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In a context of progressive loss of intellectual and interactional capacities for the elderly, the goal of this article is to examine to what extent a new technological environment can improve their quality of life. In this study, we examine the very elderly (mean age 87) who have experienced a loss in functional capacities and are dependent on managed care such as residential home care units. Using qualitative methods amongst a group of 17 residents (semi-structured interviews and longitudinal observations), we examine whether new social practices form and whether subjects feel more socially recognised. Our study shows that information and communications technologies may, to some extent, play an instrumental role in interconnectedness and social stimulation, and can also be seen as a ‘boundary object’ that communicates between the residents’ world (who are rather isolated) and their families’ world (including grandchildren).
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Can ICT improve the q
uality of life of very mature adults
living in residential home care units (RHCU)? From actual
impacts to hidden artifacts
Journal:
Behaviour & Information Technology
Manuscript ID:
TBIT-2011-0137.R2
Manuscript Type:
Full Paper
Keywords:
aging, elderly people, assistive technology, readability, healthcare, IT
diffusion and adoption
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1
Can ICT improve the quality of life of elderly adults living in residential
home care units (RHCU)?
From actual impacts to hidden artifacts
Marc-Eric BOBILLIER CHAUMON
GRePS Laboratory (EA 4163)
Lyon University (Lyon 2)
69676 BRON Cedex (F)
marc-eric.bobillier-chaumon@univ-lyon2.fr
Christine MICHEL
LIESP Laboratory
Lyon National Institute of Applied Sciences (INSA-Lyon)
69621Villeurbanne Cedex (F)
christine.michel@insa-lyon.fr
Franck TARPIN BERNARD
LIG Laboratory
UMR CNRS 5217
BP 53, F-38 041 Grenoble cedex 9
Franck.Tarpin@ujf-grenoble.fr
Bernard Croisile
Neuropsychological Department,
Neurological Hospital,
59 Bd Pinel, 69677 Bron cedex (F)
bernard.croisile@chu-lyon.fr
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Can ICT improve the quality of life of elderly adults living in residential
home care units (RHCU)?
From actual impacts to hidden artifacts
Abstract
In a context of progressive loss of intellectual and interactional capacities for the
elderly, the goal of this paper is to examine to what extent a new technological
environment can improve their quality of life. In this study we examine the very elderly
(mean age 87) who have experienced a loss in functional capacities and are dependent
on managed care such as residential home care units (RHCU). Using qualitative
methods amongst a group of 17 residents (semi-structured interviews and longitudinal
observations), we examine whether new social practices form and whether subjects feel
more socially recognized. Our study shows that information and communication
technologies (ICT) may, to some extent, play an instrumental role in interconnectedness
and social stimulation, and can also be seen as a “boundary object” that communicates
between the residents’ world (who are rather isolated) and their families’ world
(including grandchildren).
Keywords: ICT, elderly, users, psychosocial impacts, RHCU (French medical and
residential institutions for the dependent elderly)
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Introduction
Developing technologies specifically for an elderly population is justified when taking future
demographic trends into account. It is indeed possible to anticipate quite precisely the
inevitable aging of Western populations, a major transformation in contemporary societies.
This is clearly illustrated by data from Europe, the United States and Japan (Robert-Bobée
2006) which indicate a dip in the demographic curve and significant growth in the number of
people above the age of 80, designated by the category of “elders” or “the dependent elderly”
1
(Caradec 1999). Whether physical or mental, their dependency is characterized by their
inability to live alone in ordinary housing. This implies the need for a supportive presence at
home or even being placed in a specialized institution.
If the desire to age while remaining in one’s home for the longest time possible is a wish
shared by the majority, it nonetheless appears as a difficult and costly reality due to the lack
of adapted medical, social and familial structures and resources (Frossard 1990). However, if
living in specialized institutions, such as an RHCU (residential home care unit), represents a
comfortable and safe solution, as much for the elderly person as for their social circle, it also
highlights some paradoxical side effects. Feelings of solitude are more strongly experienced
than at home, with decreased autonomy and quality of life (Boulanger and Deroussent 2008).
In such conditions, the possibilities presented by information and communication
technologies (ICT) allow for innovative solutions to assist and support the dependent elderly
living in such institutions.
We conducted a longitudinal study in a residential home care unit (RHCU) with elderly
subjects (mean age 87) to investigate whether new information and communication
technologies help improve their quality of life. More specifically, the aim of our study is to
determine whether or not they gain psychosocial benefits from using a technological
environment originally developed for cognitive stimulation and rehabilitation.
To explore the possible benefits of ITC in this paper, we will first introduce the psychosocial
characteristics of the studied population and how technology can be adjusted to them in order
to prevent cognitive loss and more globally improve their quality of life. After having
described our central research question and hypotheses, we will outline our methods for
collecting data. Finally, we will present and discuss our results.
1
English translation of the French definition.
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The psychosocial profile of the elderly
In order to better understand the psychosocial difficulties that could possibly be overcome
through the use of ICT, it is necessary to accurately describe the needs and characteristics of
the social cohesion of the elderly living in RHCUs.
Fragmented social cohesion amongst the elderly
A common trait amongst the elderly is that their identity and experience of social cohesion
tend to fade (David and Starzec 1996). The elder person becomes withdrawn and stays at
home, playing an increasingly minor role both within their family and society at large (see the
Theory of roles, Rosow 1974). They live through others’ experiences and their own behaviour
regresses, as reflected by changes in their nutritional habits, hygiene and social manners. In
particular, they have a tendency to lose sight of their goals and sense of self (see the
Disengagement theory, Cummings and Henry 1961). The combination of change in behaviour
and social withdrawal can lead to a state of anomie and a major decline in self-esteem (Rosow
1974, Atchley 1985). However, more recent studies show that factors like gender,
widowhood, place of residence and illness are greater indicators of disengagement than age
itself (Hall and Havens 2002, Cambois and Robine 2003, British Columbia Ministry of Health
2004). Such social disengagement is expressed through a decline in social interactions, both
in terms of frequency and degree of involvement.
However, as Clément and Membrado
(2006) highlight, partaking in less activities does not necessarily mean being less involved in
the few that remain. As one’s resources decline, the least demanding social activities can be
privileged and they can then choose relationships from which they can expect an immediate
and satisfying exchange with the least possible investment, such as with family and friends
(see the Socio-Emotional Selectivity model, Carstensen 1992).
Special needs of the elderly living in an RHCU
Various studies (Aliaga and Neiss 1999, Colin and Coutton 2000, Boulanger and Deroussent
2008) emphasize how physical deterioration, psychological decline such as in self-esteem,
vulnerability or depression, and weakened social networks such as isolation from family
and/or friends – are more significant for people living in an RHCU than for those who live in
their own home. Social isolation in an RHCU is very pronounced and becomes increasingly
visible through a major decrease in contact with the family, rather low participation in group
activities, and few days spent outside of the RHCU. Vanhoutte (2003) suggests that entering
such an institution may increase such losses, possibly due to a mirror effect which results
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from the high concentration of seniors in one location and the presence of residence staff that
tend to focus and negatively evaluate dependent behaviour and often ignore or undervalue
positive autonomous behaviour. This contradictory context motivated our study designed to
examine the potential benefits of technologies for this elderly population with special needs.
Benefits of ICT on quality of life and social support
Gerontechnology
In current research, the term “gerontechnology” represents “the study of technology and aging
with the intention of developing better living and working conditions as well as adequate
medical care for dependent people”
2
(Clément and Membrado 2006: 55, Bouma et al. 2007).
Studies on standard ICT, such as telephone and Internet services, social networks, online
forums and messaging systems, or even more innovative ones, such as ambient and
ubiquitous technologies (Buiza et al. 2009), highlight their diverse objectives such as
allowing for the elderly to remain in their own homes and developing autonomy (Bobillier-
Chaumon and Ciobanu 2009). Other studies show that ICT can be used to rehabilitate and
reduce certain deficiencies, whether they are motor or perceptive (Fozard 2001), cognitive,
psychological (Hage 2008) or social (Kavanagh and Patterson 2001). More generally, the aim
of such technology is to improve the quality of life of the elderly (Bronswijk et al. 2002;
Blaschke et al. 2009).
