Aging and Technology - State of the Art

Full text

Aging and Technology - State of the Art
Aging and Technology
A Review of Current practice
January 2016
Prepared by
David Banes
Mada Center
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Aging and Technology - State of the Art
Contents
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Aging and Technology - State of the Art
Introduction
This document seeks to identify some of the ways in which older people can benefit
from technology. Technology has significant potential for older users, helping them to
remain active, healthy and connected to their family and community. We recognize that
some older users have never made significant use of technology, whilst others may be
confident with some forms of technology whilst anxious regarding adoption of newer
forms of technology.
Older users are not a single group, they have a diverse range of needs and
experiences. In determining an approach to meet those needs we need to understand
some of the issues they face and how technology can assist.
Understanding the needs of the elderly
There are many changes that occur to our bodies as we age. Whilst they emerge
gradually it is important to understand that they may create barriers to an active and
independent life. Many older people do not consider themselves to be “disabled” but
rather face barriers and challenges through a variety of functional limitations.
According to AARP, the natural aging process contributes to a variety of health
problems, they make the point that whilst no two people age in the same way, there are
some common age related issues we may experience in later life. These might include:-
● Hearing, which declines especially in relation to the highest pitched tones.
● Memory and thinking, whilst the majority of older people do not experience
significant memory loss there is some decline in the ability to recall information
and express thoughts clearly. Such conditions increase significantly in people
over 85 years.
● A loss of muscle and bone strength and coordination occurs with an
accompanying loss of mobility, agility, and flexibility.
● A decrease in the sensations of taste and smell and a decline in visual ability
may occur as a person ages.
● Changes take place in the cardiovascular and respiratory systems, leading to
decreased availability of oxygen and nutrients throughout the body.
● Vision, age related degeneration of sight is common, it is usually assisted
through glasses or small magnifying devices for reading etc.
These age-related changes often require some changes to be made in our daily lives.
Age, like many conditions, is something that needs to be managed and acoomodated, it
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Aging and Technology - State of the Art
cannot be reversed or “cured”. There are many effective ways to cope with it with
increasing age and increasingly older people are discovering that assistive technology
devices and services and home modifications provide new ways to "get around"
limitations.
Three trends suggest that assistive technology devices and services and home
modifications will play a significant role in helping older persons remain independent,
rather than relying solely upon others.
● A growing size and percentage of the population of the Qatar is over 65 years
old.
● Assistive technologies offer older persons the promise of greater independence.
Currently there are more than 23,000 assistive devices and this number grows
rapidly.
● The aspirations of older people are growing with an increasing desire to remain
active and involved in society and the community.
What is Assistive Technology?
Assistive technology (AT) has been defined as
“any service or tool that helps older adults or persons with disabilities perform activities
that might otherwise be difficult or impossible.”
For older adults, such technology will be diverse ranging from an aid to improve
mobility, an amplification device to make sounds easier to hear, or a handheld magnifier
for someone who has poor vision. Many people may need some assistance some of the
time, or may need combinations of solutions to meet their needs.
In this model the Assistive technologies are anything that aids continued participation in
daily activities. The solutions allow many people to live as independently as they wish.
In this document we will focus upon high tech solutions, we recognize the importance of
assistive technologies for mobility, independent living and personal care, but here we
will focus much more on the social and emotional needs of the users.
Regardless of the form of aid that we are considering it is important that careful
evaluation of take place before purchase. Using technology may have an impact in
unanticipated ways which can change routines and the need for other forms of support.
In considering the potential technology and its impact upon older users we should also
be aware of the wider trends of technology use that are occurring and provide the
context for intervention to take place.
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Aging and Technology - State of the Art
Some key points to take into account in planning to support older persons through
technology would include
● The term `assistive technology' incorporates a wide variety of devices, it may
mean different things to different people
● Assistive technology can be supportive, preventive or responsive.
● Perceptions may vary as to whether or not assistive technology has sufficient
benefits, understanding the evidence base and pilot programs can assist in
addressing this. It is clear that existing research supports the greater use of
assistive technology but further evaluation and `local learning' is needed.
● The views and needs of people using assistive technology need to be taken into
account, the greatest advocates for take up of technology are the seniors
themselves
Technology Trends
Planning to implement Assistive Technology into the lives of older people requires us to
consider the wider context and technology drioft for the future. Some of the relevant
technology trends that can be identified include:-
● Cloud computing
● Software as a service
● Personalized interfaces
● Ubiquitous mobile
● Connected devices and objects
● Wearable technologies
In planning to meet the needs of an older community in Qatar, we should take due
regard of these trends to ensure that we are seeking to “future proof” the users to be
able to benefit from innovation as it arises.
Current Use of Technology by Seniors - International Perspectives
According to surveys in the US, seniors today are comfortable using technology and cite
its importance in helping them stay connected to family, friends and the wider world.
● The majority of seniors said that technology is somewhat or very important in
helping them stay in touch with family/friends (87 percent), keeping up with the
world (84 percent), learning new things (80 percent), and staying mentally sharp
(79 percent).
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Aging and Technology - State of the Art
● More than 4 in 5 (81 percent) low-income seniors said that technology is
somewhat or very important in helping them stay in touch with family/friends.
● When asked which technologies they use frequently, 75 percent of seniors say
cell phones, 68 percent say computers, 65 percent say the Internet, and 62
percent say email.
● Low-income seniors are less likely to use these technologies frequently: 54
percent use cell phones, 25 percent use computers, 21 percent use the Internet,
and 20 percent use email.
● Nearly 1 in 3 (30 percent) seniors frequently use social networking technology,
compared with 9 percent of low-income seniors.
● Thirty-eight percent of seniors rely on GPS devices, while more than half (57
percent) of adults ages 18-59 use this technology for directions while on the
road.
