Aging Through Technology

By: Timothy Hornik, LMSW

Introduction

In 1966, Gene Roddenberry inspired a new generation of inventors with the airing of “Star Trek.” The broadcast captured these imaginations, encouraging them to bring the futuristic tricorders, phasers, artificial intelligence, and communication systems to the present. Nearly 50 years later, many of the gadgets Captain Kirk or Doc McCoy used to accomplish their missions materialized in research labs, Universities, healthcare settings, homes, and even in our palms, improving quality of life for many (Briggs, ND). This technological revolution consisting of computers, smart phones and tablets, social media services, wireless medical equipment, wearables, the internet, World Wide Web, and numerous other high and low tech, forces one to interact with technology on a daily basis.

This review aims to examine how the generations that witnessed the first airing of “star Trek” and who now qualifies for an AARP membership perceives and integrates technology into their lives. Common myths suggest that seniors despise or are incapable to learn how to integrate these items into daily activities. However, research from sources ranging from Gallup polls to research articles and conference summaries to personal blogs indicate a growing percentage of seniors adopting technologies. Based on these concepts, this analysis will summarize findings from these sources to describe statistical usage across generations, conceptual paradigms for adoption, communicating through mobile and online services, technologies impacting health and wellbeing, Telehealth centered healthcare, and recommendations to embrace technology. It is postulated that despite convincing evidence that technology benefits everyone regardless of age or disability, numerous barriers from individual beliefs to lack of inclusivity to federal policies hinder widespread adoption (Lustig & Olson, 2013; Thielke et al., 2012; Waterston, 2011).

To ensure uniformity throughout this document, the following terms are defined as such. The terms seniors and older adults refers to those 65 years and older. The millennials constitute those born between the 1980’s to the early 2000’s. For brevity, the term technology is used to describe the range of devices classified as assistive technologies, mobile devices, computers, wearable medical sensors, gerontechnologies, ubiquitous healthcare technologies, smart home technologies, or other phrases found in the literature that pertains to this category of technologies.

Statistical Usage of Technologies Across the Generations

Throughout the different generations and across the lifespan, different reasons propagate why one adopts technology. Youth views iPhones as status symbols, while older adults purchase them for work. Blind individuals clamor to these because it promotes independence, where an elderly person just desires a method to contact family and friends. Regardless of these differences, industry, politicians, and consumers recognize the importance of technology in life. Events like “The Hour of Code,” (N.D.) and M-Enabaling Summit (2014) attempts to demystify electronics to seniors through collaborative training sessions to international conferences that pulls together consumers, advocacy groups, developers, and federal agencies (Dujmovic, 2014; G3ICT, 2014). Despite these efforts, younger generations remain the largest demographic living a digital lifestyle, as older adults slowly lag behind.

Analyzing the methods each generation communicates through digital and mobile means provides a snapshot on these adoption trends. A recent Gallup poll found that only 10% of those 65 years and older achieves social goals on a daily basis through mobile devices or social media services. This stands in stark contrast to the 34% of those 18 to 29 or even the 26% for those 30 to 49 (Newport, 2014).

The number of seniors who adopted online identities and mobile devices directly impacts these statistics. The PEW Research Center surveyed older adults and obtained convincing evidence that numerous seniors regain from the online world, though this trend appears to decrease each year. The findings show that 41% of seniors do not use the internet, 53% lack high speed internet services, and 23% lack mobile phones. Opposing these actions are the feelings from 79% of seniors who go online state that this disconnected population is at a disadvantage with remaining in contact with family and knowledgeable about current news. This belief is reinforced with 94% of online seniors suggesting that the internet a safe and efficient method for teach (Smith, 2014). Based on this evidence, the gap will continue to narrow, as younger generation’s age and older ones accept technology into their lives.

Conceptual Paradigms for Adoption of Technology

Several different theories and models arose recently to explain how and why seniors, healthcare professional and caregivers select technological solutions. This review will summarize three different models where one identifies six themes and 26 categories used in decision making processes) Peek et al., 2014), how Maslow’s hierarchy of human needs determines appropriateness (Thielke et al., 2012), and four factors that support technological aging solutions (Agostini, Winstein, & Bickmore, 2012). The commonalities that promote adoption include devices that promote safety, self-determination, belonging, social contact, and gratifying feedback for accomplishing objectives. Working against these are financial costs, privacy concerns, duplication of tasks, or losing social interactions because a human attendant is no longer required.

