Inclusion of Seniors in the Design of Assistive Technology

Assistive technology helps many older adults complete essential tasks, thus providing them a means to remain functionally independent within their communities. However, many older adults either reject the use of devices or misunderstand their intention. The gap between design and need may be bridged through the active participation of elders in the design process. Previous studies have focused on older persons’ attitudes toward adopting new technology, emphasizing how to promote and maintain usage. Recent research reveals the necessity of including older adults in the design, research, and application of assistive technology in an effort to meet the real needs of this diverse population instead of the needs perceived by the designer. Assistive technology developers’ conceptualizations sometimes do not mesh with the needs of consumers, and this disconnect can negatively impact seniors’ ability to age-in-place. Developers may focus on a narrowly defined idea of health while older adults often have broader characterizations of what it means to be healthy. Inviting older adults to participate in the design of assistive technology will encourage older persons’ use of this technology and thereby improve their social interactions and support their aging-in-place. MEANINGFUL DEVICES AND ASSISTIVE TECHNOLOGY 3 Meaningful Devices – Inclusion of Seniors in the Design of Assistive Technology Introduction Alice, an 83 year old woman living independently, calls it the “Cadillac of Walkers,” and its sleek curves, shiny chrome, and sturdy workmanship mirror the qualities of a luxury automobile, But no matter how fancy the walker, it just doesn’t work for Alice. “It’s too bulky and heavy. I can’t fold it by myself and put it in my car. I have to hunch over it and can’t stand up straight. ” (Alice, personal communication, February 3, 2015). Regardless of how beautiful to look at or expensive to acquire, this piece of assistive technology does not work adequately for Alice. Would it have made a difference to Alice if the designer of her walker asked for her input on its construction? Could Alice’s unique needs have been incorporated into a device that serves her more appropriately? If the answers to these questions are “Yes,” then why are designers not asking them? Or are they? “Participatory design” incorporates a product’s future customer as a co-designer with researchers, developers, and engineers. Co-design can occur anywhere along the design continuum: from conceptualization to prototype testing to post-launch redesign. In this model, exploration of possible solutions occurs in tandem with the design process so that the result is a final product that meets a defined need. Participatory design has pushed designers from creating products for a generic consumer to “designing for people’s purposes” (Sanders & Stappers, 2008, p. 617). * Name changed to protect confidentiality. MEANINGFUL DEVICES AND ASSISTIVE TECHNOLOGY 4 Co-designing with older adults could prove invaluable for identifying answers to the persistent problems of aging. By responding sensitively to this segment of society, which is sometimes ignored or condescended to, design professionals can support the aging-in-place of older adults with inventive concepts inspired by the rich contributions of their audience. One area of aging where participatory design could be influential is in the realm of assistive technology. Assistive technology and adaptive equipment – like Alice’s walker – play an important role in the functional independence of older adults. The Older Americans 2012 report shows that using assistive equipment allowed Medicare enrollees over the age of 65 to maintain their independence and remain living within their home communities rather than in long-term care facilities (Federal Interagency Forum on Aging-Related Statistics, 2012). However, assistive technology is not a one-size-fits-all solution – as Alice can attest. Despite the best intentions of designers, many older adults reject the use of devices, misunderstand their intention, or become frustrated at their ineffectiveness. The gap between design and need may be bridged through the involvement of elders in the design process. Current research reviewed in this paper emphasizes the need for including older adults in the design, research, and implementation of assistive technology in an effort to meet the various needs of this diverse population. What are Assistive Technology and Gerontechnology? Assistive technology provides a way for seniors to successfully engage in essential tasks. It helps someone perform an activity that may otherwise be beyond her functional ability. Activities of daily living (ADLs) are tasks of self-care like bathing, toileting, and feeding. As people age, their ability to complete these activities can diminish due to physical or cognitive MEANINGFUL DEVICES AND ASSISTIVE TECHNOLOGY 5 limitations. Assistive technology supports seniors’ ability to complete ADLs independently rather than to seek help from others. The variety of such equipment is extensive. A systematic review of 184 articles showed wide variability in what was considered assistive technology (Piau, Campo, Rumeau, Vellas, & Nourhashemi, 2014). Assistive technology is a broad term that includes items like reachers, computers, and entire homes designed to assist the independent living of older adults. The term gerontechnology likewise encompasses electronic, “smart” solutions ranging from social networking apps to remote health monitoring systems to soiled underwear detection patches. With such variability among devices, the research into their efficacy can be equally as varied. The goal of these myriad devices is to support the functional independence of seniors. While many older adults may seem resistant to technology use, there is evidence that the so-called “digital divide” between the older and younger cohorts is not as wide as some think (Wallace, Graham & Saraceno, 2013). As the Baby Boomers enter the senior generation, their familiarity with technology should increase the number of equipment options available. This group is already comfortable using cell phones and personal computers. Integrating technology into daily living – even for people with functional limitations – may be easier for Baby Boomers than for their older siblings. Inclusion Along the Design Continuum Current social research focuses less on the devices themselves and more on the psychological aspects involved in the older cohort’s decisions to both begin using and to continue using assistive technology. Suggestions for future research in this area point toward the inclusion of older adults in the development of gerontechnology that best fits their unique needs. MEANINGFUL DEVICES AND ASSISTIVE TECHNOLOGY 6 Peek et al. looked at what specifically influences older people to use assistive technology to allow them to remain in their communities (2014). They found that much attention has been paid to the pre-implementation stage of gerontechnologies (when a technology has not been used) but not to the post-implementation stage (after a technology has been adopted); the concerns and understanding of technology differ in the two stages and can have different effects on the continued use of the adaptive devices. The pre-implementation stage might focus on the fear of the unknown (for example, privacy intrusion and ease-of-use considerations), whereas, the post-implementation stage might be based on usability factors (for example, device satisfaction in real-life situations). Peek et al. found that more research is being done on how to convince older adults to use technology in the pre-implementation stage than on how well that technology suits their needs in the postimplementation stage (2014). The authors recommend more quantitative research into the postimplementation stage. Botero and Hyysalo are product designers who agree with this assessment. Working with The Active Seniors Association, a group of older people building an intentional community in Finland, Botero and Hyysalo discovered that the design process could not simply stop once a product was delivered. Working together with the association coordinating the housing community, the designers went through several iterations of a community calendar, some of which included a website, an electronic bulletin board, and a digital meeting book. Eventually, the entire group decided upon a paper-based system that met the needs of the senior population. The final result was far from what the designers originally envisioned; however they discovered that maintaining a collaborative relationship with the end-users allowed their initial design to evolve to better fit the expressed needs of the seniors (Botero & Hyssalo, 2013). MEANINGFUL DEVICES AND ASSISTIVE TECHNOLOGY 7 Cultural Considerations: What is Old Age? As they age, many older adults prefer to remain at home (Hooyman, Kawamoto & Kiyak, 2015). Providing a way for them to do that can increase their quality of life (U.S. Census Bureau, 2014). Independence increases feelings of satisfaction and motivation to continue with a task. Independent older adults will likely be both physically and emotionally healthier (Hooyman et al., 2015). Perception of health impacts the choices seniors make when integrating assistive technology into their lives. Older people wish to remain independent and living at home, and sometimes this emphasis on “productive aging” can lead them to eschew adaptive equipment for fear that they will be labeled sick or unable (Joyce & Loe, 2010). The Western cultural value placed on remaining busy and economically viable contrasts sharply with the glorified ideal of a peaceful retirement. The emphasis on productivity can lead older people to feel worthless. “There is a strong incentive to encourage continued economic contributions from all citizens and to minimize their dependence and drain on resources” (McLean, 2011, p. 31