● Adults ages 18-59 are more likely to use cutting-edge technology than seniors,
citing greater use of tablets like an iPad (43 percent compared with 20 percent),
media players like an iPod or MP3 player (54 percent compared with 19 percent)
and videogames like a Wii or other console (46 percent compared with 14
percent).
The study identified two key factors that impeded such take up of technology, these
were a lack of understanding and cost concerns which combined to prevent more wide-
spread adoption.
Seniors cited barriers to using more technology, including "I don't understand how to
use it" (34 percent) and "I don't think I need it" (34 percent). Concerns of data privacy
and security follow close behind, with 28 percent of seniors citing these issues as
preventing them from using more technology. Smith A (2014)
The barriers to uptake of technology are further discussed by Beech and Roberts (2008)
they state that
“Older adults face several unique barriers and challenges when it comes to adopting
new technologies, which would include:-
•Physical challenges to using technology:
Many seniors have physical conditions or health issues that make it difficult to use new
technologies. Around two in five seniors indicate that they have a "physical or health
condition that makes reading difficult or challenging" or a "disability, handicap, or chronic
disease that prevents them from fully participating in many common daily activities".
This group is significantly less likely than seniors who do not face these physical
challenges to go online (49% vs. 66%), to have broadband at home (38% vs. 53%), and
to own most major digital devices.
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•Skeptical attitudes about the benefits of technology:
Older adults who do not currently use the internet are divided on the question of
whether that lack of access hurts them or not. Half of these non-users (49%) agree with
the statement that "people lacking internet access are at a real disadvantage because
of all the information they might be missing," with 25% agreeing strongly. But 35% of
these older non-internet users disagree that they are missing out on important
information, and 18% of them strongly disagree.
•Difficulties learning to use new technologies:
A significant majority of older adults say they need assistance when it comes to using
new digital devices. Just 18% would feel comfortable learning to use a new technology
device such as a Smartphone or tablet on their own, while 77% indicate they would
need someone to help walk them through the process. Among seniors who go online
but do not currently use social networking sites such as Facebook or Twitter, 56% would
need assistance if they wanted to use these sites to connect with friends or family
members.”
The Impact of Assistive Technologies
There has been significant research indicating the potential impact and benefits of
integrating assistive technologies into the live of older people Mann et al (1999)
suggested that “the rate of decline can be slowed, and the cost of institutional care
reduced through a considerate provision of assistive technology and an accessible
environment.”
This was further elaborated by Beech and Roberts (2008) they noted that the potential
benefits for people who use assistive technologies and associated services included:-
● increased choice, safety, independence and
● sense of control
● improved quality of life
● maintenance of ability to remain at home
● reduced burden placed on carers
● improved support for people with long-term
● health conditions
● reduced accidents and falls in the home.
They continue and commented
“When placed against wider research with older people, AT devices do target issues that
they have identified as being important. These issues include concerns about being
unable to undertake household chores; not wanting to be a burden on family members;
fear of being taken ill when alone; and fear of accidents such as falls. These issues are
categorized in AT provision as supportive, responsive or preventative.
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Captel outline these benefits still further in the US, they noted that the benefit reported
fell into three broad areas
● Fulfillment and independence
Ultimately the use of Assistive technologies should enhance the quality of life of older
persons. The American Association of Retired Persons has reported that seniors who
keep up to date with the internet can produce a positive impact on key areas of life,
including:
1. personal fulfillment
2. health preservation
3. social connectedness
4. functional capability
5. caregiver support
● Stimulate the mind and body
Technology provides news ways to assist older people be have a healthy mind and
body. Participating in a video or computer game can be both entertaining but also offers
an opportunity to enhance mental health as well. Researchers have been exploring how
teaching elderly individuals how to play online activities can boost the brain and
increase cognitive longevity. Scientists from Poland discovered that all of their subjects
between the ages of 65 and 75 years of age, completing a series of several computer
games was able to improve memory, expand attention and increase sequencing
abilities. Furthermore, video game systems have also proven to promote participation of
physical activity with seniors due to a number of available virtual recreation programs
that teach users how to dance or do yoga, two extremely beneficial forms of exercise for
the elderly.
● Social connectivity
For many seniors, life tends to be a series of extended episodes of isolation, primarily
due to being separated with friends and family by long distances. Using email and social
networking platforms are a great way to easily stay in touch with those who are the
closest to you, and all it takes to speak with someone face to face is a computer,
camera and internet access.
Sometimes social isolation provokes feelings of loneliness and despair, another
emotional aspect that the internet has helped seniors conquer. Researchers from
Michigan State University have reported that elderly individuals who spend occasional
time online can drastically reduce symptoms of depression, just another example of the
vast benefits of new-age technology.
http://www.captel.com/news/senior-living-and-independence/benefits-technology-
usage-se niors/
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Aging and Technology - State of the Art
Finding the best solution
It is important that anyone considering assistive technology has clear information on
what is available. People respond differently to different devices, and the products
should meet the needs of the individual as best they can. Choosing a piece of assistive
technology is not always easy, but it is important to find the best solution. Decision-
making should be shared, and the person should be supported and involved as much
as possible in discussions and choices. If someone has been using a device (eg
Smartphone or tablet) when younger, then a solution based around this technology may
be easier for the person to adopt.
Many devices can be bought independently, but before doing so it is advisable to seek
professional advice.
Things to consider when looking for assistive technology
There is no one-size-fits-all approach to choosing assistive technology what works for
one person may not work for another. For example, one person might find it helpful to
have a recorded message reminding them to take their keys with them, while another
person might find this confusing. It can help to think carefully about the person's specific
needs and capabilities, and consider what the benefits of using the technology might be.
