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Reflections on Older People in Relation to ICT-AI

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Abstract

The rapidity of innovation in ICT/ AI generates issues on the role of older citizens in understanding, accessing and using these new technologies. Co-creation, system reliability, ethical issues such as social justice and inequalities, monitoring and data privacy, freedom and autonomy, safety, security and liberty, and the various dimensions of accessibility that need to be considered, need to be carefully considered by innovators and policy makers. Resources are being given to research and practices to support the health and well-being of older people but to be successful will need to include them.
Reflections on Older People in Relation to ICT-AI
Elizabeth Mestheneos1 and Ilenia Gheno2
1NGO 50plus Hellas, Athens, Greece
2AGE Platform Europe, Brussels, Belgium
liz.mestheneos@gmail.com, ilenia.gheno@age-platform.eu
Keywords: Older People, Human-Computer Interaction, Monitoring, Accessibility.
Abstract: The rapidity of innovation in ICT/ AI generates issues on the role of older citizens in understanding, accessing
and using these new technologies. Co-creation, system reliability, ethical issues such as social justice and
inequalities, monitoring and data privacy, freedom and autonomy, safety, security and liberty, and the various
dimensions of accessibility that need to be considered, need to be carefully considered by innovators and
policy makers. Resources are being given to research and practices to support the health and well-being of
older people but to be successful will need to include them.
1 INTRODUCTION
The extraordinarily rapid speed of technical
innovation through the digital revolutions of ICT and
AI in the past decades has left many older people
excluded from or ignorant of these developments.
The implications from the implementation of ICT/AI
innovations are yet unknown.
The digital revolution saw the introduction of the
mobile phone in the 1980s, mobile computers 1981,
the internet and world wide web 1990, Google 1998,
the smart phone in 2007, tablets 2002 and the iPad
2010. The dates indicate the rapidity of changes
impacting on social interaction, business, the state
and the citizen. The 4th Industrial Revolution
currently underway extends well beyond
communication to robotics and AI, nanotechnology,
quantum computing, the Internet of Things,
biotechnology, Blockchain, 3D printing and
autonomous vehicles. The large variations in the ages,
educational level and experiences of older peoples
impacts on their access to and use of digital
technologies. (EC 2018). Inadequate and rapidly
changing data and, for those over 74 years, missing
data, means there is inadequate information on older
people's use and experiences of ICT.
The socio-economic context for the introduction
of ICT/AI includes increasing life expectancy not
matched by an equivalent growth in healthy life
expectancy, continuing urbanization of world
populations, and globalization in commerce,
production and communications. The dimensions of
such changes generate high complexity in
management and for future planning, while
contributing to inequalities in access, knowledge
about and usage of ICT/AI particularly evident
amongst older people.
2 HUMAN – COMPUTER
INTERACTION
2.1 The Critical Importance of
Co-creation
Technological ICT/AI innovations designed to help
older people have all too often not encouraged an
active and reflexive role for older citizens. While EU
funding research programmes increasingly mention
co-creation with users and professionals, this is not
always understood by technical designers and
professionals as providing extra value in innovation.
Assumptions that older people are technophobes arise
from ageist attitudes presuming older peoples'
incapacity to deal with modern life, the lack of public
support for later life learning and the absence of peer
support. Older people may also be ageist but may also
be hesitating in the adoption of technical and ICT
innovations for reasons that arise from their very
different and varied perspectives and life histories.
Mestheneos, L.
Reflections on Older People in Relation to ICT-AI.
In Proceedings of the 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2019), pages 7-12
ISBN: 978-989-758-368-1
Copyright ©2019 by SCITEPRESS – Science and Technology Publications, Lda. All rights reser ved
7
2.2 System Usability and Reliability
While smart phones and tablets have simplified ICT
usage, other aspects, in addition to costs, stop older
people using them easily, including a lack of
confidence, a lack of social and technical support in
using them from ICT buddies, and the fear of
breaking them or rapid redundancy.