Using ICT amongst the elderly: what impact on their quality of life?
Quality of life can be defined as a global evaluation of the satisfaction a person gets from their
life, based on their own criteria (Abeles et al. 1994). Quality of life includes two types of
factors (Leung and Lee 2005):
- objective or situational determinants which are external to the person, such as the nature
of hobbies, standard of living, social and family support,
- and subjective or positional determinants which are specific to the person, such as
personality-related traits like optimism and pessimism, feeling isolated or autonomous,
self-esteem and health.
Various studies show that ICTs are likely to have beneficial effects on both of these
dimensions of quality of life. We will highlight research primarily focused on implementing
ICT with the objective of allowing the elderly people to remain in their own home. This
2
English translation of the French definition.
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choice is mainly due to the lack of studies, to our knowledge, that have been carried out on
the effects of ICT in RHCUs.
1) First, at the external level, ICTs are considered to lead the elderly to open up and become
(re)integrated into society (Charness et al. 2001, Bagnall et al. 2006). Taking part in social
activities (such as hobbies or workshops) or being part of a social network is thought to
reduce their self-isolation and withdrawal into their homes. For instance, certain technologies
try to offer an alternative to the surveillance or assistance” they are subjected to (such as
distance surveillance) by turning friends and family into a possible source of moral and
material support for the elderly (for an example see the “Whereabout Clock system”, Sellen et
al. 2006). Other technologies aim to transform the elderly’s home, initially considered as an
isolating shelter, into a centre of social connectivity and virtual openness towards the outside
world. For example, Internet teleservices for information, interaction and games offered via
accessible media (such as an interactive TV) aim to reinforce social cohesion and help them to
go, virtually, out of their home (for examples see: the T@PA project, Thepautet al. 2004, and
the @ctivage project, Bobillier-Chaumon 2008, Leonardi et al. 2008).
2) On a more personal level, other studies have shown how ICT could get the elderly to gain
greater autonomy by restoring their self-confidence in their learning capacity and through the
use of innovative systems. A study by Blit-Cohen and Litwin (2004) shows that the elderly
who use ICT perceive their aging process differently, as feelings of finiteness become less
present and oppressive, altering their perspective of their past and future. A study by Billipp
(2001), conducted with psychologically fragile elders who use the Internet, demonstrates that
those who belonged to discussion groups had a greater chance of coping with their
weaknesses than those less connected. However, he states that people who learn with the help
of a nurse have better results in terms of self-esteem and decreased depression than those who
learn by themselves.. Very few studies have been conducted with elderly subjects living in
RHCU-type institutions. We can, however, point to the study conducted by McConatha et al.
(1994), which showed that being taught how to use computers helped enhance residents’
feelings of self-efficacy and self-evaluation of their competencies and independence. The
study conducted by Otjacques et al. (2009) analyses residents’ needs and expectations about
assistance tools supposed to help them in their RHCU everyday life. Results show that there is
no regularity and each specific life experience modifies the needs. McDonnell and Grimson
(2010) show that technology can be used in RHCUs as a complementary activity useful for
supporting the informational and social aims of the more active residents. Indeed, usually
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activities proposed in RHCUs are designed for the weakest residents and so can lead to
understimulated or bored active residents. Technologies are so viewed, as we have done in the
case of the MNESIS projet, as a means to maintain or stimulate their capacity. Renaud and
Van Biljon (2008) and Otjacques et al. (2010) focus their studies on the role played by social
context in the acceptance and appropriation process.
However, these benefits have been called into question by results from other studies that show
no major improvement in the quality of life of the elderly after having used ICT. For example,
Slegers et al. (2008) conducted a longitudinal study analysing the impact of Internet use on
the development of well-being and autonomy amongst 191 seniors, yet their results show no
impact, either positive or negative. Dickinson and Gregor (2006), who carried out a major
literature review on the topic, point out that the analyses are usually incorrectly carried out
and conclusions are often only partial and limited. Furthermore, it is difficult to distinguish
between the effects related to the social interaction stimulated by computer courses, and that
directly induced by computer use, as indicated by Billipp (2001, Cf. supra). We also identified
results that were incorrectly generalized for different age categories
3
which each have very
distinct features, such as age groups with or without deficiencies and those who are either
socially integrated or isolated. Moreover, a methodological review highlights the limits of
data collection techniques, which are usually quantitative, based on questionnaires and/or
interval scales. These provide only a partial representation of how individuals understand their
own social cohesion and self-perception. In addition, these methods are not sufficient to
explain the social and subjective experiences of an elderly person in their actual living
conditions. The impact of ICT is generally measured directly following the subject’s
participation in a training course on using the Internet, after which they are immediately asked
how they benefit or could benefit from these technologies. The temporal component of such
evaluations is not accounted for in a rushed data collection process, failing to apprehend the
actual long-term impact.
Central research questions and hypotheses
3
The notion “seniors” (or third age), referring to people between the ages of 65 and 80 years old, is a
sociological construction that associates retirement with pleasure, vacation and leisure activities and not with rest
and inactivity. Real aging, after the age of 80 (or fourth age), is designated through the category “elderly” or
“dependent senior” (Charue-Duboc et al. 2010)
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As we have seen, physical, social and mental degenerations accumulate with old age and tend
to increase after individuals have been placed in RHCU-type institutions (known as the
“mirror effect”, described by Vanhoutte 2003). Nonetheless, aging should not be considered
as a series of irreversible losses. It would be more accurate to consider aging as a process
characterized by crashing falls and striving to rebuild (Freund and Baltes 2000), which can
lead the elderly to bank on the benefits of technological environments to provide a dynamic of
compensation, stimulation and remediation. ICT could therefore generate a global
readjustment of the elderly person’s life, also likely to affect their interpersonal and social
environments (Fozard and Kearns 2008).
Given that very few studies have assessed the psychosocial impacts of ICT on elderly adults
living in RHCUs, the aim of our research is to evaluate whether the use of a technological
environment can help improve their quality of life. Initially developed within a cognitive
stimulation programme, we hypothesize that the technology would also lead to psychosocial
stimulation through the impact it has on their social structure and the more general effect on
various internal and external factors that determine the quality of life of a mature adult (Leung
and Lee 2005). More specifically:
- Hypothesis 1: The use of new technical devices would have a positive effect on the self-
esteem of the elderly. Indeed, by using new devices, deploying new skills, demonstrating
that they are still able to learn, and finding meaning in the various uses (to communicate,
for amusement, to explore, to discover), we hypothesize that the elderly user will develop
a more positive self-image.
- Hypothesis 2 : The use of new devices will have a positive effect on the social integration
of the elderly person. Mastering innovative technological equipment should increase the
recognition and positive evaluations they receive from their social circle such as from
family members, medical staff or social acquaintances (other residents). The elderly user
could also feel that they belong to a community of pioneer users with whom they share
common values and motivating factors. Finally, the possibility of communicating from a
distance (such as electronic messaging) can allow contact with their close friends and
family to be re-established or accentuated.
- Hypothesis 3 : The use of ICT will have beneficial consequences on residents’ social
practices. The elderly person will be more engaged and implicated in the activities of the
residence and it will enable them to develop social skills and reinforce existing
relationships.
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Method
Presentation of the technological devices
Dedicated to a mature audience, the Activital™
4
software (Croisile et al. 2002) offers three
types of complementary activities (see Figures 1, 2, 3): cognitive and leisure games, such as
the Towers of Hanoi, a residential journal editing tool to develop creativity (DTP
5
), and an
intuitive emailing device designed to optimize social ties and communication. Each program
is designed to socially and cognitively stimulate its users. The electronic games, for example,
draw upon memorization skills, categorizing the attention and reasoning capacities of the
subjects. The level of difficulty can progress, depending on the user’s successes or failures.