It is important to make sure the technology is supporting the person and not restricting
them. It is also a good idea to look at the person's living space and see if there are
adaptations to the environment that may help (eg making sure there are good lighting
levels and removing trip hazards). When choosing assistive technology, some things to
consider include
● Whether there is definitely a need for assistive technology, or whether there is
another solution
● The person's needs, preferences and ability to use devices, and how these might
change over time
● The level of support the person can rely on
● How well the technology will fit in with the person's usual routines
● Whether the technology requires a phone line or internet access
● The cost of the technology
It is also worth being aware that the earlier the technology is introduced, the more
successful it is likely to be. This is because the person will have more time to get used
to it.
Ethical considerations
Assistive technology can have considerable benefits for older people, but it also has
some potential negative aspects, and there is a risk that it can be misused. It is
important that assistive technology is always used for the right reasons. It should be
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primarily for the benefit of the person, to enhance their independence, safety and daily
living. In practice it will often also benefit the carer, but it is important that the person's
needs are put first. It is also important that they are clear about the purpose of the
technology and how they might benefit from it.
Assistive technology should not be used simply as an easy way for a carer to monitor a
person without their consent or interests being considered. Nor should it be seen as a
replacement for the human interaction that carers, friends and relatives provide.
Consent is particularly important. When choosing to use assistive technology and
selecting the systems or devices to use, the person with should be involved in any
decisions, and their consent must be sought and gained, wherever possible. In some
cases this may not be possible, if the person doesn't have the ability to make decisions
for themselves (known as `capacity'). In these, cases, decisions need to be made in the
person's best interests, and must also be the least restrictive option. This is a particular
issue with safer walking technologies. If someone doesn't have capacity to consent to
carrying such a device, the carer may not explain the true purpose of it or may conceal
it (eg in clothing). This is a threat to the person's privacy, and is therefore not the least
restrictive option.
Ultimately, nobody should be forced into using technology they don't want, and
technology should only be used when it's needed or wanted. Each person's individual
needs should be considered carefully when weighing up the pros and cons of any
device.
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Aging and Technology - State of the Art
Technologies and Aging
One definition which emphasizes the role of AT in maximizing the independence of older
people is,
“AT is any product or service designed to enable independence for disabled and older
people. The technologies embraced by these definitions include devices that might form
part of `telecare' and `telehealth' service packages (that is, assistance devices linked to
response teams via a person's telephone, such as community alarm services, detectors
or monitors of fire, gas or falls).” Beech R and Roberts D (2008)
The definitions also embrace a range of technologies from low-level to high-tech
devices, however. These may also include more general technologies such as access
to the internet which might have a role in promoting the independence and wellbeing of
older people. When reviewing the research evidence for this briefing paper, this broad
perspective of AT was adopted.
Orlov (2013) describes four aging-in-place technology categories that have emerged:
● Communications and engagement. This includes email, chat, games, video, cell
phones, Smartphones and tablets, as well as personal computers.
● Home safety and security. All manner of home security systems are emerging.
The systems deal not only with possible intruders but a growing range of
personal health and safety issues. They use sensors, webcams and digital
communications to provide help with fall detection and the broader areas of
personal emergency response systems.
● Home health and wellness. Telehealth and mHealth (the "m" stands for mobile),
medication and disease management tools and fitness products.
● Learning and social contribution. Home-centered communications technologies
can help people stay connected with friends and family, engage in online learning
and education, participate in volunteer activities and earn income from home.
She continues
"Customers will demand products that are as attractively designed and easy to use as a
game or tablet, ubiquitous as a cell phone and as extensible as a PC," and that to
further commercialize the aging-in-place market, she says four conditions have to be
met:
1. Technologies must be intuitive and well-supported.
2. Device vendors must be capable of integration and extension. "Many of today's
gadgets don't communicate into or out of the home, but especially with each other,”
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3. Costs to consumers must be affordable.
4. Products must be available on widely adopted platforms. "Too many user interfaces
are one-off designs, unlike any others, even within a single device like an iPad …. so
consumers may gravitate towards applications that work with ones they already use,
including Facebook or Skype."
There are a very wide range of modifications available to assist older people to use
technology. These will include
● Adaptive switches. Modified switches that seniors can use to adjust air
conditioners, computers, telephone answering machines, power wheelchairs,
and other types of equipment. Increasingly voice recognition is used to activate
these switches.
● Communication equipment. Anything that enables a person to send and receive
messages, such as a telephone amplifier.
● Computer access. Special software that helps a senior access the Internet, for
example, or basic hardware, such as a modified keyboard or mouse, that makes
the computer more user friendly.
● Education. Audio books or Braille writing tools for the blind come under this
category, along with resources that allow people to get additional vocational
training.
We can further categorize such aids by need
Vision
● Low vision
Eye glasses, large print playing cards, card holders, screen magnifier for
computer or TV, large button telephone, bright colored objects
● Blind
Braille books, books on tape, guide cane, screen reader for computer
Hearing
● Hard of hearing
Hearing aids, amplified telephones, visual alerting systems,
● Deaf
Head phones for personal control of sound on TV or stereo, or at church or
concerts
● Written communication tools, visual alerting systems, text telephone (TTY)
Physical access to technology
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● Limited range of motion, limited use of hands, fingers or arms, limited strength
Communication and work related devices; alternatives to the standard computer
keyboard used for typing in data such as alterative and onscreen keyboards,
switches, joysticks, touch screens.
Environmental Control
● Limited strength, limited range of motion, limited reach and mobility, low vision,
hard of hearing
Adaptations of timers, telephones, light switches, switches which can be
activated by pressure, eyebrows, breath; text telephones, control mechanisms
with sonar sensing devices, adaptations of existing tools, personal pagers, alarm
systems, visual signalers
Thinking and Organization
● Forgetfulness, confused thinking, memory loss
Pill dispensers, electronic calendars, timers, specifically designed computer
software such as computer-assisted instructional programs, information
management and record keeping systems
It is clear that successful use of technology by seniors is not dictated by the device, but
by the functionality and ease of use of applications upon that device. Many modern
connected technologies have the elements of customization and personalization built
into the operating system. It is the applications that engage the users, not the
technology per se.
