A 2018 paper by Elers and colleagues, reports on research to develop information and communication technology (ICT) to support “Ageing in Place” for older people in New Zealand. Ageing in Place refers to policies, adopted in several developed countries, which promote health and social care services that enable older people to live independently and safely in their own homes in their communities for as long as they wish and are able (Normie 2011). These policies were conceived on the view that ageing at home will benefit older people’s social and psychological wellbeing, and help national governments to reduce the cost of institutionalised care for a rapidly expanding older population. The assumed role of ICT in Ageing in Place policies is to help older people communicate their needs quickly and easily with their care network, and at the same time, to assist governments in providing efficient and inexpensive care to vulnerable adults living at home (Sixsmith and Sixsmith 2008). In the paper discussed in this blog, Elers and colleagues focus on the qualitative phase of their research endeavour.
The authors conducted semi-structured face-to-face interviews with ten community-dwelling older people (aged 74-92 years) living alone with care needs, and 31 members (in total) of their informal support networks. The interviews explored the benefits and barriers of incorporating care-related home monitoring equipment (e.g. camera, sensors) and generalised ICT devices (computers and mobile phones) and applications (email, Skype, social media) into daily life.
The paper draws attention to two benefits of ICT-use for older people. Firstly, older participants discussed the positive impact of ICT-use on their social networking in terms of intergenerational relationships, which in turn positively affected their overall wellbeing. Similar effects were described in Galbraith and colleagues’ (2015) review of cross-generational activities and services, where both younger and older participants experienced improved self-confidence and self-esteem, increased feelings of joy, and a deeper understanding of – and increased empathy for- others. Secondly, participants commented on the potential for monitoring equipment to provide reassurance and a sense of safety for the older person’s family or support network. An interpretation of these findings could be that younger participants perceive ICT-use as a way of balancing their caregiving role with other responsibilities in their lives. Together these benefits point to the role of ICT in strengthening longstanding family ties in contemporary society, where the family members are often dispersed across the globe. Accordingly, when exploited sensitively, these “digital family bonds” can supplement the delivery of timely and personalised professional support to older people with care needs.
Elser and colleague also discuss the barriers that prevent older people from using ICT. They underline the generalised apprehension that older participants had towards ICT, which they attributed to perceptions that the cost and accessibility of devices are prohibitive, and that ICT-use reduces human contact. Most notably however, the authors emphasise how older people’s perception that ICT interferes with control over their privacy and identity is a significant barrier to their adoption of ICT. These concerns are not unfounded. There is a growing need to use internet-enabled devices to access – and to participate in – today’s increasingly digital society. However, at each contact with internet and related online services, an individual leaves a traceable “digital footprint”, which includes nuggets of personal information and clues to their identity (Internet Society, 2019). Who has access to the information and how it may be exploited is unclear; and regulation to date is wholly inadequate to safeguard against unscrupulous activity.
The authors conclude that ICT which is accepted by older people and can support their Ageing in Place has four essential features: the technology must be low in cost, easy to use, adaptable to an individual’s changing needs, and can guarantee the secure transfer of personal data. The authors also recognise that Ageing in Place does not occur without the engagement of the extended support network, and that their views on the ICT need to be taken into account. All in all, the paper contributes valuable evidence to the wider discourse around the feasibility of integrating ICT into care services, and the impact of ICT-use on the quality of life of older people and the wider family network.
Strength and Limitations
The paper has some limitations. Firstly, there is a lack of clarity on the specific ICT being discussed. Throughout the paper, the authors refer to ICT with home monitoring functions without describing specific devices, services or functionalities. In the UK, a wide range of monitoring technology (often referred to as “telecare” services) are available, including wearable devices such as pendant (neck or wrist) alarms and fall detectors, and sensor technology placed throughout the home such as door alarms, flood detectors and presence alarms (Telecare Services Association, 2019). To fully appreciate participants’ views of the home monitoring equipment, the readers would benefit from a description of the devices, their functions and the context in which they could be employed. Furthermore, the authors explain that the findings from their analysis would inform the development of a technology “prototype” in a later phase of the project, but they do not comment on the type – or purpose – of the technology, device or application that is being developed.