Peek et al. (2014) investigated factors that influence the acceptance and integration of technology in daily life. Through this, they recognized that concerns about technology, anticipated benefits, actual needs, duplication of effort, social and societal influences, and personal factors as the six core themes. Concerns around technology, starts the process off with skepticism fueled by financial costs, risk to privacy, and usability. Next, safety, usefulness, and reliability form ones anticipated expectations. These benefits are evaluated against actual personal needs like the ability to engage with family, review health status, or promote wellbeing. The forth factor examines if the device duplicates the function of another item or personal care attendant. Many seniors often rely on caregivers for emotional support, and would prefer human interactions over a mechanical solution. Following these, a social and societal review significantly influences any decisions. Finally, personal factors, like desire to age in place and personal feelings, ultimately cast the deciding vote (Peek et al., 2014). This model skillfully recognizes that selecting technologies to age in place goes beyond completing tasks, but requires one to evaluate multiple orders of affects.

Maslow hypothesized that basic physiological needs, security, belonging, esteem, and self-actualization form the five basic human needs (McLeod, 2007). Thielke et al., (2012) transferred these concepts from a sociological perspective and framed how one selects technology to age in place. The first two human requirements rectify objective goals to survive. At the basic human needs level, few items are required, unless a person possesses difficulties with basic activities of daily living. Appropriate technologies may include simple alerts, reminders, or guidance to complete tasks. Once these initial needs are met, safety and security must be addressed through sensors for falls or alarms when stoves might be on, (Thielke et al. 2012).

The remaining three human needs require deeper understanding of personal hopes and goals. In order to promote love and belonging, one needs to turn towards social media services, video and voice messages, and other communication platforms. Following this, one pursues higher levels of personal esteem. Technologies may encourage this, for example when one masters new devices. However, if feelings of helplessness arise from depending on a device, esteem may decrease. At the highest level, self-actualization comprises of altruistic feelings and creativity. For example, participating in political advocacy online or writing a blog can fulfill these desires (Thielke et al., 2012.

The final model investigates four interconnected factors to transform rehabilitation, independent living, and foster healthy living through technology amongst seniors. The first factor derives from manufacturers and developers of technologies. The evolutionary and sometimes revolutionary advances, like discrete alert sensors, touch screens and wearable sensors, increases effectiveness and opens new pathways for care. The second factor brings together rehabilitation outcomes with consumer centered care that promotes autonomy, competence, and social involvement. Focusing on the desire by many to remain in their homes, the third factor strives to tie together simple and advance technologies, smart home systems, and Telehealth services. Bringing these three factors together, longevity dividends refers to the personal health, social and relationship, and economic benefits from technologies that assist the impact from age related conditions despite living longer (Agostini, Winstein, & Bickmore, 2012). The main takeaway from this perspective is that adopting technology requires all four factors to work together to encourage aging in place.

These three models offer a different solution to evaluate and promote technology for aging in place. Healthcare professionals, caregivers, and consumers must comprehend that approaching this topic requires extensive knowledge on personal needs and desires, training and support, and motivating factors that encourages or blocks acceptance.

Communicating through Mobile and Online Services

While theories indicate that Millennials will always flock to social media over their lifespan ((Anderson & Rainie, 2010), an increasing number of seniors found their own niche within these networks. In a PEW survey, Duggan and Smith (2013) found that 71% of online adults use Facebook, while 45% of online seniors reported sharing on Facebook, a increase of 10% over a year. Interestingly enough, LinkedIn is the only social networking site where those 50 years and older outnumber the millennials (Duggan & Smith, 2013). From these findings, platforms, like Facebook, will become the mixing pot for all generations, while professional and organizational social media services will draw those who invested much of their personal time and identities into their careers.