Julia Davis (2013) summarizes the N4A (2013) report in the US noting that the report
recognizes that over the past few years older adults have been the fastest growing
segment of the online population. As in Qatar, more and more people over the age of 60
are going online and using Facebook, Google, and YouTube etc. Older persons are
increasingly emailing, texting and connecting via social networks and it is having a
positive impact on their lives as they are communicating more frequently with family,
reconnecting with old friends, keeping up with community developments and managing
their health issues.
In the N4A (2013) report "Staying Connected: Technology Options for Older Adults"
users are introduced to basic functions of how to use tools like Facebook, email and
texting, including privacy and safety information. The guide also introduces YouTube,
Twitter, Skype, Instant Messaging and blogging, all tools that older adults can use to
stay connected through the internet and on cell phones with a variety of tech tools. The
guide points out that in a matter of seconds you can send a message, receive a photo
or broadcast an invitation to a family gathering.
While younger people are typically the "experts" on these new resources, many older
adults also utilize the internet, social media and cell phones to communicate and
receive information. These tools are an effective way to connect with family, friends and
community resources.
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Getting Started
The importance of a community resource to learn and try technology has been
highlighted repeatedly in the research; community learning options are extremely
valuable in establishing and maintaining interest. There is a great deal of opportunity for
an organization such as IHSAN to offer classes and other resources to help elders get
started with these new tools, a second great resource is within the personal social
networks of users, most older persons have family, friends and neighbors familiar with
computers and cell phones and often willing to mentor.
Applications and Functions
The initial technologies that had the greatest interest to older persons were those which
helped communicate and maintain social relations. In the US these included Text
messaging, email, Facebook. Instant Messaging, YouTube and Twitter. Whilst the range
of applications in Qatar would be similar it would be important that the applications
identified reflect those preferred by the wider community in order to ensure that older
persons have the greatest opportunity to engage with wider social networks. In a recent
study Radcliffe D (2015) reported that within Qatar and the GCC region the applications
and networks demonstrating the greatest growth and uptake were those which strongly
protected privacy and safety online, and which were dominated by visual media. The
most popular of these were WhatsApp, Instagram and Snapchat. Even where the
community continued to use less recent technologies such as Facebook there was a
strong preference for statuses related to photos and videos over text.
This will have implications for the introduction of such technology to older persons, they
may need to learn to use slightly more advanced features such as using the camera to
feel they are getting the most from the technology and interactions.
Adapting to technology is increasingly important for seniors to enhance their wellbeing.
An individualized instructional approach or small group setting is most likely to
encourage uptake of technology. Enhancing quality of life including leisure and travel is
likely to maximize the interest in learning a new technology. However, seniors’
adaptation to new devices is restricted by rapid pace of change. Once a senior has
learned a specific technology, they may be resistant to change. Managing this process
will require professional support through a trusted body.
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Planning for Technology and Older People
Mobile and portable technologies provide much of the focus for use by older people. In
the US it was reported by the Pew Research Center (2014) that
“Older people, 65 and older, are the most likely to reap the emotional benefits of
Smartphone technology. More than any other age bracket, they consider a Smartphone
to be "freeing," rather than "a leash," … The elderly also felt more strongly than any
other age group that Smartphones are "connecting" devices, as opposed to
"distracting."
In understanding the use of technology by older persons, we need to appreciate that
they do not use the technology in the same way as younger people, it is important that
we do not assume that seniors are "too old" or automatically "uninterested" in emerging
technology just because there is a potentially steep learning curve.
According to Stevenson (2013) The key technologies that offer opportunities for older
people include
1. Tablets and iPads. From games that promote brain fitness to apps that track health
information, a tablet can have a variety of positive impacts on seniors' lives. Seniors can
view photos, listen to music, read, learn languages--plus the devices are lightweight,
their touch screens are easy to use, and font sizes can be adjusted for easier reading.
2. Hearing aids. Having to wear a bulky listening device is no longer an excuse for older
adults to go without hearing aids. The continuing miniaturization of devices and the
improvement of wireless transmission methods like bluetooth has meant great strides in
hearing assistive technology. Hearing aids can be tiny, transparent, and nearly invisible
or even implanted inside the ear itself.
3. Video and computer games. Software such as Candy Crush, Minecraft, Angry Birds,
or the Nintendo Wii, have been shown to improve cognition, mental agility, and even
physical health for seniors, with devices such as the Wii Fit. Not only that, video games
can promote social interaction.
4. Video messaging. Social interaction can be significantly enhanced through software
such as Skype. Communicating with family long-distance is a snap, you can view your
family in real time, and us available for a wide variety of devices .
5. Health tracking software. If a senior has access to a computer or a mobile device,
they should be aware of the wealth of software and apps available to help monitor their
health, remind them of medications, and even track their nutritional needs, empowering
them to take charge of their own wellness.
6. Smartphones. Cell phones are becoming more senior-friendly, with models that have
larger buttons and readouts, as well as photo speed dialing and voice recognition to
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make usage easier. Not only are cell phones crucial to helping seniors stay connected
with friends and family, they may also help perform critical safety functions like providing
medication reminders and GPS locations.
7. Wireless home monitoring. Home monitoring systems that employ sensor devices
can be, literally, lifesavers for those seniors who live alone, either at home or in assisted
living. They can detect emergencies such as falls, report unusual behavior, and even
track vital signs, without intruding on privacy.
8. GPS. For those who are concerned about getting lost, or who have dementia and
occasionally wander, GPS technology can immediately alert caregivers to their location
if they leave their comfort zone. There are separate GPS trackers that attach to the wrist
or clothing, as well as Smartphone GPS apps.