As organizational systems, both in the public and
private sectors, become increasingly based on ICT,
older people never trained or with no access to the
technology become increasingly excluded. They must
rely on their children or paid help e.g. digital tax
declarations in Greece. So, although services overall
may be more efficient and better, many older people
become marginalised and more dependent on others.
Older people with cognitive problems and cognitive
decline also become increasingly excluded.
What about those who do not wish to use ICT? Do
they get excluded as citizens if they refuse to use the
technology? Technologies which contribute to
infantilizing or disabling the older person rather than
supporting him/her, and those taking away or
supporting a maximum degree of their autonomy are
unhelpful. There is also a kind of risk associated with
misuse: if the user relies very much on technology,
there comes a point when s/he is basically giving up
certain of his/her abilities and skills: laziness is a risk
with physical and mental consequences.
2.3 Justice, Fairness and Inequality
ICT and AI generate new ethical problems for
societies that add to existing moral and value
dilemmas for humans. There has been a large increase
in many EU countries in economic inequalities
(Eurostat 2018) since the 1980s. Many older people
are particularly aware of this, making them more
sensitive to the insecurities faced by younger
generations and local communities. AI and robots are
displacing human workers in many jobs. On line
shopping, for example, kills many local shops and in
some areas, this leads to a reduced sense of
community and jobs available for their families and
neighbours. (Knowles, Hanson 2018) Supermarket
check outs in many countries require the shopper do
the work of checking out their purchases. Banking is
increasingly on line requiring less paid workers in the
community.
Thus, older people are right to point to the uneven
gains that accumulate in the development of new
technologies which leads to their hesitation about
their easy and unproblematic adoption. Growing
economic inequalities, greater job insecurity, tax
avoidance, with their impact on relative wages and
thus social risk, are issues that are being discussed,
though not necessarily acted on, at a very high level.
(World Economic Forum, 2019). We do not know
what the implications are for the future, until now
perhaps risks have affected the more vulnerable, but
AI and ICT will be continuously disruptive for
organizations and jobs. However, they also offer the
possibility that ICT/AI-human interaction will
improve, that ethical issues for citizens concerning
the relationship between AI and humans are
confronted and that citizens become increasing co-
advisors in research and development (Stallcatchers,
2018). Some forms of AI will impact on the care and
support of dependent older people, and this will
require communities of practice which will be in
consultation with older people and their carers.
Ethical issues include what is to be done when people
no longer have good cognitive capacities impacting
on their legal capacities to make decisions. Perhaps
AI will be better at making some kinds of ethical
decisions concerning self-determination than self-
interested, tired and irritable humans? However urban
living, the increasing indication of isolation and
loneliness - perhaps especially though not exclusively
among older people, - suggests that technology, while
able to help in some respects, cannot replace human
care and human contact, and what I believe we all
need – a physical touch and hand to encourage,
reassure, comfort and support us. Even if AI turns out
to be better at diagnosis and some kinds of treatment,
the human support people need when in crisis and
pain cannot be replaced by Facebook, robots, AI and
its likes - though there is a role for these too.
Health technologies for monitoring health conditions
e.g. heart, kidneys, ultrasound, are often developed in
the private sector e.g. Apple Watch, with high costs
for purchase or subscriptions, suggesting that
inequities in accessibility to health care could become
worse for the poorer in the community unless a NHS
underwrites their cost as a way of improving public
health and decreasing acute and long term care costs.
3 MONITORING
3.1 Privacy and the Ownership of Data
Common problems that face us all, including older
people, concern privacy in the use of our data.
Technology to aid older people e.g. Remote
Monitoring, Mobile Health Monitoring, leads to
issues such as who owns the data when collected from
individuals and sent to manufacturers, health and care
services. Reports on AI in the healthcare sector
(Maddox T., Rumsfeld J.S, Philip R., Payne O, 2019)
ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health
8
suggest that current laws and regulations are nowhere
near sufficient to keep an individual's health status
private in the face of AI development. It will be
feasible for data to be misused and potentially sold on
the open market. In the USA, companies e.g. health
insurance companies, buy anonymous health data, but
their business model is to find a way to attach names
to this data and sell it even if this is unethical.
