximum nine months, right, or six, nine months, well, much smaller funding, of course. But that was uh made it possible to to explore on an idea and test if if, well, if that was well accepted. And then if that was uh successful, then you could build, well, big project to really build the solution. Or what also have happened is that, for instance, companies that have a product that was used in a certain domain, realized, well, this could very well be used also in this uh in this sector where you can support people to to live independent. For instance, from the energy sector or from, I know one of the first projects, uh, that was from, uh, in the Netherlands, TNO from from the defense sector, you know, surveillance, um, solutions and so on. Well, we have this advanced technology, why can we not make it available for safety and security of people at home? So, and then via the project, they, they tailored these, uh, these ideas and these solutions to useful product. And again, the horizontal business services, what I mentioned, we really spent a lot of time and also money on supporting projects to to um learn business, uh, aspects, yeah. No, the lessons learned, well, we have lessons on program level and lessons for health and care innovators. We thought this audience is mostly interested, I guess, in the last group. So the first one is start with people, not with technology, unless you want to, well, what I said, you what you can do is you have a technology and you want to explore if it works in the sector for uh older adults to to to stay independent and have a better quality of life. But even then, you start with in in in investigating uh what they want, what they need and then see if your product fits in and not the other way around. Build for integration, not isolation, I meant I mentioned that and I explained that already, I think. Well, another one is anticipate regulation. Over time, a lot of regulation came up, uh like the GDPR, AI compliance, MDR, uh and if you only start halfway or later in the project to realize that you have to comply to that, you have uh lost a lot of time, but also maybe already made a lot of errors. Test in the real world, so not only in a lab situation, where actually it might be good, especially I heard that often in projects for people with dementia, make sure that you first test with people to make sure that your solution is working good when you start really uh testing and and implementing it uh for people with dementia or or because they get completely confused if errors come up in the screen, you know, or the system is just not working well. So a real test in the real world, but be sure that you what you produce, what you provide to people, especially people who are, well, mentally a bit um challenged that they they get real uh solutions to use. Align with payers also very important what I said earlier, the third, the public sector and the care is important to include because they are for many things, the ones who are going to pay and it has to fit in their strategies and in the reimbursement systems. Design for inclusivity and localization. We walked around here and almost everything is in French. And in France that's okay, but if you want to go international, it doesn't work. So if you want to test something in, well, wherever in Netherlands or England and most things are in French, it both works. Diversified dependencies and revenue, yeah, that is, well, it's it's kind of um obvious maybe, uh but but still, you know, being dependent on on one company to provide part of the solution is is risky. And also, um you have to really try to find the good blending of financing, uh again, not the project, but who's going to use is is it a consumer product, will the informal cares pay, will the organization buy it for all its uh clients. You have to find a good balance to be able to uh to really um scale. Leverage existing support structures, we, I think that is, uh now, uh you have a lot of ecosystems of companies, funders, care organizations, et cetera, so really try to get all the support uh that you can make become a partner in such a network. And the last one is plan for after the project because if you start doing that when project is finalized, many partners will have been gone. They have other projects and you kind of end up alone with your product. So that's really really often you need to make already agreements with partners about uh future collaboration about uh IPRs as well. Yeah, yeah. So that are the, well, the main lessons that uh would be good to take into consideration. There are on quite generic level, but still, uh, I mean, I just I'm an evaluator in a Dutch program now, uh, since very recent and I realized that in their calls and in their criteria, not all these things are are fulfilled and then it's really difficult to assess projects that look very promising as positive if really crucial parts are missing. So I'm really curious about how that will go, but I, I will really try to um spread this message because it's really um yeah, there's a lot of data in it that kind of um prove that it that is, that these are important elements, yeah. Thank you. You will find on our website a web page with all these key messages were developed and if you feel even more motivated, then you can read the full report, which is very interesting.
[27:26]Thank you, thank you for joining. Thank you. Thank you very much and we are happy to see you later on upstairs. Thank you. Thank you.