9. Home assistive devices. Assistive technology in the home can go far in helping
seniors remain independent and safe. Besides home monitoring and GPS, there are
devices such as LED lighting, medication dispensing appliances, photo-enhanced
phone dialers, and stove shut-off systems, all of which can help seniors with mild
cognitive and motor impairment.
The technologies offer many built in facilities which maximize ease of use by older
people. For instance as eyesight fades and it becomes harder and harder to see the
printed page, what a tablets offer to their users to simply expand the type to a size that
is easy to read. There is no need to have to ask for a large type newspaper or book, you
simply adjust the text to make the font the best size for you. This type of functionality is
available on many devices including tablets, phones and ebook readers.
However when we think about introducing the technology to older users it is important to
focus initially upon the apps they will use, and then to introduce later some of the
“backroom” technology and functions that they need to know (saving pictures, changing
text size etc).
As Eldercare note
“People of all ages are using the internet, cell phones and other technologies to
communicate with family and friends in new and exciting ways. In a matter of seconds
you can send a message to your son, receive a photo from your granddaughter or email
an invitation to a family gathering. While younger people are typically the "experts" on
these new resources, many older adults also utilize the internet, social media and cell
phones to communicate and receive information. These tools are an effective way to
connect with your family, friends and community resources, particularly children and
young adults.”
Digital Unite, a UK based NGO offer a structure which can be used to develop the skills
and interests of older people.
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They structure their training and written guides around the activity and functions that are
most popular with elderly people
Computer basics
This covers the key aspects of getting started with a computer (PC) it includes getting
started, an introductory guide to help beginners get going, and guidance on choosing a
computer to help elders make the right choice, using a computer and how to use
Windows 8.
Creating documents
This provides easy-to-follow guides as the basis for training on using Microsoft Office
programs. This includes WordPad, word and Excel.
Email & Skype
Using technology to stay in touch with family and friends is a major use of technology by
older people. These guides outline the technology and how to use it. They include
email, Skype and webcams
Using the internet
Using the internet and the World Wide Web is an important part of the experience of
older users, these guides and materials focus upon how to search and browse, how to
connect and how to save and store favorite sites
Hobbies & interests
Recognizing that most people want to use the Internet for support an existing interest
these resources help older users to build upon those hobbies through the use of
technology. These include a range of Activities & interests, Reading & learning, Games,
Health & Fitness, Travel,
Music & audio books,
This includes a wide range of ways to get access to Music and audio content including
audio books. This would include devices such as choosing and using an MP3 player,
iTunes and streaming services such as Spotify and Internet Radio, audio books &
podcasts
Smartphones & tablets
Helping people to get started on using mobile technologies is often the ideal start to
digital inclusion. Increasingly such touch devices are the preferred platform for older
users
TV & video,
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Traditional television and video is undergoing a huge change which offers older users
the opportunity to have content on demand which they can plan around their other
needs and activities. New opportunities include YouTube and Online television & films
Social networking & blogs
There are many tools that allow older people to connect with both familiar and new
friends and contacts. These might include Facebook, Twitter, Blogs, Pinterest,
Instagram, WhatsApp and Snapchat
Digital photography
Photography is a significant interest to older users and allows them to share and take
part in family activities. Digital photography makes this especially accessible
Internet security
Support and guides on how to stay safe online is important with older users, addressing
it clearly encourages online uptake
Shopping & banking
Transport and discomfort can make both shopping and banking difficult for older people,
online transactions reduce the time taken and free up time for other activities where
wanted
First Steps for Older People
In planning the introduction of such technologies for older people a simple three stage
process should be introduced
1 Identify the Platform such as
•Mobile Phone
•Tablet/iPad
•PC
•TV
2 Introduce the apps that reflect the needs and aspirations of the users such as
•Facebook
•Email
•Camera
•Snapchat
•etc
3 Configure the device and apps for ease of use for the user
•Alerts
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•Fonts
•Text to speech
•Colours
•etc
Each stage stages should be reflected in preparing an adoption plan for users and
should outline the individualized or small group training required. Preferences for
training should be respected and might include
1 Training from an IHSAN tutor or Mada team member (in many countries this is done
by volunteers or sessional team members)
2 Self help materials and guides
3 Intergenerational learning where younger family members are assisted to train and
support older family members
It is important to plan and communicate with older users how they will be helped when
the technology goes wrong or they forget how to do something. In these cases support
from family and friends is especially helpful.
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Home Modifications
Home modifications are technologies that make it easier for a person to overcome
environmental problems including any feature of the home that is unsafe, that restricts
access and limits task performance, or that results in discomfort. Four types of home
modification can be identified.
● Universal design, life-span designs applied to a new home that work for everyone
regardless of age or physical abilities (thirty-two inch wide doors, lever handles,
and full length mirrors that accommodate everyone including wheelchair users),
● Adaptability, installation of adjustable sinks, counters, and grab bars so that they
can be moved to different heights for different people,
● Accessibility, application of public building codes to private homes for easy
accessibility both outside and inside the home,
● Accessible routes, a continuous pathway that is free of hazards and abrupt
changes in level that connects all important areas of the home.
Assistive Technology in the Home
With the growth of connected devices and smart homes, the integration of assistive
devices with home modifications to eliminate barriers in the homes of older persons is
becoming more widespread.
In many cases home kits can be purchased online for simple installation at home.