The EU has attempted to confront some of these
issues via Data protection law and GDPR (General
Data Protection Regulation) which gives some
protection for an individual’s privacy, identity,
reputation, and autonomy, but this does not work with
Big Data analytics and artificial intelligence (AI).
These latter both draw non-intuitive and unverifiable
inferences and predictions about the behaviors,
preferences, and private lives of individuals (Mobile-
Age, 2018). The European Court of Justice has also
made clear that data protection law is not intended to
ensure the accuracy of decisions and decision-making
processes involving personal data, or to make these
processes fully transparent.
3.2 Respect for the Autonomy and
Freedom of the Person
It is difficult for any person to be adequately informed
or to decide on how and to what extent s/he is willing
to work with and provide data via ICT. Do we know
how and in what ways ICTs/AI can and may invade
our privacy and infringe our freedoms? What
safeguards and mechanisms of control over their use
can reasonably be put in place, carefully balancing
security and freedom for each individual? In many
European societies the value of being autonomous i.e.
able to make our own decisions and choices as adults,
is something we believe in and respect. But what
happens when cognitive capacities decline? To what
degree do we encourage autonomy even if this leads
to dangers for the individual with dementia or
Alzheimer type diseases? Thus, there are real dangers
in feeling adequately in control of the technology
being used, knowing when to say no, and not being
abused by those developing the ICT/AI systems.
In a European Horizon2020 project,
MATUROLIFE, in discussion groups led by AGE
Platform Europe, there were a variety of definitions
of the meaning of independence that unsurprisingly
vary by individual, culture and age (MATUROLIFE,
2018). We are all interdependent but there is a danger
that in some areas technologies may make older
people dependent. While the current benefits of AI
and ICT may be unclear, in the longer term a better
use of them may be made. AI, although discussed in
terms of diagnosis, offers possibilities in reducing the
current amount of time spent by doctors and health
professionals in administration and allowing more
face to face time and human contact. However, as
citizens will we have to fight for the time and
resources saved through the use of AI, to be spent in
better “hands on” care of people, especially older
people. Care in the home by home based AI interfaces
e.g. for chronic illnesses, can provide real support for
older people who need monitoring, but also the
capacity to consult and receive reassurance about
their health problems. This offers respect and freedom
to some extent. Yet we are still far from such a system
and integrated care systems are still rare in most
Member States, while many digital technologies are
at the experimental stage or already obsolescent by
the time they are ready for deployment.
Longevity is generally positive if you have
money, reasonable health and social networks. But
what happens when partners die, children do not exist
or are few and far away, when local urban community
social life is limited, when public facilities and
environments are unpleasant or dangerous or not
designed to include older people who may be frail. AI
and ICT cannot overcome existing socio-economic
problems but should also not exacerbate them.
3.3 Safety, Security and Liberty
Can ICT and AI systems help overcome some
problems that in particular older people face, in a safe
and secure manner that does not deprive people of
their liberty? The care of older people with diseases
like Alzheimer is already problematic: how far should
one supervise and monitor people who have
significant cognitive problems? AI should be able to
assist people in making their desired decisions e.g. to
go to the local shop, buy the product they want, and
get home and European innovative projects such as
the Horizon2020 Frailsafe project attempt such
support. All ICT and AI systems are based on
programmes and hackers and malicious people can
corrupt these. We already have a lot of experience of
the misuse of various ICT technologies: cheats, liars,
the mischievous and the greedy have always been
with us e.g. false news, scams, identity theft. Trying
to make systems safe and ensure that people are not
cheated and abused in the use of ICT/AI will be a
constant battle.