The computer-assisted publication tool allows the user to compile various searches carried out
on diverse themes and from different sources of information (Internet, reading, memories,
personal experiences, and visits outside the residence). The emailing device has an address
book and so users store only once the complete email address. This software offers a very
intuitive framework in which they collectively structure gathered information into a journal.
Finally, the electronic messaging allows them to send and receive messages with attachments
(such as photos) to and from close friends and families (notably children, grandchildren, and
friends outside the residence).
These programs were designed according to criteria for numeric accessibility in order to cater
to the specific needs of elderly users: adapted screens (font, size, colour), coherently
structured interfaces and simple dialogues. Numeric accessibility, according to the definition
by the Web Accessibility Initiative (WAI 2001), takes product characteristics into account
that can cause problems in user-friendliness, in particular for a specific group of users who
consider the product unusable. In the context of this project, the idea is to make the
technological environment (software, entry systems and the presentation of the information)
available for the most elderly and fragile users, regardless of their physical or mental
capacities or their previous knowledge of technological environments. They had to therefore
perceive, understand, navigate and interact in a more efficient and intuitive manner with the
technical environment, but also create content (text and images). That’s why we choose to
adapt interaction device to task. For example, the elderly have the opportunity to use both
resistive touch screen and a mouse for item selection, navigation or game playing. They can
4
Activital, www.activital.fr
5
Desktop Publishing
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use these devices for text writing (by pointing at letters on a numeric screen) or they can use a
classical keyboard.
Insert figure 1 - 2 and 3 here
Figure 1: Game screen Figure 2: Journal editing screen Figure 3: Emailing screen
Study design
With regard to
our central research question, we chose a longitudinal framework comprising
observations of a group of 17 elderly people living in an RHCU over a total period of 20
months. Data collection was carried out in three stages (see Figure 4):
- Stage 1: Carried out before the Activital™ introductory training sessions. Over a period of
six months, we aimed to diagnose the study participants’ psychosocial profile (in terms of
their personal experience, relationships and social habits).
- Stage 2: Carried out during the introductory training period. Throughout the six months of
training, we identified the different uses of the device in addition to problems encountered
while using it.
- The training workshop (with three to four residents on average) was held twice a week
(45-minute sessions). Recreational therapists from each residence supervised these
sessions. Indeed, even though the software was adapted for the elderly, most of them had
never used a computer and so we made the assumption that they could be lost and may be
frightened to begin to use it alone. The recreational therapists had been previously trained
by the software publisher on how to use the program. On all other days, the computers
were available for the residents, allowing them to develop their newly acquired skills.
During each session, one topic (mail, Web, game, text redaction) was presented and used
according to predefined exercices. Collaboration was not a real focus during these
sessions; moreover, residents had the opportunity to work with the others. In newspaper
redaction sessions, the animator chose, after discussion with the residents, a subject linked
on the one hand with activities organized by the residence like a visit to a museum or a
reception done with family, or on the other hand with a news event. Tasks realized during
these sessions consisted in searching for information (text and pictures) on the Web and
using it to write an article with the publisher tool.
- Stage 3. Carried out after the training. We repeated the analyses carried out during Stage 1
over an eight-month period in order to identify the various psychosocial developments
related to our research question.
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We collected data in real-life situations, taking the organizational constraints of the residence
into account (such as meals, activities and medical treatments) in addition to the elderly
persons’ daily life rhythm (impromptu visits, fatigue and third-party interruptions). We
attempted to compensate for these obstacles by developing tools ad hoc and by following and
analysing their social activites. Our main concern was that the tools were integrated in the
best possible way into their life environment without being too intrusive. We consider these
tools to be a means of getting closer to the real-life conditions of the elderly people studied.
Sample group
Forty people
6
volunteered to take part in our experiment. However, only 17 of the 25 subjects
who were initially chosen
7
were actually observed throughout the three research stages. They
met the following four requirements for participation in our study:
1. They passed Folstein’s Mini Mental State
8
test with a score higher than or equal to 25: a
score lower than or equal to 24 points allows a distorted state of consciousness to be
evoked and a diagnosis of insanity to result (Derouesné et al. 1999);
2. They had minimum motor and perception skills in order to be able to interact with the
computer-based environment;
3. They had the ability to express themselves and describe a personal, social or
psychological experience;
4. Their close friends or family, living outside the residence, had to have Internet access to
allow for email exchanges.
The sample could therefore not be representative (in terms of gender, age, length of stay in the
residence, previous professional occupation, family structure and psychological profile) of the
entire population living in the residence. Nonetheless, we will use the term “sample” (or the
“Mnesis Project” as it was called in the RHCU during the research project) when referring to
the 17 participants.
The “Mnesis Project” group (see Table 1) is primarily composed of women (88%) living in
and around the city of Lyon, France. On average, residents have three children and six
grandchildren and have lived in the RHCU for three years. Eighty-two per cent are both
6
For obvious ethical reasons, we allowed these people to attend the technical training sessions.
7
Mortality is high among this fragile population. We therefore had to take deaths as well as transfers to other
homes into account.
8
MMS: This test allows for possible cognitive deterioration to be identified and prevented.
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widowed and have had a professional career. Within their professional lives, four of them
(24%) had previously had the opportunity to use a computer (punched cards), 11% had used
one with their family, and 66% had never used one before.
Insert Table 1 here
Table 2: Characteristics of the sample chosen for the study
Data collection methods
We used five complementary observation methods (M1 to M5 in Figure 4 below) for the
various stages in our longitudinal approach. The aim was to render social data objective
through methodological triangulation, thereby situating the results in a larger perspective. In
other words, while certain methods were used to highlight the reality of participants’ social
practices (M3 and M4 observations), others were used to assess how the individuals (or their
friends and family) perceived their personal and social situations (M1 and M2 semi-directive
interviews).
(M1) Semi-directive interviews with the residents: All 17 subjects were interviewed before
and after the technology training sessions (the average length of interviews was 60 minutes).
Interviews were conducted in the residents’ rooms and tape-recorded in order to facilitate
analysis. We adapted as needed for pauses in the interview when the subject asked for one or
showed specific signs of weakness or discomfort such as silence or marked hesitation.
However, it is important to note that the majority of the interviewees managed to last the
entire duration of the interviews and were motivated to describe their experiences. This
dynamism can also be explained by the criteria for selecting participants from the sample (see
above).
We addressed four major topics in the interviews: the person’s social and biographical
background and their personal life journey; their social ties (elements of their family structure,
the state and nature of their social relations both within and outside the residence, and their
social practices); training-related expectations and motivations; and finally changes (in terms
of impact and development or regression) perceived after the computer training.
(M2) Supplementary interviews with families and residence staff: Conducted with the
subjects’ family members and medical staff, the aim of these interviews was to compare
statements and supplement some of the information provided by residents (regarding family
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visits, for instance, or participation and engagement in activities). The idea was not to
question claims made by one person or another, but rather to additionally explore the way in
which each one evaluates the beneficial effects of ICT on the state of their social
relationships.
We further developed two observation methods in order to assess participants’ level of social
practices.
(M3) Observations of activities on a typical day: Six elderly people (chosen randomly from
the initial sample) were observed throughout an entire day (from waking up in the early
morning to going to bed in the evening). We limited the observations to these six persons
because the management team asked us not to disrupt the organization of the services and the
quietness of the other residents. All activities having to do with individual and collective
social practices were noted. These participant observations were carried out before and after
the computer training. Their daily practices were recorded on a chart composed of five
activity levels (coordinate axis), spread according to a temporal scale (abscissa) (see Error!
Reference source not found.).
- Level 5 (collective activities amongst residents): when several residents participate in a
common activity, whether a verbal exchange or an interaction, for example games (such
as card games), workshops or conversations.
- Level 4 (collective activities with family): similarly to level 5, collective activities,
exchanges or interactions with family (during visits, emails, phone calls).
- Level 3 (passive collective activities): when several individuals gather without a specific
productive goal or exchange within the group: TV room, afternoon tea or meals (if silent).