These might include:-
● Remote control switches for electric lights
● Emergency 24-hour monitoring systems
● Ergonomic tools and kitchen utensils
● Travel aids such as electronic maps
● Telephone amplifiers and loud ring signalers
Improving the quality of life for older people living in their own homes has been made
easier by these technologies. Some of the more interesting solutions available
internationally include
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Medical Alerts
One of the most frequently used products over the years for seniors living alone or not
receiving continuous supervision is a medical alert device, also known as a personal
emergency response system, or PERS. These devices provide a wearable "SOS"
button, typically in the form of a necklace pendent or bracelet, and a base station that
connects to the home phone line. These tools can be provided in a monitored model or
an unmonitored model, or, to deal with falls or health emergencies that happen outside
the home, there are mobile-alert GPS products now available that work anywhere.
Monitoring Systems
More sophisticated technology for home monitoring also are available. These systems
will let you know whether an elder is waking up and going to bed on time, eating
properly, showering or taking their medicine. These work through small wireless sensors
(not cameras) placed in key locations throughout the home. The sensors will track
movements, learning daily activity patterns and routines, and will notify family members
via text message, email or phone if something out of the ordinary is happening. For
instance, if someone went to the bathroom and didn't leave, it could indicate a fall or
other emergency. Such systems also allow family to check up on patterns anytime
through the system's password-protected website. And for additional protection, offer
SOS call buttons as well that can be placed around the house, or worn.
Medication Management
Ensuring that mediation is being taken is important to maintain personal healtha nd well
being. There are a range of medication management devices that will dispense her
medicine on schedule, provide constant reminders and notify family members if
medicine is not taken.
Supporting health and care needs
Technology is increasingly supporting older people to live as independently as they
wish, and it's helping many families avoid difficult decisions in providing care for an
aging parent. "Smart" technology such as sensors, voice activation, GPS, Bluetooth,
cellular connectivity via mobile phones, Smartphone monitoring apps and sophisticated
computers are making aging in place a viable option for an increasing number of
people.
There are devices to track medication and wandering, activity or inactivity in the house,
falls and real-time health information. With mobile push-button personal emergency
response systems, called PERS, and GPS location tracking, aging family can be
monitored whilst at home or out and about at home. "Device stigma" is vanishing.
Tracking devices are popular and widely used. Technology such as the apple watch,
Samsung galaxy gear or Fitbit are widely marketed as lifestyle choices, an elder
wearing one is unlikely to be perceived negatively. There are many such devices that
can help someone overcome challenges with memory, orientation or communication
that may be affecting daily life.
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Automated prompts and reminders
One type of reminder, based on a motion sensor, plays a pre-recorded voice prompt
when there is movement nearby. For example, a sensor placed near the front door
could remind someone to lock the door, or one in the kitchen could remind someone to
turn the oven off. Another kind of reminder is set to play a message at a certain time.
For example, someone may record a message reminding them to take their medication
or telling them that they have an appointment. This can be done on a mobile phone or
tablet also. Such reminders can be personal with a family member or carer able to
remotely access a tablet in the person's home and support them with reminders. This
means the person has an active display of appointments, visitors and activities, as well
as the reassurance of knowing where people who can help are and how to contact
them.
Clocks and calendars
There are lots of solutions available to help people keep track of the day and date.
Automatic calendar clocks can be helpful for people who lose track of which day it is.
Many show both the date and day of the week. Some clocks also show clearly whether
it is morning or evening. These can help prevent people getting confused about the
time, particularly in the light summer evenings. Clock and calendar apps can also be
downloaded for tablets, which you can configured for personal preferences.
Medication aids
There are lots of different medication aids available. Simple boxes for pills (dossette
boxes) have compartments for each day of the week and specific times of the day. They
can help people remember to take their medication on the right day and at the right
time. More advanced technology might include automatic dispensers for pills that are
taken regularly. These are usually stocked by the pharmacist to ensure no mistakes
occur. When the medication needs to be taken, the dispenser sets off an alarm and the
right compartment opens, allowing the person to access their medication. The alarm
may continue until the pills are removed from the dispenser. There are also devices that
can send an alert to a friend or relative to notify them if the medication hasn't been
taken, or if the device isn't working, has low battery or needs refilling.
Locator devices and solutions
These can be used to help someone find things they regularly misplace, such as keys
or a wallet. A small electronic tag is attached to each item. In one such system, the
person has a dedicated locator device and, if they mislay the item, they can click a
button on the locator device to make the tag beep. The locator device will need to be
kept somewhere obvious, such as on a pendent around the neck. Those solutions built
as apps can be included on a smartwatch or other wearable. This less intrusive
approach attaches a small tile to each item and these are linked to a smartphone
through an app. One such system stores the last place your phone `saw' the tile, which
is displayed on the phone's map function.
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Communication aids
These can support people with dementia to stay in touch with others. The most common
type of devices are adapted telephones. These can be pre-programmed with frequently
used numbers. The person can then call a friend or relative by pressing a single large
button or a button with their photo on it. Some telephones are even designed so only
preset numbers can be dialled. Many Smartphones also offer this option using their
touch-screen function. For a person who has problems with speech, an app can be
used to communicate through text and images may help.
Safety
Safety is a big concern for elderly people. Technology that supports someone to remain
safe can help them to stay independent for longer. Technology designed to support a
person's safety includes the following:
● Automatic lights that come on when the person is moving around. They can help
to prevent trips and falls.
● Automated shut-off devices that can stop the gas supply if the gas has been left
on, or turn off a cooker if it's been left on. These may need to be installed, which
may cost money, and there may be costs for reconnecting the gas supply.
● Water isolation devices that can turn off a tap if it's left running, preventing
flooding.
● Special plugs that allow users to choose a certain water depth in a sink or bath. If
the water goes above that level, the plug opens and the water drains. They can
also include a heat sensor that changes the color of the plug when it reaches a
certain temperature. This can help prevent floods and scalds.
● Fall sensors that can register if a person has fallen.
● Telephone blockers that can be used to stop nuisance calls.