AI relies on its decision making mimicking the
human brain and it learns from large sets of data
resulting in algorithms. Known as a “black box”, we
can see what goes in it and what comes out, but not
how the outcome was arrived at. (European
Consumer Consultative Group, 2018). Currently we
are very aware that humans make decisions based
Reflections on Older People in Relation to ICT-AI
9
often on prejudice and assumptions prejudice and
widespread ageism in many of our countries results in
all kinds of inequalities from treatment protocols to
banking loans and insurance. We manoeuvre these
with difficulty but what will happen when AI makes
the decisions and are even less transparent. In this
sense AI generates new problems of freedom, the
capacity to understand how decisions are reached and
the liberty to appeal against them. By and large,
lawmakers haven’t decided what rights citizens
should have when it comes to transparency in
algorithmic decision-making. Our language adopted
the term Kafkaesque to mean situations where
individuals are threatened by remote and inaccessible
bureaucrats and rightfully, we fear non transparent
bureaucracy with power over our lives. AI needs to be
built to provide "recourse," or the ability for people to
feasibly modify the outcome of an algorithmic
decision.
Nonetheless we will continue to use and develop
AI that will almost certainly be valuable in dealing
with social and health problems: AI does not get tired,
sick, fed up nor does it forget: thus, it can act 24 hours
a day to support humans, professionals and patients,
with information and data. ICT systems as they
currently operate appear to create an extra burden of
administration for health and care professionals but
within a reasonable period of time AI will become
intelligent assistants supporting effective
administration keeping records and saving time and
effort. I doubt that anyone believes that AI should
work alone in interacting with individuals with social
and health needs. How to integrate and use AI for the
benefit of all is very much under discussion. It is
likely that Al within the next 10 years will
revolutionise support to older people e.g. facilitating
their empowerment, community inclusion, personal
care e.g. in bathing and toileting, or just general
support. All these are forms of work which can relieve
professional and informal carers and even help avoid
abuse.
A major point that will have to be made clearer
for individuals, especially if they are cognitively
confused, is whether they are talking to a person or a
technology, a machine.
4 ACCESSIBILITY
Something can only be accessible if you are aware of
it's existence and potential. Here we need a lot more
education and intergenerational support and
exchange. It will be valuable if everyone is aware of
the questions, opportunities and risks associated in
the use of technology. It also needs to be available e.g.
physically throughout the country in rural as well as
urban areas. 5G apparently has a huge capacity to
help access to AI and ICT technologies and
programmes. The EU appears to be keen on free
access to the internet to ensure non exclusion on that
basis (European Commission, 2018). This will help
with something already mentioned – affordability.
4.1 Inclusive Design
One major difficulty is that introducing adaptations to
houses to make them accessible for all with
disabilities, whether these are physical adaptations, or
digitally smart and inclusive, costs money. Overall
older people are least likely to live in modern homes,
occupying older housing stock, are more likely to live
in rural areas, few have smart infrastructures and,
importantly, they are least likely to be able to afford
or be willing to install adaptations. Those with the
most need for support e.g. older, frail women and
those with multiple chronic health conditions, are
often the least technically aware, and also have less
disposable income. In many countries older people
struggle with the cost of a tablet or smart phone and
the subscription to the internet. Thus, there are doubts
about the private purchasing of AI e.g. IoT, wearable
technologies. They seem cost viable but will need to
be linked to a paid for broadband system. The efforts
by the EU to make broadband accessible to all is a big
step forward.
Sensors are increasingly being used via smart
phones, web cameras, tablets, and smart clothes to
monitor motion in homes and in the community, thus
providing useful interlinks with family carers and
some professional health and care services. The cost
of sensors is relatively low but the problem of
ensuring they are non-intrusive and their data remains
under privacy controls remains.
Considerable work at EU level is undertaken to
ensure that web contents are accessible and that
interfaces can be personalised for users. Standards
exist in the industry with accessibility issues
addressed via a Legal framework (eAccessibility +
European Accessibility Act). All ICT and AI products
and services will have to ensure they are accessible as
well as secure with reference to protection of an
individual's data.