- Level 2 (individual activities): the resident is involved in a solitary physical or intellectual
activity such as watching TV in their room, going for a walk, reading, writing, or playing
paper or computer games.
- Level 1 (passive individual activities): the resident is alone and is not doing any activities:
such as taking a nap.
At the end of these observations, the elderly subjects and medical staff received a summary of
our notes and were able to make adjustments as necessary so that our analyses of their typical
day reflected their own reality as closely as possible.
(M4) Observation with activity time sheets:
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To evaluate whether the use of ICT influenced the social practices of study participants, we
analysed their engagement in different activities offered by the residence (cultural activities,
games, singing or painting workshops) over a period of one month (before and after the
computer training sessions). We compared their activity participation with that of residents
who were not a part of the studied “Mnesis Project” group.
To constitute a control group, we compiled a list of all the elderly subjects participating in the
different activities offered (from their attendance sheets). Then we randomly chose 15 people
and tracked their participation in various activities with the same method employed to track
the sample group. Finally, we carried out two kinds of note taking: (i) the presence and
absence of subjects in the different workshops, and (ii) their level of implication in these
workshops.
To be certain that notes taken by the different researchers were relatively homogenous, we
limited our evaluations to two levels of engagement. We noted “active” engagement in which
the elderly person asked questions, reacted and was attentive versus a “distant/passive”
engagement in which the person appeared sleepy, absent, apathetic or was actually asleep.
To simplify our analyses, workshops were categorized into: (i) expression and
communication-based activities (such as board games, reading and writing); (ii) manual
activities (like DIY, cooking, painting); (iii) physical activities (like relaxation exercises and
walks); (iv) sociocultural activities (events, shows); and (v) cognitive activities (language,
memory games).
(M5) Online connection log:
Our final method consists of analysing their use of technologies based on a log that tracks
online connections during the training stage (by recording the number and length of
connections, and the quantity of emails sent and received). These results are not presented in
the present article but are nonetheless published (see Michel et al. 2009).
Insert figure 4 here
Figure 4: Observation protocol: methods used in a longitudinal framework
Method of data analysis
Data collected from the semi-directive interviews were subjected to thematic discourse
analysis. We established thematic categories related to our central research question and,
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within those, split semantic units into subcategories that highlight relevant indicators of
quality of life. For example:
- Self-esteem was identified through discourse units that referenced participants’ mastery of
the technology, their level of success in using the system, their acquired development of
skills and autonomy, and their commitment to their life projects.
- Social integration in discourse units was identified through the theme of recognition from
their social circle, mention of collaborative forms of solidarity amongst sample group
participants, and the quality, nature and frequency of relationships with their close friends
and family.
- Social practices identified through discourse units indicate their implication and
coordination in the collective activities related to the “Mnesis Project” (such as learning to
use the new technology or creating a digital journal with the PAO).
Data obtained from the daily activity logs (M3) are presented in tables that document, hour by
hour, observed levels of activities (see Chart 1), and then processed quantitatively with Excel
(see Table 4). Data from activity time sheets (M4) were similarly organized by tables taking
into account workshop attendance (by both the “Mnesis Project” group and the “Other
Residents” group: see Table 5 and Chart 2) and their level of engagement for each activity
(represented by +, ++, -, -- : see Chart 3).
Results
Presentation of data
Results are organized by three levels of analysis that identify indicators highlighting the
impact of ICT on various aspects of the quality of life of an elderly person. In particular, we
consider (a) the way they see themselves (level of self-esteem), (b) their perception of how
their social ties develop (with their family, other residents and staff) (level of social
integration), and (c) their participation and actual involvement in social activities (level of
social practices).
Use of technology and self-esteem
Several factors appear to impact on how an elderly person recovers feelings of social worth
and recognition, influencing both their private and displayed self-image.
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Insert Table 2 here
Table 3: Nature of psychosocial impacts (worth and self-esteem) as mentioned by elderly
interviewees (n = 17)
Understanding how to use the technology: As shown in the above table, the use of innovative
technologies makes the subjects feel valued (16 individuals). Despite initial reluctance and
anguish of some of them (“I can’t do it, it’ll be too hard”
9
), they discover that they can in fact
grasp a technological universe, which is entirely new to them, providing a deep sense of
satisfaction and recognition. As one subject expresses: “I’m very proud of myself, given my
age, it showed me that I could still learn how to use computers.” This is reminiscent of their
experience of success and increased skills developed through brain-training exercises,
allowing them, once again, to be more positive about their cognitive capabilities. “As you
progress from one level to the next you can see that you improve, that your intellectual level
progresses…” The same dynamics that provide a sense of personal value are experienced
through creating a residence journal with a computer. Beyond the technological understanding
of the DTP program, the elderly person is actively involved in the entire process, beginning
with designing a template, writing articles, typing them on the computer, and then printing the
final version. “Despite my age I can see that I have learned a lot. I am able to produce a
journal and write articles. I saw that it was not as complicated as I thought it would be and
that I could do it.”
Positive feedback from others: Encouragement (from medical staff, family members or
friends) of the elderly person’s use of technology plays an equally important role in their self-
evaluation process. Signs of recognition represent positive feedback that stimulates and
motivates the person to further commit to participating in the training. “My family
encouraged me right from the start, it was a surprise, albeit a very good one, they are always
asking me how it’s going and they’re very pleased. They always encourage me to continue.”
However, such recognition is not one-sided and the elderly person’s social circle benefits
from the same positive value judgement and recognition, identifying them to the older
residents. In a way, they assimilate the elder person’s success as their own: They see us
differently: for example, my granddaughter says to her friends, ‘My granny knows how to use
a computer.’ She’s very proud of me, and so am I.”
9
The citations presented in this results section are the English translation of interviews carried out in French.
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The computer activity also allows the elderly subject to acquire a certain technical knowledge
(computer basics and vocabulary, handling innovating devices), which provides an
opportunity to share a common frame of reference with their grandchildren and show them
that they are still with itand cannot be looked down upon by the younger generation. “At
the beginning I thought that I was too old for this but now people tell me that I’m a ‘modern
granny’.”
Regained autonomy: Increased satisfaction comes from the autonomy regained through the
use of new technology: any subjects (seven people) are very proud to show that they are able
to use a computer without any help, even outside the organized training sessions, or can ask
for more training for new programs (such as Word) or other technology (like digital cameras).
These initiatives also indicate their confidence gained by learning something new. “I even feel
able to use other programs. I would like to move on to other things that I could be offered to
learn. I just feel at ease.” We additionally remarked that the use of such technology allowed
them to relive past experiences that could increase their confidence in their own personal
capacities and autonomy.
An “identity echo” (Caradec, 1999) corresponds to the meaning these technologies adopt in
relation to the history and life course of certain elderly people (nine individuals in the
category “Has meaning for the users”). They cite examples of gratifying episodes and
reference their social status that makes them feel legitimate as an individual: “I was a
supervisor so in my work I needed a lot of concentration and I had responsibility and I really
loved it, I loved my work. I rediscovered in front of a computer the same attitude that I had in
my work.” Similarly, the technological device recentres the user’s interests on subjects other
than themselves, moving them away from their current difficulties, such as illness. “In the
beginning, I tried with L. [the course teacher] to find [on the Web] artefacts related to
General De Gaulle. Having looked about quite a bit, we retraced all that I had done, and now
everything is organized and listed.”
However, this autonomy can become problematic when it means only having to rely on
oneself to be organized and accomplish the various computer-related activities. Thus, two
older subjects expressed feeling uneasy as they were normally accustomed to following a
calm rhythm set by the residence (recreational therapy, activities and meals). They quickly
felt overwhelmed by the DTP activity (computerized journal). “I have an idea for an article
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[recipe] (…) but I’d rather not have a computer in my room. I would end up having no more
time to myself.”