What drives an older adult towards any form of social networking is the desire to remain connected with family or belonging to a group (Thielke et al., 2012). Maintaining these relationships, albeit digital ones, shown numerous positive effects ranging from an increase in activeness to avoiding social isolation (Mitzner et al., 2010). However, these health factors are not sufficient enough to keep people returning. What keeps people returning to online communities is a sense of entertainment and belonging (Deng, 2013). Two forms of online communications that promote these feelings occur when seniors discuss and learn about their disabilities or engage with political activism.

For seniors with age-related disabilities, an online identity has two distinct benefits outside of efforts to remain connected with family. First, societal perceptions of physical visible disabilities disappear as interactions key in on thoughts rather than physical attributes (Lustig & Olson, 2013), as a sense of anonymity forms. Secondly, email and social networking helps seniors learn and adopt post-modern views of disablement like affirmative and social disability models (Darling, 2010). Through these views of disablement, older adults feel empowered to direct their own medical care and understand that the environment creates the barriers that confines them (Darling, 2010; Putnam, 2005). Processing this information and accepting ones disability has the potential to dramatically increase the morale and wellbeing of a senior who might be limited to their home.

Skimming over ones timeline on Facebook or Twitter during election years, one notices a dramatic increase in politically inspired commentary. While political activism is more frequent amongst younger adults, seniors also partake, especially when attitudes reside along more extreme conservative or liberal ideologies (Rainie et al., 2012). When these pursuits enhance belonging or altruistic feelings, an older adult demonstrates the willingness to embrace social media to achieve personal goals.

Technologies Impacting Health and Wellbeing

Before blindly rushing to obtain technological solutions for aging in place, a thorough assessment of positive and negative impacts on health and wellbeing needs to occur. Increasing surgical outcomes and healthy living, reducing cognitive decline, and developing rapport through technologies stimulate willingness to purchase technologies. However, social and cultural concerns, feelings of dependency, and being bombarded by multiple alerts counter these gains. This next section will elaborate how wearable fitness trackers, online games and services, social media alerts, and Artificial Intelligence (A.I.) navigate through such measures.

Wearable fitness and health devices exploded onto the technology scene over the last year. This partially stems from the ability to sync these devices with computers and Electronic Health Records (EHR) and increase in cosmetic appeal. Scientific research and personal blogs have explored the benefits for integrating wireless activity trackers in settings like post-surgical care to home environments. Cook et al. (2013) touted the perks of a Fitbit sensor to observe the number of steps older patients take immediately preceding surgery, where movement is essential to discharge planning and recovery. Once a senior returns home, reviewing Senior Guide Online (2014) summary on the top ten fitness trackers may encourage them to purchase a similar device their healthcare team promoted during rehab. If successful, one may feel motivated, like Crump’s (2014), blog post on how adopting activity trackers will reverse his lifestyle that led him to being morbidly obese.

Social and cultural constructs stand in the way for wide spread adoption for wearable technologies. The underlining system behind Fitbit and Nike Fuel products is the ability to share your progress, spurring competition. Older adults indicated a concern that this would interrupt social connections and establish a fitness hierarchy. This works against relationship building endeavors of social media services (Thielke et al., 2012). A second barrier for wearables enters from cultural beliefs by traditional Koreans. Death while sleeping customarily is perceived as good luck and participants felt that the sleep tracker might diminish this outcome (Peek et al., 2014). Both of these concepts appear within the previously discussed models of adoption under the categories for personal perceptions. To overcome these stigmas, education and advertisement must expunge these detrimental thoughts, and highlight culturally sensitive inclusion paradigms.

Despite political advocacy groups targeting games as disruptive and harmful or spending too much time Googling as addictive, these guilty pleasures started to produce positive health outcomes. Games that require self-directed switching between various sub goals tend to increase speed in task switching, increased working memory, and raised intelligent measures (Waterston, 2011). Small et al. found a remarkable difference in executive functioning of older adults who were experienced internet searchers versus novice web surfers (2009). The executive functioning of the brain consists of energizing, task setting, and monitoring roles (Waterston, 2011). Just based on regular video gaming and internet browsing, aging adults will improve their ability to devise and monitor tasks, which declines over time (Mitzner et al., 2010; Small et al., 2009; Waterston, 2011).