4.2 Transport Accessibility
This sector is under rapid development both for
public and private transport and is based on AI
holding out potentially important help for the
autonomy of older people who, if unable to drive, will
nonetheless be able to move around not just in cities
ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health
10
but in rural areas where currently public transport is
often uneconomic to provide.
4.3 Service Accessibility
On line shopping for the digitally able who are
physically compromised will certainly help many
older people but will represent a threat, already
mentioned, to local services and communities. Older
people tend to be more attached to their localities and
marrying ICT and AI developments to local
communities will need to be observed and
considered. Digital literacy is key in this.
5 DISCUSSION
Behind all developments in ICT and AI must be clear
human values to ensure the most vulnerable
individuals, including older people needing
assistance, are helped in retaining their functional and
moral autonomy as long as possible. We need to
prevent situations of vulnerability and avoid the
isolation of the sick and vulnerable. Exercising the
rights of older citizens requires that they obtain valid
and understandable information enabling them to
support their autonomy and decision-making
capacity. There need to be established control
mechanisms that prevent family members,
professionals, directors of centres and services or
others from making decisions that should be made by
the elderly person. Finally, it is evident that we all
need to have continuous training and support whether
as end users, which may involve providing basic
health and digital literacy, or as developers and
healthcare professionals.
In AGE Platform Europe we argue for all
Member states and the EU to disaggregate statistics
to better understand the situation of older persons
rich and poor, rural and urban, healthy or unhealthy,
dependent or independent. Older people are very
varied in what makes their people’s lives worth living,
dignified and fulfilling and this must be under
constant review.
New developments will change and possibly help
many older people e.g. exoskeleton help in walking,
ordinary glasses with a camera and data recognition,
as used by pilots, which will enable the wearer to see
someone's name and any essential data. The health
linked watch to warn individuals of any untoward
events and stimulate physical activity and correct diet
is already with us but not yet linked to our health
systems. But each innovation has potential and not
necessarily desirable consequence e.g.the
medicalisation of everything through mobile apps.
We need to be cautious about expertise and
knowledge and what we measure e.g. changing
opinions and fashions over diet, cholesterol. This is
an exciting time to live in but the inclusion of older
people in debates on ICT-AI innovations can help in
the essential reflexive process.
ACKNOWLEDGEMENTS
Thanks are given to the many AGE Platform Europe
members who contributed as individuals and
organizations to reflections on ICT and AI in many
and varied programmes concerned with standards,
ethics, accessibility and all the many other social
questions that arise from trying to ensure that older
people best use and benefit for ICT and AI. Thanks
are also conveyed to the Secretariat at AGE Platform
Europe for its support and inputs on older people’s
views and perceptions in the field.
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We are only at the beginning of a rapid period of transformation of our economy and society due to the convergence of many digital technologies. Artificial Intelligence (AI) is central to this change and offers major opportunities to improve our lives. The recent developments in AI are the result of increased processing power, improvements in algorithms and the exponential growth in the volume and variety of digital data. Many applications of AI have started entering into our every-day lives, from machine translations, to image recognition, and music generation, and are increasingly deployed in industry, government, and commerce. Connected and autonomous vehicles, and AI-supported medical diagnostics are areas of application that will soon be commonplace. There is strong global competition on AI among the US, China, and Europe. The US leads for now but China is catching up fast and aims to lead by 2030. For the EU, it is not so much a question of winning or losing a race but of finding the way of embracing the opportunities offered by AI in a way that is human-centred, ethical, secure, and true to our core values. The EU Member States and the European Commission are developing coordinated national and European strategies, recognising that only together we can succeed. We can build on our areas of strength including excellent research, leadership in some industrial sectors like automotive and robotics, a solid legal and regulatory framework, and very rich cultural diversity also at regional and sub-regional levels. It is generally recognised that AI can flourish only if supported