Regained hope: Interviews carried out with medical staff indicate that most residents tend to
retreat into their personal past or become entrenched with current illness, waiting for the end
of their lives to come and slowly cutting themselves off from others. For example, one elderly
person states: “My life has slowed down in a way: I never leave my room, I don’t take part in
any activities anymore, and I never talk to any of the other residents apart from during
mealtimes. I feel like my behaviour is a little savage. I do group activities on my own, like
when I watch TV, like the game ‘Countdown’.” Here, use of the technological environment
was thus seen as a means of projecting oneself into the future. Some of the residents said that
they enjoyed thinking about their emails or the article they had to write for the following
week. “I always prepare little drafts and write them down first. I get the idea, find the
necessary information, and then I write about the topic.” In certain cases, residents project
into long-term projects, like one person who set up a knitting workshop and uses the Internet
to look for knitting patterns for sweaters she would like to make for her great-granddaughter.
Others (three people) point out that the training sessions reinforced their feeling of finiteness,
i.e. the feeling that the end of their life is coming quickly, despite, or because of, the positive
impact of the technology. “Unfortunately it’s too late; I’m too old and won’t have enough
time. (…) It’s harder at my age, so why continue?”
However we must also consider the self-efficacy factor as a possible predictor of commitment
issues in computerized activity, which could also have an impact on the self-esteem when
associated with the use of ICT. Indeed, those who participated in the study are, for the most of
them, rather dynamic and in good health, compared with the rest of the residents. For these
reasons, they can have greater confidence in their behaviour and in their capacity to achieve
their goal. Therefore they would present more positive attitudes, motivation and engagement
on actions to perform. This can lead to a more favourable position toward technologies and to
a stronger engagement in their use and other related activities (such as training session tools,
cognitive games, computer designed resident newspapers). But conversely, the self-esteem
that derives from the use of ICTs (social valorisation, successes IT tests) could also strengthen
the feeling of self-efficacy in dealing with those situations and with new computerized
activities. In other words, self-efficacy (Bendura, 1982) would be a very strong factor in self-
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esteem and in the commitment of the use of ICTs, which should be better evaluated. We’ll
discuss this in more detail in the conclusion part of the article and more specifically in the
research projections.
Social recognition and integration
Thematic analyses of factors of social integration are detailed in the table below. Results
globally show that ICT can act to rebind social relationships, shape a collective group within
the residence (stated by 12 people), and reactivate existing social networks (such as with
family). These results, expressed 17 times out of 17 interviews, will be discussed later in more
detail.
Insert Table 3 here
Table 4: Nature of psychosocial impacts (integration and social ties) mentioned by elderly
interviewees (n = 17)
a) Forming a collective within the residence
Despite the fact that the seniors have very little contact with each other (especially those
living on different floors (There are very few relationships inside the residence, everyone
keeps to themselves”), the training sessions allowed for a collaborative dynamic to take shape.
This social group could thus develop closer relationships by talking amongst themselves and
encouraging and helping each other during the activity (see Picture 1).
Insert Picture 1 here
Picture 1: Computer training session: two older women helping each other
This closeness also enabled them to feel like pioneers, experimenters enjoying a technological
adventure. This form of collaboration reduced some of their age-related fears (“not feeling
totally outdated…”) and thus led to greater group cohesiveness. “Since attending the sessions
I’ve also started talking to the other people who are doing the course more often. Before that,
we never used to talk to each other much as we didn’t live on the same floor.”
New social practices also emerged, based on collaborative interactions. As previously
mentioned, this applies to designing the journal which required that the group learned to get
organized and distribute the necessary tasks and roles to finalize the release (who does what
and with whom, what deadlines?). This collaborative effort was also necessary to allow them
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to overcome skills- and aptitude-related issues amongst certain group members. “We even
thought that two people working together could complement one another rather than just
manage to get by on their own with the computer.” Here we observe the way an individual
identifies with their social group, contributing to formalizing their social identity, a relational
process of self-investment in which the appreciation of peers is fundamental.
However, despite the fact that such social dynamics emerged within the workshops, they did
not go beyond the circle of people attending the sessions and, as expressed by some residents
who did not participate, they felt left to the side. Apart from a few rare exceptions, the
computer sessions did not attract as many participants as expected. Residents responded with
disinterest, and a form of mutual rejection even emerged between project participants and
non-participating residents. “In terms of relationships with the other residents, there was no
contact. The other people aren’t interested in what we do during our training sessions. They
don’t know what we’re doing.”
b) Reactivation of social networks outside the residence
As previously shown, the use of the technological devices gave the elderly subjects a new
social status and legitimacy which made them “attractive” again. They became a subject of
interest and curiosity for their social environment. Conversation topics (when face-to-face)
were enhanced by computer-related themes. “We sometimes talk about computers when I visit
my daughter, and then she shows me a few things.”
The emailing device represents another virtual means to strengthen pre-existing social
contacts or to compensate for those that are more difficult to establish due to distance or
personal reasons (such as professional activities or reduced mobility). “They’re all happy
[family members, A/N]: my children answer as soon as I send them an email. It helps to keep
in touch since they are far away.” With an average of six emails sent per session between the
elderly resident and their friends and family, the messaging system was also seen as more
flexible and much less intrusive than the phone. The choice of emails came from a fear of
being disturbed: “You never know if it’s the right time to call, if they have time when you call
(…) now they can send a message whenever they have the time.”
However, for some participants (two individuals), computers did not appear to compensate for
their social isolation. The computer instead revealed their isolation, making it more visible
and tangible. This applied, for instance, to a participant who thought that her weak family
relationships were mainly due to the distance or to her family’s work overload. During the
course, her project was to (at least virtually) restore these relationships. However, she
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received no responses to the emails she sent: “The problem is that my children and
grandchildren are far away; I sent them some emails but no one answered. They are far
away. They call me, though, so it’s not a problem. They also have a lot of work and they’re
very busy so it’s understandable…”
Social practices
Residents’ interaction levels based on daily activity logs (M3)
Chart 1 presents the means of social practice level of six residents during a day, before and
after the experiment. Weak level (1 or 2) refers to individual activity like rest or reading in
their room. High level (4 or 5) refers to collective activities (game, discussion). Level 3 refers
to collective passive activity (like watching TV or reading a book in the lounge, or eating
witout discussion).
It’s interesting to note whether collective activities are organized or not by the residence. For
example, in the morning (before 9.30am) and in the afternoon (after 6.30pm), residents have
the opportunity to stay alone in their room (to read, watch TV, have breakfast or dinner in
their room), or they can go to the lounge in order to talk to others, play cards, or watch TV in
the common room. The periods between 9.30am and 11.30am and between 3pm and 5pm are
dedicated to activities organized by the RHCU like computer activities, choir, painting
courses, writing workshops, collective reading or games. These leisure activities are not
obligatory but all the residents must have lunch in the same room (between 11.30am and
12.30pm). In the evening, conversely, they can choose to have dinner alone, in their room, or
with the other residents.
Insert Chart 1 here
Chart 1 : Comparison of interaction levels during a typical day
The calculation of the average level of activity in one day (Chart 1) shows that the residents
have the highest number of interactions with most people: in the morning (between 9.30am
and 12.30pm), during the organized activities and the collective lunch, or in the afternoon
(between 3pm and 5pm) during and after the organized activities. There are fewer interactions
between 1.30pm and 3pm during their nap, at the beginning of the day (when they have their
breakfast alone in their room) and at the end of the day.
Insert Table 4 here
Table 5: Anova test relative to moment (before/after) relative to the experiment and hours of day
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The shape of the graph is identical before and after the training session. The value of the t-test
presented in Table 4 shows that, when we consider the whole day, there is no significant
impact of the training session (Pr > |t|=0,210). Nevertheless, we can notice a significant
difference in four periods of the day: 11-12am, 4-5pm, 5-7pm, 7-8pm (Pr > |t| <0.0001). In
fact, residents are more active during the time they can have collective active activities
(games, discussion) and are less active just after. This indicates that, while the computer
activity did not fundamentally change the residents’ pace of life, it nonetheless increased their
activity level by privileging practices in which they are in groups and active. But, after that,
the residents need to have some rest, by doing more personal activity or activity with a low
level of social interaction. They are trying to be quieter, to rest up. Moreover, after 7pm, they
come back to spend time with the others until the evening. A typical example is residents who
choose to have dinner or take part in social activities in the lounge (by watching TV or
talking) rather than stay on their own in their bedroom.