Relatedly, there was a lack of consistency when describing the benefits and barriers of technology. Within the thematic analysis, the authors did not discern between the different types of ICT – i.e. whether the technology was for home monitoring or for general-purpose – and the impact each type of ICT had on different family members. The presentation of the findings went from one type of ICT to another without reflecting on the fact that divergent opinions could be in part attributable to the different functions of the technology.
Finally, the paper lacks insight into the negative impacts of Ageing in Place policies and the potential for ICT to exacerbate problems of social isolation and loneliness, which especially affects older people living alone and with a limiting condition. As such, living independently in their own home is not a universally beneficial or even desirable goal (Sixsmith and Sixsmith, 2008). Policy makers need to be mindful that endorsing technologies, which enable remote support and care, may offer short-term reassurances for some members of the care network but may also lead to enduring difficulties for many vulnerable adults.
Implications for Policy and Practice
The paper prompts important reminders to developers and policy makers about the role of ICT in the care of older adults. First, some older study participants made facetious remarks about their own controlling nature (and their desire to be in control of how technology would be used and managed) – perhaps exposing their sense of defencelessness in the face of the unknown threats of cyberspace. This insecurity brings to mind Naess and colleagues’ (2016) discussion of assisted self-presentation for care home residents, where professional carers act as envoys of the social identity that vulnerable older people choose to demonstrate to others. Similarly, the findings stress that ICT developers, national governments and care providers have a responsibility to create inclusive applications that both promote and protect the digital identity that older people choose to present.
Also, the authors contrast older participants’ positive and negative attitudes towards ICT, thereby obliquely describing the cognitive dissonance, which some older adults experience towards ICT. Colleagues and I published a study (Damant et al.2016) in which we observed how conflicting feelings lead many older people to make “trade-offs”: where the benefits of ICT-use in one aspect of their life are weighed against the inconvenience to another. For instance, participants in the current study deliberated the value of home monitoring equipment in terms of promoting their independence and curtailing a move into residential care, against their concerns about privacy and security.
In considering both sides of ICT used to support “Ageing in Place”, Elers and colleagues underscore the importance of understanding technology as a tool to abate some of the challenges of modern family life and not as a panacea for older people’s entire social and care needs.
Conflicts of interest
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Elers P, Hunter I, Whiddett D, Lockhart C, Guesgen H, Singh A (2018). User Requirements for Technology to Assist Ageing in Place: Qualitative Study of Older People and Their Informal Support Networks. JMIR mHealth and uHealth.6(6):e10741.
Damant J, Knapp M, Freddolino P, Lombard D (2016). Effects of digital engagement on the quality of life of older people. Health and Social Care in the Commuinity, 25(6), 1679-1703.
Gilbraith B, Larkin H, Moorehouse A and Oomen T (2015). Intergenerational programs for persons with dementia: a scoping review. Journal of Gerontological Social Work, 58, 357-378. [PubMed Abstract]
Internet Society (2019) Your Digital Footprint Matters. Available at: https://www.internetsociety.org/tutorials/your-digital-footprint-matters/, accessed on April 16, 2019.
Normie L (2011). Technology for Ageing in Place, Global Ageing: Issues and Action (International Federation on Ageing) (PDF), 2: 45- 51.
Naess A, Grip Fjaer E and VabØ M (2016). The assisted presentations of self in nursing home life. Social Science and Medicine, 150, 153-159. [PubMed Abstract]
Sixsmith A and Sixsmith J (2008). Ageing in Place in the United Kingdom, Ageing International, 32, 219-235. [Abstract]
Telecare Services Association (2019). What is TEC? Available at: https://www.tsa-voice.org.uk/what-is-tec, accessed on April 16, 2019.