by a robust computing infrastructure and good quality data: • With respect to computing, we identified a window of opportunity for Europe to invest in the emerging new paradigm of computing distributed towards the edges of the network, in addition to centralised facilities. This will support also the future deployment of 5G and the Internet of Things. • With respect to data, we argue in favour of learning from successful Internet companies, opening access to data and developing interactivity with the users rather than just broadcasting data. In this way, we can develop ecosystems of public administrations, firms, and civil society enriching the data to make it fit for AI applications responding to European needs. We should embrace the opportunities afforded by AI but not uncritically. The black box characteristics of most leading AI techniques make them opaque even to specialists. AI systems are currently limited to narrow and well-defined tasks, and their technologies inherit imperfections from their human creators, such as the well-recognised bias effect present in data. We should challenge the shortcomings of AI and work towards strong evaluation strategies, transparent and reliable systems, and good human-AI interactions. Ethical and secure-by-design algorithms are crucial to build trust in this disruptive technology, but we also need a broader engagement of civil society on the values to be embedded in AI and the directions for future development. This social engagement should be part of the effort to strengthen our resilience at all levels from local, to national and European, across institutions, industry and civil society. Developing local ecosystems of skills, computing, data, and applications can foster the engagement of local communities, respond to their needs, harness local creativity and knowledge, and build a human-centred, diverse, and socially driven AI. We still know very little about how AI will impact the way we think, make decisions, relate to each other, and how it will affect our jobs. This uncertainty can be a source of concern but is also a sign of opportunity. The future is not yet written. We can shape it based on our collective vision of what future we would like to have. But we need to act together and act fast.
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Artificial intelligence (AI) is gaining high visibility in the realm of health care innovation. Broadly defined, AI is a field of computer science that aims to mimic human intelligence with computer systems.¹ This mimicry is accomplished through iterative, complex pattern matching, generally at a speed and scale that exceed human capability. Proponents suggest, often enthusiastically, that AI will revolutionize health care for patients and populations. However, key questions must be answered to translate its promise into action.
European civil law rules in robotics
  • European Parliament
European Parliament, Policy Department C: Citizens' Rights and Constitutional Affairs, European civil law rules in robotics, October 2016, http://www.europarl.europa.eu/committees/fr/supporting-analysessearch.html Reflections on Older People in Relation to ICT-AI
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Policy Brief: Privacy implications of technologies to address social isolation amongst older people
  • L Matsakis
Matsakis L. (2018) What does a fair algorithm look like? https://www.wired.com/story/what-does-a-fair-algorithm-look-like/ Mobile-Age, H2020 project, Policy Brief: Privacy implications of technologies to address social isolation amongst older people: https://www.mobile-age.eu/project-outcomes/policy-briefs.html PROGRESSIVE, H2020 project, D2.1 Ethical Framework for Standards in the Context of ICT for AHA. https://progressivestandards.org/ethical-framework/
Report of the Independent Expert on the enjoyment of all human rights by older persons
  • Stallcatchers
Stallcatchers (2018) https://stallcatchers.com/main United Nations, Report of the Independent Expert on the enjoyment of all human rights by older persons, A/HRC/36/48, 21 July 2017
How to manage AI's risks and rewards
World Economic Forum (2019) How to manage AI's risks and rewards, https://www.weforum.org/agenda/2018/ 01/how-to-manage-ais-risks-and-benefits ICT4AWE 2019 -5th International Conference on Information and Communication Technologies for Ageing Well and e-Health
Cybersecurity for connected products
  • Beuc Anec
ANEC, BEUC, Cybersecurity for connected products, draft position paper, March 2018: http://www.anec.eu/images/Publications/position-papers/Digital/ANEC-DIG-ITAL-2018-G-001final.pdf
169 million Europeans between 16 and 74 years (44% ) do not have basic digital skills. No data for 74 years and over
European Commission (2018) WiFi4EU, Free Wi-Fi for Europeans, https://ec.europa.eu/digital-single-market/en/policies/wifi4eu-free-wi-fi-europeans European Commission (2018), 169 million Europeans between 16 and 74 years (44% ) do not have basic digital skills. No data for 74 years and over. https://ec.europa.eu/epale/en/content/nearly-half-europeans-donthave-basic-digital-skills