These different results indicate that the software may have had an impact on residents’ social
practices but is also tiring. We will further develop these analyses with a detailed account of
workshop participation.
Levels of interaction amongst residents, based on activity time sheets (M4)
Table 5 compares the average level of participation in residence workshops. For example,
before the training, one subject from the sample group participated in an average of 15.27
activities, out of which 4.8 were expression and communication activities.
The experimental group (the 17 subjects of the “Mnesis Project” sample group) is compared
to the control group (the 15 from the “Other Residents” group randomly selected) over a one-
month period before and after the computer training sessions. This control group is not
participating is the Mnesis research.
Insert table 5 here
T
able 6: Means of participation (per month) of the two groups in the workshop activities (observed
before and after the training)
A first analysis of this table leads to three general remarks:
- Over the same period studied, average workshop participation increased in both groups
(“Mnesis Project” sample group and control group), but not equally.
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- “Mnesis Project” participants attended more workshops than control group participants,
regardless of the period taken into account (respectively 15.27 against 12.25 before the
training, and 24.33 against 12.35 after). This shows that “Mnesis Project” participants are
very active, curious and dynamic and appear to be more concerned about their physical,
social and cognitive skills than those in the control group.
- Workshop participation of those in the “Mnesis Project” group greatly increased after the
training period (from 15.27 to 24.33, i.e. 62% increase). This indicates that the six-month
computer training could have had an impact on their level of participation in residence
activities.
We are now going to specify these behaviours for each activity and for the “Mnesis Project”
sample group only.
Insert chart 2 here
Chart 2: Means of participation (per month) for the “Mnesis Project” group
(before and after the computer training) (n = 17)
A more detailed analysis of these results (see Chart 2), and especially those obtained before
the training, shows that physical and manual workshops were the least popular among the
“Mnesis Project” group and that expression and communication activities (4.8) and social and
cultural activities (5.4) were the most attended workshops. Interest in the latter is confirmed
and even increased following the training sessions, as “Mnesis Project” members participated
almost twice as much in the social-cultural and expression workshops (respectively 9.10 and
8.18), with participation progressing slightly more than for the other workshops. A possible
interpretation is that the training inspired greater interest in the general fields (due to the
information obtained via the Internet or email when discussing these types of workshops).
Even with slow progression, participation in the cognitive activity workshops amongst the
“Mnesis Project” group remains more significant (from 2.93 to 3.17) than amongst those of
the “Other Residents” group (from 1.23 to 2.34). This confirms the dynamism of those
subjects who can share different activities (digital ones or traditional ones) and who seek out
this bias as a means to occupy themselves and maintain their cerebral capacities. This may
explain why a certain number of “Mnesis Project” group members chose to decrease their
participation in the classic workshops which they did not find particularly stimulating and
even felt they could make them regress. “The training sessions are not sufficiently
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intellectual, or the residents don’t participate. It’s not dynamic enough for me.” For these
reasons, they preferred to concentrate their time on digital training sessions that are more fun
and better adapted to the evolution of their own cognitive profile.
With regard to the “Mnesis Project” participants’ attitudes towards the various workshops
before and after the training, we tried to assess the level of attention and involvement
(individual answers or ask questions) compared with inattentiveness (passivity, apathy) over a
period of one month (see Chart 3). Due to the constraints of presentation of the chart, only the
active attitudes are shown. The passive attitudes must be deduces. For example, in manual
activities (after the experimentation), the “Mnesis Project” group show an “Active attitude”
for 84% of the observation time, so the level of “passive attitude” is 16%.
Insert chart 3 here
Chart 3: Evolution of attitudes and (active) interest of elderly people for each type of workshop
(before and after the training) (n = 17)
Chart 3 shows that before the training, all participants played an active role in most activities
(between 80% and 100% for all sessions), especially for the physical activities (such as fitness
training and dancing) and cognitive activities (each person was questioned individually). As
previously mentioned, this confirms that our subjects are very dynamic. Passive moments,
although very rare, can be observed in manual activities (18% of the total time when their
motor skills do not allow them to complete some of the tasks, such as baking) and in
expression and communication activities (13% of the time when dozing off during singing,
music or storytelling sessions).
No significant changes were observed in their levels of involvement after the training session.
Before the training, they had very strong interest levels which, compared to those after the
training, were only slightly higher, but this
does not appear, however, to result from the
computer training sessions.
However, we must be careful with these results, especially for manual and physical activities
(before and after experimentation). Although people are strongly involved in these
workshops, we could see before (in Chart 2) that the frequency of their participation is very
low. In other words, if the frequency of participation of these activities is weak, the
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implication of the few participants is nevertheless very important. This shows too that the
elderly of our sample are very motivated and dynamic for each activity.
Communicating with the ICT device
The 24 training sessions allowed residents to use the emailing tool, the DTP tool (word
processing) and the cognitive stimulation games. Participation was equally distributed
amongst activities and use of the emailing device was very heterogeneous. Over the six-
month experiment period the residents sent an average of 9.81 emails, with a standard
deviation of 9.92 (one resident sent 27 emails, while two others only sent one). Residents
were divided into two groups: 63% characterized as “non-autonomous users” (less than eight
emails over the entire period) and 37% described as trained users” (19 to 27 emails). The
word processing course allowed them to collaboratively write a four-page document, similar
to the RHCU journal. However, very few residents voluntarily sought out going to the
computer room outside training sessions.
Discussion
The various results tend to show that the use of ICT would improve the quality of life of
elderly people living in an RHCU. As previously mentioned, the various benefits mentioned
(according to criteria defined by Leung and Lee 2005) include:
- On a personal level (internal): the elderly person gains self-esteem from using these
devices and through increased recognition and validation (from their social environment),
the ability to regain self-confidence in their behaviour, or (re)display certain skills (by
being autonomous and taking initiative).
- On a more situational level (external): individuals show greater dedication to and
involvement in a more active group in which they mutually help and support one another,
greatly increasing diversified social practices compared to before the use of ICT.
These results confirm similar benefits demonstrated by prior research carried out with elderly
populations (McConatha et al. 1994, Leung and Lee 2005) or populations with very similar
social and biographical characteristics (as applies to socially or culturally underprivileged
people; Bier and Gallo 1997, Anderson and Tracey 2001, Henderson 2001). We do indeed
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observe a positive impact on their autonomy, their ability to react (or psychological
empowerment
10
), their learning capacity, and the rehabilitation of certain functions.
In an RHCU, which is a rather closed and confined environment, the technological device acts
like an object of agency (enabling mediation, socialization and stimulation) which can be
instrumental, not only for a person’s own life experience, but also for their relationships
within close social circles. An object of agency is a system with the potential to transform
situations and individuals through the constraints and resources that it brings with it. To a
certain extent, it also allows the individual to, both socially and psychologically, make plans
for the future as generated cognitive involvement and social engagement are beneficial for
countering the harmful effects of being inactive and socially isolated (such as social
abandonment which is restricted in terms of activities) and/or institutionally isolated (the
residence increases both the phenomenon of dependence and being shut in, according to
Vanhoutte (2003). Moreover, the possibility of setting, and even surpassing, their own goals
(succeeding at games, sending emails, and using the DTP tool) might also boost their self-
esteem and self-confidence, and provide the opportunity to achieve and accomplish more
(Rosenberg et al. 2010).
Nonetheless, as Dickinson and Gregor (2006) point out, it is also necessary to question the
actual nature of the object that truly influences these various psychosocial categories: are
improvements the result of the mere use of this technological environment? Or are changes
generated from what happens around and through the use of new technology, such as the
gained interest of other people, increased group dynamics, dedication to a new activity, or
organizing a research project (an innovative and therefore stimulating project including
regular follow-up with participants’ increasing attention and time and social exchanges)?