Safer walking
Exercise is important to older people, and walking can have both physical and
psychological benefits for them. However, there may be times when walking does
present risks, such as the person getting lost or leaving the house during the night when
they are not appropriately dressed. Some people may consider safer walking devices or
apps. Types of safer walking device include both alarm systems which provide an alert
when someone has moved outside a set boundary and tracking devices or location
monitoring services which use GPS or mobile phone technology to locate and track the
person. These take a variety of forms and include watches, Smartphone apps, key rings
and pendants. These are generally used when there is a particular risk of the person
getting lost or going missing and when an alert is triggered display the location of the
person on a registered device. Many such devices also allow the person to press a
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Aging and Technology - State of the Art
panic button if they get lost. Such technology is increasingly integrated into current
Smartphones. There are some issues to consider regarding reliability, charging and
availability of the signal required for the devices to work effectively.
Telecare
Telecare refers to a system or devices that remotely monitor people living in their own
home, enabling them to access support or when necessary. Such systems include
community alarms, sensors and movement detectors, and video conferencing. These
are to support independence and personal safety, helping reduce risks and can be
useful for people with dementia.
According to the Alzheimers Association in the UK, telecare has traditionally been
provided by a community alarm or monitoring service provided through social services.
However, it is now possible to set it up privately. Telecare comes in various forms and
may be used for a range of situations:
● Community alarm This is a pendant worn by the person that they press if they
become worried or if there is an incident (eg they have a fall). The person will
need to remember to wear the pendant.
● Medication reminders An automatic pill dispenser can be linked to a call centre.
If the medication isn't taken at a set time, an alert is raised and the person is
contacted to remind them to take their medication.
● Floods Sensors can be fitted on skirting boards or floors in the kitchen or
bathroom. If taps have been left running and cause a flood, the system will shut
off the water and raise the alarm.
● Extreme temperatures Sensors will send a warning signal if the temperature is
very low, very high, or changes suddenly. This can be useful in the kitchen for
example, to detect a pan that has boiled dry. It can also detect if the temperature
in a room is low enough to pose a risk of hypothermia.
● Absence from a bed or chair A sensor is placed on a bed or chair. If a person
gets up and doesn't return within a pre-set time, or if they don't get up in the
morning, an alarm is raised.
● Getting up in the night Sensors placed by the bed can be used to activate an
alarm when the person gets up in the night for example, to alert someone to help
them get to the toilet. Similarly, lights with movement sensors can switch on if a
person gets out of bed or enters a room.
● Leaving the home A system may be set up to trigger a response if the front door
is opened, perhaps during specified times (eg at night), or if a person does not
return within a specified time.
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Aging and Technology - State of the Art
● Devices to monitor daily activity These are unobtrusive movement sensors that
can oversee a person's activity in their home over a period of time. They can
sometimes help relatives or community services get a better idea of a person's
activity during the day and night. This can allay fears that the person with
dementia is not coping well, and may help others to step back and not become
too closely involved. Alternatively, it may show that the person needs more
assistance and can be used to start discussions about the type of support that
may help. An alert can easily be set to tell the person monitoring if something
unexpected happens, such as a visitor at an odd time or the person leaving their
home in the middle of the night.
Devices to support emotional and physical health
Assistive technology is increasingly being used to support a person's social life and
provide opportunities for activities and enjoyment. Helping them to maintain
relationships, skills and wellbeing. With the increasing availability of tablets,
Smartphones and apps, there are many new options to help people stay in touch and
engage with those close to them. These can include reminiscence, creative activities
(eg music), video calling and life story work. Some specific forms of leisure that can
have an therapeutic benefit would include
● Digital photoframes programmed to show a slideshow of photographs and may
help support conversation with others
● Puzzles and games
● Sensory stimulation devices that use touch, sound and light (eg a sensory
cushion)
● Mental stimulation (eg `brain training' devices)
● Easy to use equipment (eg music players and radios).
A tablet used to deliver these can itself become a topic of conversation, and so lead to
more interactions for the person. This is particularly true for `intergenerational'
interactions, where the shared experience of the technology gives a younger person a
connection that might otherwise not have existed.
Technology can also be used to encourage exercise and support rehabilitation exercise
programs; technology such as the Fitbit seeks to help people lead healthier, more active
lives. The Fitbit and similar products offers innovative products and online services that
make people more aware of their activities and hence motivate them to be healthier.
Often these principles of gamification are integrated into these to add additional levels
of motivation. Technology such as the Fitbit Ultra Wireless Activity Tracker or the
Jawbone Up 24 displays real-time activity stats so it is easier to reach goals. Tracking
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Aging and Technology - State of the Art
steps taken, stairs climbed, distance travelled, calories burned, activity level and sleep
quality. Similarly the Fitbit Aria Wi-Fi Smart Scale allows users to track their weight,
body fat percentage and BMI over time.
The advent of gaming based on gestures has also added new ways to help people stay
fit in their own homes. Technologies such as the Nintendo Wii with the additional Wii Fit
unit or the Microsoft Kinect on Xbox have been shown to offer new ways to exercise,
repeat exercises or practice skills such as balance.
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Leisure: potential trends
Opportunities for elders to use technology to participate and enhance leisure
experiences are considerable. Current technologies and high speed connectivity
provide the opportunity for more engaging entertainment through services that support
higher quality audio-visual presentation and are more tailored to the user's interests.
They also offer more life-like remote social interaction through the sharing of information
about oneself and others. Increased personalization offers better and easier access to
leisure services, and potentially lower cost access to leisure services.
Reading
For many people access to reading is in itself a leisure activity. Increasingly technology
is available that makes reading for older people easier and less obtrusive. One popular
technology that allows users to increase the size of the text, change contrast or font
settings to maximize readability is an eBook reader such as the Amazon Kindle.