Auld and Case (1997) and Lloyd and Auld (2001) demonstrated that collective hobbies (like
computer training sessions) allow elderly people to participate in positive social interactions
and experiences that would improve their quality of life. As Leonardi et al. (2008) highlight,
the (temporal, spatial and social) conditions of these collective practices not only allow the
group to share a common experience (such as discovery, success and failure) but also
represent an opportunity to surpass themselves, improve and maintain their social ties.
As we are reminded by the Pygmalion effect, even simply participating in a research project
can have a curiously motivating impact (Balez 2007). The research team grants special
10
Psychological empowerment can be defined as a motivational state which results from the feeling of being
competent (Conger and Kanungo 1988).
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attention to the participants, and being selected as a research subject certainly impacts on
participants’ self-esteem and level of commitment, especially amongst elderly subjects.
Finally, it seems that improved quality of life is not only due to technological factors (despite
the fact that the innovative character of the project and certain related uses may have had an
influence) but instead depends on context-related factors (type of given support such as
stimulation and encouragement from the group, activities around the project) and individual
factors (such as residents’ personality and their prior experience). Thus, the use of ICT points
out new activities and skills that are activated but also highlights the dynamics at play around
the use of new technological devices (especially through exchanges, interest and respect from
their social, family and medical environment). This leads us to consider ICT as a possible
“boundary object” (Star and Griesemer 1989, Trompette and Vinck 2009), a space that allows
for communication but also recognizes different worlds such as the residents’ world (which is
rather confined) and the families’ world (especially the grandchildren’s). Caradec (1999) had
already demonstrated that technological media could be either an obstacle or a bridge between
generations, depending on whether the social environment encouraged and supported the
person as they were learning to use them (a bridge metaphor) or whether they were
stigmatized or appropriated the elder person’s use of these devices as their own (a door
metaphor).
In other words, as highlighted by Chevalier et al. (2008) and Otjacques et al. (2010), in order
for ICT to encourage social cohesion amongst individuals (creating enriching relationships
that positively impact on their quality of life), the training sessions should more actively
include their personal environment (such as other residents, supervising staff, and family).
Learning situations should be created that would emphasize the elderly person’s skills and
therefore allow for an authentic exchange among participants. Moreover, the modality of
access to ICT should be rethought to allow a more autonomous appropriation. We could
indeed see that very few of our sample Mnesis group use the system outside the training
sessions. We noted that if the elderly are not regulary supported, encouraged and coached by
their trainers, they lose their confidence and so don’t dare to use the computer. Perhaps a
solution could be a kind of pair tutoring, where expert residents follow the beginners, or to
elaborate a specific user guide (paper and computer) for this elderly population with special
needs. Access to and localization of the system in different rooms of the residence could be
proposed too. Each of these solutions should be evaluated.
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Altogether, in order for ICT to improve an elderly person’s living conditions in an RHCU, the
most innovative and accessible ICTs must be designed and implemented, but the practical
social needs for their diffusion and personal use must be carefully taken into account.
Conclusion
Our objective was to assess the impact of information and communication technologies (ICT)
on the quality of life of the elderly living in specialized residential home care units (RHCU).
Living in such an institution can lead to major social seclusion for elderly people, which could
accentuate previously existing physical, cognitive and psychological losses (known as the
mirror effect). However, we hypothesized that such losses are neither necessarily unavoidable
nor permanent and that recovery was possible within an adapted environment, such as a
technological one, that can provide the necessary stimulation and/or compensation for certain
losses.
Although the generalization of our results is limited, because of the absence of statistical tests
and the lack of representativeness of our sample, the various obtained data show that, in this
specific context of activity, the technological environment seems to have a rather positive
effect in the quality of life of these weakened persons.
Thus, not only do ICTs provide a person with new skills and capacities to act (physical,
intellectual, social aptitudes) but they also provide new meaning and the possibility of making
new future-oriented plans. Nonetheless, the conditions of our research experiment (training
sessions, providing help and support, implementing new devices) undoubtedly helped
enhance this feeling of achievement. We therefore point to the means and terms (social,
organizational and structural) of implementing such technologies for this specific type of user.
Another element to be taken into account is the computer self-efficacy (CSE) feeling,
proposed by Compeau et al. (1999), in order to specify the concept of personal self-efficiency
(Bandura 1982). Indeed, the confidence that a person has in their capacity to use the
technologies (from their past experiences, their capacities and former professional resources,
and social support) can have a consequence on their level of use of devices. For example, in
our case, the the most dynamic persons in the residence chose to get involved in the
experiment. We think it would be useful, in the future, to conduct two types of studies in
order to better understand this process: (i) estimate the incidences of CSE on the use and on
the impact of the system; (ii) measure the impact of different methods of ICT access in the
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residence in order to appreciate whether it has an effect on the individual and collective
appropriation of devices.
It would also be interesting to study the learning processes of the elderly during training
sessions (difficulties, help brought by the trainer or the residents) in order to adapt teaching
methods to this population.
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Figure 1: Game screen Figure 2: Journal editing screen Figure 3: Emailing screen
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Nr. of
residents
Mean age Gender
distri-
bution
Marital
status
Past
professional
occupation
Descendants
(Nr. of children
and grandchildren
on average per
resident)
Length of
stay in the
residences
Prior I.T.
knowledge
17 87 years
Standard
deviation:
3.77
15
women
and
2 men
14 widows/
widowers,
2 singles
and 1
married
7 employees,
4 civil servants,
3 self-
employed,
3 without an
occupation
3 children (~ age 60)
6 grandchildren (~
age 30)
3 to 14 great-
grandchildren
3 years on
average.
Standard
deviation:
2.23
4 older adults in
their past
professional career
(punched card
systems) and 2
through their
family
Table 1: Characteristics of the sample chosen for the study
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Figure 1: Observation protocol: methods used in a longitudinal framework
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Category
Number of
elderly people
who addressed
the theme
Theme
referred to in
a positive
manner
Theme
referred to in
a negative
manner
Theme referred
to both in a
positive and
negative manner
Worth, self-esteem…
Through understanding ICT use
17
16
0
1
Through recognition and encouragement
from their environment 16 16 0 0
After regaining autonomy
9
7
0
2
Has meaning for the users
9
7
0
2
Through
regained hope
8
5
3
0
Total 59 51 3 5
Note: These data correspond to the number of residents, amongst the 17 people of the sample, who evoked the theme.
Data mentioned in t he right column refer to the distribution of participants who had mentioned the theme either
positively, negatively or neutrally.
Table 1: Nature of psychosocial impacts (worth and self-esteem) as mentioned by elderly
interviewees (n = 17)
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Category
Number of
elderly people
who addressed
the theme
Theme
referred to in
a positive
manner
Theme
referred to in
a negative
manner
Theme referred
to both in a
positive and
negative
manner
Integration and social ties…
Through forming a collective 12 8 3 1
Through reactivating existing social networks 17 15 2 1
Total 29 23 5 2
Table 1: Nature of psychosocial impacts (integration and social ties) mentioned by elderly
interviewees (n = 17)
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Picture 1: Computer training session: two older women helping each other
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Chart 1 : Comparison of interaction levels during a typical day
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Table 1: Anova test relative to moment (before/after) relative to the experiment and hours of
day
Variables t Pr > |t|
Constant 8,093
< 0,0001
Before experiment
-
1,257
0,210
After experiment
Period - 10 - 11am 2,915
0,004
Period - 11 - 12am 4,296
< 0,0001
Period - 12am - 1pm 3,375
0,001
Period – 1 - 4pm 1,534
0,126
Period – 4 - 5pm 6,751
< 0,0001
Period – 5 - 7pm 4,986
< 0,0001
Period – 7 - 8pm 3,989
< 0,0001
Period
8
-
10pm
0,460
0,646
Period - after 10pm -1,381
0,169
Period - before 8.30am -1,995
0,047
Period
-
8.30
-
9am
-
1,074
0,284
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Expression and
Communication
activities
Manuel
activity
Physical
activity
Social and
cultural
activities
Cognitive
Activity Total
Control
Group
(Other
Residents)
Before
training 3,95 1,55 0,8 4,72 1,23 12,25
After
training 4,59 1,81 0,74 7,58 2,34 17,06
Sample
Group
(Mnesis
Project)
Before
training 4,8 1,38 0,78 5,38 2,93 15,27
After
training 8,18 2,4 1,48 9,1 3,17 24,33
Table 1: Means of participation (per month) of the two groups in the workshop activities (observed
before and after the training)
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Chart 1: Means of participation (per month) for the “Mnesis Project” group (before and after the
computer training) (n = 17)
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Chart 1: Evolution of attitudes and (active) interest of elderly people for each type of workshop
(before and after the training) (n = 17)
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... 41 42 We choose the training tool, Happyneuron Pro (Happyneuron Pro is a product developed by Scientific Brain Training), because it is a well-known cognitive remediation product frequently used by the SLTs in France, and in particular by the SLTs participating in our study. Research and clinical studies have shown the effectiveness of the training programmes proposed in Happyneuron Pro software to improve cognitive functioning in patients suffering from different diseases and in normal ageing [43][44][45][46][47][48] Each training session lasts approximately 45 min and consists of 10 exercises of varying lengths, but not exceeding 4 min (see table 2 for details). The training programme stops automatically after 45 min, even if the patient has not completed the 10 exercises planned for the session. ...
Article
Full-text available
Introduction Recent studies on cognitive training in patients with Alzheimer’s disease (AD) showed positive long-term effects on cognition and daily living, suggesting remote computer-based programmes to increase training sessions while reducing patient’s travelling. The aim of this study is to examine short-term and long-term benefits of computer-based cognitive training at home in patients with mild to moderate AD, as a complement to the training in speech and language therapists’ (SLT) offices. The secondary purpose is to study training frequency required to obtain noticeable effects. Methods and analyses This is a national multicentre study, conducted in SLT offices. The patients follow training in one of three conditions: once a week in SLT office only (regular condition) and once a week in SLT office plus one or three times per week at home. The trainings’ content in SLT office and at home is identical. For all three groups near and far transfer will be compared with evaluate training frequency’s effect. Our primary outcome is executive and working memory scores in experimental tasks, and the secondary is neuropsychological tests and questionnaires’ scores. Linear models’ analyses are considered for all measures with a random intercept for patients and another for per practice. The fixed effects will be: three modality groups and time, repeated measures, (T0—pretraining, T1—post-training, T2—long-term follow-up) and the interaction pairs. Ethics and dissemination The study got ethics approval of the national ethical committee CPP Sud Méditerranée III (No 2019-A00458-49) and of the National Commission for Information Technology and Liberties (No 919217). Informed consent is obtained from each participant. Results will be disseminated in oral communications or posters in international conferences and published in scientific journals. Trial registration number NCT04010175 .
... The internet promotes communication between older adults and family, relatives, and friends; reduces loneliness; and enhances self-efficacy (24). It plays a role in social bonding, creating a connection between their world (where they are fairly isolated) and their family (including grandchildren), thereby effectively improving their quality of life (47). ICT has proven to be a new resource in both logical speculation and empirical research, and possession of digital resources yields independent and significant advantages in many fields (6). ...
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Digital inclusion can bridge the digital divide and reduce the social exclusion of older adults, yet it is understudied in China. This research examined factors influencing the digital inclusion of older adults in China and the relationship between digital inclusion and quality of life. Data collected from 312 older people (M = 69.6 years old) in Nanjing were included in a multinomial logit model to tackle these questions. Their attitudes toward technology were the most significant factor predicting their digital inclusion. Other factors included party affiliation, living situation, personal average monthly income, occupation, and capacity for instrumental activities of daily living (IADLs). This study shows digital inclusion has a direct impact on quality of life. It also serves as an intermediate variable that affects older people's attitudes toward technology and their IADL capacities. Most importantly, digital inclusion promotes social integration of older adults and improves the quality of their lives. Hence, it should not be ignored. Older people's attitudes toward technology are one of the keys to promoting their digital inclusion.
... Technologies that encourage social engagement, physical activity, and provide interactive gaming or exergaming have all demonstrated positive impact on residents' quality of life (Bobillier Chaumon et al., 2014;Jung et al., 2009). The value of social and leisure technologies is obvious especially when all group activities are canceled to maintain physical distance, and residents are isolated in their rooms. ...
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The COVID-19 pandemic has exposed persistent inequities in the long-term care sector and brought strict social/physical distancing distancing and public health quarantine guidelines that inadvertently put long-term care residents at risk for social isolation and loneliness. Virtual communication and technologies have come to the forefront as the primary mode for residents to maintain connections with their loved ones and the outside world; yet, many long-term care homes do not have the technological capabilities to support modern day technologies. There is an urgent need to replace antiquated technological infrastructures to enable person-centered care and prevent potentially irreversible cognitive and psychological declines by ensuring residents are able to maintain important relationships with their family and friends. To this end, we provide five technological recommendations to support the ethos of person-centered care in residential long-term care homes during the pandemic and in a post-COVID-19 pandemic world.
... 12 Furthermore, telemonitoring would be also a good option for addressing the increasing costs associated to the healthcare of frail elderly patients. 13 This type of solution, indeed, let to decrease the number of visits and costs, improve the overall quality of life and allow patients to stay in their residency. 5,14 e-Health solutions like telemonitoring, however, requires suitable systems to provide and manage the needed care for age-related chronic diseases. ...
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e-Health technologies may potentially improve healthcare assistance for frail elderly subjects. However, despite the interest and potential benefits of the field, research highlighted that several challenges remain, such as scarce wide spreading of information and communication technology technologies among the elderly and infrastructural difficulties. The aim of this survey was to assess to what extent digital technologies are widespread and used among Italian geriatricians. We conducted an online survey addressed to geriatricians, from the SIGOT (The Italian Geriatric Society) website, collecting the 78 completed questionnaires. We then analyzed with descriptive statistics the data. Results showed a still scarce use of digital technologies in geriatric practice in Italy. However, more than 60% of the SIGOT geriatricians who participated in the survey responded that the use of digital technology had increased significantly due to COVID-19 pandemic and for 80% of the members, the priority areas for the use of technologies for the care and treatment of the elderly are the management of chronic diseases and the prevention of hospitalization.
... Despite the difficulties, digital technology holds a promise to improve older adults' well-being. Most researchers are in agreement regarding the benefits inherent in IT and its ability to enable older adults to live more comfortable and independent lives in their current homes and communities (Bobillier Chaumon et al., 2014;Golant, 2017;Russell, 2011). However, there seems to be a discrepancy between what IT has to offer and what older adults actually want and need (Mannheim et al., 2019). ...
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Many older people find it difficult to navigate the digital sphere and to use online services. The aim of the present study was to examine the extent to which user experience (UX) experts, who are entrusted with making websites and online services accessible, are aware of the unique needs of older users and whether they possess the appropriate resources and training. The research data were collected through 28 semi-structured in-depth interviews with UX practitioners, teachers, and researchers. The findings revealed two aspects of ageism: individual and organizational. At the individual level, ageism is expressed in a lack of awareness and understanding of the unique needs and difficulties of older users in the digital space. At the organizational level, ageism is manifested, among other things, in the lack of in-depth research among older users and the lack of appropriate training in characterizing older users. The result is digital ageism.
Chapter
About one-fifth of the population in the United States in 2015 will be age 65 or older in 2050 and loneliness may be a contributing factor that inhibits their well-being and overall health. As the number of older adults continues to escalate, information and communication technologies such as smartphones and computers may create an increase in social connectedness leading to a decline in loneliness and social isolation. Results from this pilot study suggest that the older adult participants demonstrated some degree of loneliness. As the older adults used social media to connect with friends, family, and other information of interest, there was an increase in social connectedness for many of the participants, but the intensive iPad intervention was not significant in terms of reducing loneliness for either group over time.
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