Lightweight and with immediate access to a range of texts such readers are especially
popular with older users who find that they prefer the technology to traditional large print
books which are heavy and cumbersome. Such dedicated devices are often more
suitable for older users than apps for tablets as the devices have non-reflective
surfaces.
When text becomes impossible to access, some of the devices also offer text to speech
to listen to books, or can access a library of audio books with human speech reading
the books rather than synthesized
Gaming
Increasingly seniors are taking advantage of a range of games for computers and
mobile use. In research up to a third of seniors report playing one or more games daily.
This is similar to those in the 30-50 age bracket. However the types of games played
are likely to be different with elders preferring puzzle games and electronic versions of
traditional games such as jigsaws, card games or board games. According to the
Entertainment Software Association (2006), computer gamers under age 18 actually
make up less than one-third of all players, and people over age 50 make up 25 percent.
The average age of the most frequent game purchaser is 40 years. Video and computer
games have become the biggest single pastime of adults. Other research has
suggested seniors are embracing gaming as a way to connect to their children or
grandchildren. The continued growth in online gaming will make it possible for older
adults to play together with friends and family who may live far apart.
Travel
Lee B and Groves D (2014) discussed travel within a lifestyle definition. Within this
definition travel is “being able to function, communicate, and to use resources to move
around a community, as well as to visit a distant destination.” Historically older travelers
have relied upon an agent to make all arrangements, for may this has changed through
the use of technology. Online services such as Expedia have increasingly become the
preferred means of making arrangements for travel. Such technology shift can have an
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impact in helping seniors increase mobility within their community, as well as to a distant
destination. Apps for booking taxis easily such as Uber are very helpful to older users,
although without support we are aware that seniors are not as effective in using such
technology as the general population. However, older adults who learn how to use the
technology can benefit from it in their pursuit of leisure and travel
Technology allows books can be read, for pictures to be taken and shared, and
information to be found. All of these information products are very desirous by the
seniors. Much of it depends upon simple touch screen technology which is increasingly
the preferred interface for older users. Offering a preferred technology, configured to
needs is motivating for many. Motivation is very important and leisure activities can be
extremely motivating for many. Such motivation increases the desire to use the
technology making life easier and functional. Avoiding overloading the potential users
with undue complexity is important to avoid any anxiety and frustration, which can lead
to abandonment.
Supportive Technologies
There are a range of technologies available that have been designed specifically to
meet the needs of older users. These are useful to be aware of where mainstream
technologies are not proving effective in meeting needs.
Some examples include
Targeted Tablets, offer a simple and easy-to-use interface that combines video chat,
photo sharing, e-mail and other popular features into a simple touchscreen device.
These are usually delivered fully installed and ready to go out of the box, so are easy to
set up.
Smart TV’s offer high-definition video calls and access to the Internet on a large
Television screen. Such technologies do not require a computer and are designed for
the living room. Such models often feature a high-definition camera with wide-angle lens
and a microphone array. They may also allow users to share photos from an SD card or
USB memory stick and to send and receive video mail. Choosing such a technology is
complex and care should be taken to consider the design of the on screen menus and
the remote controls before purchasing.
TV amplifiers help people with hearing loss to hear a television or radio clearly without
turning up the volume. With such technology, users can set their own headset volume
and tone while others around them set the television volume to their preferred level.
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Case Studies
`John had been admitted to hospital...and his wife Eileen went to stay with their
daughter... John had dementia and his wife was not in a position to look after him any
longer. Everyone wanted John to be able to join his wife at the daughter's house but the
daughter and son-in-law were concerned about how they would manage...a number of
items of technology were provided to enable John to be independent but also to support
the whole family.'
`A 90 year-old man had been in hospital for some time and his family had some
concerns about him returning home...he was at risk of falls and fire...a smoke detector
(accompanied by a protocol for the emergency services to be notified if triggered), a fall
detector...and an enhanced hearing device for the phone were installed.'13
Beech R and Roberts D (2008) Assistive technology and Older people SCIE Research
Briefing 28
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Conclusion
Users of AT have identified the benefits and downsides to their experiences of AT. Many
of the benefits relate to wellbeing and confidence in living independently rather than to
direct health benefits, but have been shown to be important in the package of care
delivered.
Although many of the questions about service provision are posed by practitioners, it is
relevant for users and carers to be involved in the process. Users and carers should be
consulted during discussions about using AT in their care package and have the
opportunity for continuing input. In this way, users and carers can help ensure that they
are clear about the nature and use of the AT device, in order to get the most out of it. In
addition, it would be beneficial to the increased use of AT as a health and social care
response for users and carers to be involved in future design and development
programs.
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Mann WC, et al (1999) Effectiveness of Assistive Technology and Environmental
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Elderly: A Randomized Trial. Archives of Family Medicine. May/June. Volume 8.
Beech R and Roberts D (2008) Assistive technology and Older people SCIE Research
Briefing 28
Stevenson S (2013) 10 Technologies that seniors should embrace Senior Living Blog
Benefits of technology use for seniors http://www.captel.com/news/senior-living-and-
independence/benefits-technology-usage-se niors/
Smith A (2014) Older Adults and Technology Use Pew research Center
ElderCare (2013) Staying Connected Technology Options for Older Adults National
Association of Area Agencies on Aging
Orlov L (2013) Market Overview
Davis J (2013) Helping Seniors Get Connected Through Technology Parentgiving.com
Radcliffe D (2015) Social Media in the Middle East
https://damianradcliffe.wordpress.com/2016/01/21/report-social-media-in-the-middle-
east- the-story-of-2015/
Lee B and Groves D (2014) Seniors: Technology, Leisure, and Travel. International
Journal of Humanities and Social Science Vol. 4, No. 14; Bob Lee, David Groves,
Sperazza L J, Dauenhauer J and Banerjee P (2012) Tomorrows seniors: Technology
and leisure programming - Journal of community Informatics Vol 8 No 1
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