Enhancing executive functioning may become necessary for older adults to decipher the flood of alerts and notifications digital lifestyles bombard users with. While social media services, texting, and mobile communication platforms provided individuals with ways of communicating in drastically different manners than in the past, Skeptics cite several different concerns. These include potential cognitive deficits related to being bombarded by alerts, impacts on literacy skills due to writing in “textese,” and the potential for addiction. With every new email message, liked comment, retweet, and text message, a corresponding alert ascertains ones attention. This forces the brain to cypher between each distraction while maintaining cognizant with the initial task (Waterston, 2011). Based on the individual and the potential for dementia, these distractions decrease productivity by elevating confusion while the brain determines the source.

Siri, Cortana, and GoogleNow represents cutting edge personal digital assistance solutions with a diverse range of functions from creating reminders, sending messages, and controlling smart home systems. While they are not classified as A.I., they create the foundational trust future A.I. systems will build upon. These complex systems started to surface in the literature promoting wellbeing amongst seniors. Thielke et al. (2013) mentioned a study where severely cognitively impaired older adults achieved personal needs related to belonging after being introduced to robotic animals that responded back. Differently, Bickmore’s team discovered that patients responded very favorably and expressed feelings of ease, when addressing an A.I. with humanistic characteristics, while being discharged from the hospital. He further noted that patients felt more willing to ask embarrassing personal questions that retained to their condition (Agostini, Winstein, & Bickmore, 2012). These A.I. systems will continue to grow in popularity with the adoption of smart phones by seniors and medical centers rely on such items in Telehealth services.

Telehealth Centered Healthcare and Smart Home Technologies

The Office of the National Coordinator for Health Information Technology defined Telehealth services as an array of “electronic information and telecommunication technologies,” that delivers clinical services, consumer and professional healthcare training, and personal and public health administration. Often this is confused with telemedicine, which only includes clinical and therapeutic interventions. Regardless, both rely on video conferencing, EHR, high speed internet networks, and other technologies that connect healthcare professionals and consumers (HealthIT.gov, N.D.).

Since the inception of Telehealth nearly 40 years ago, technological infrastructures, legal and privacy regulations, financial, and administrative policies prevented its growth ((LeRouge & Garfield, 2013). Two examples illustrate that despite these concerns, Telehealth can still be executed. These examples includes the findings from a research study by the Department of Veterans Affairs (VA) and Mayo Health Clinic’s integration of mainstream platforms. Both of these demonstrate efficacious care, ease of use, and financially affordable solutions.

The VA implemented and researched the U.S. largest enterprise-based community Telehealth care services for older Veterans with multiple chronic conditions. Over a four year period, the VA gathered enough supporting evidence to declare that Telehealth services can provide these high risk patients with sufficient care to remain in their homes. Additionally, the Telehealth program noticed a 25% decrease in bed days of care, and 19% less hospitalizations amongst participants (Darkins et al., 2008). As a caveat, the generalizability is limited, with 95% of participants being male (Darkins et al., 2008), and the funding mechanisms governing VA care compared to privatized healthcare systems (Lustig & Olson, 2013). Despite these limitations, the study sets precedents for adoption and future investigations.

In order to replicate the VA’s Telehealth program, several parameters must be met. The fundamental tools involves transferable EHR’s, networking infrastructure between medical centers and consumer’s home monitoring equipment, web based portals to access healthcare information securely, and faith in the system (Lustig & Olson, 2013). The Mayo Health Clinic attempted to achieve each of these goals. Alongside the launch of iOS 8, Mayo released an application that syncs with Apple’s HealthKit, the individual’s primary care team, EHR, and any paired sensor or wearable health device. The final outcome from these relationships involves realtime monitoring of vitals and activity by the healthcare team, quick and efficient communications between consumer and their clinic, and the ability to collect a host of data to make informed decisions (Carr, 2014). This capability meets the desire of many seniors and caregivers looking for mainstream products to track health goals and seamlessly works with healthcare professionals. The accessibility and activity tracking features simply serves as a bonus for adoption.

The biggest barrier for medical centers to rely on Telehealth services comes from variations with medical insurance coverage. MEDICARE restricts Telehealth services to patients whose providers reside in areas deemed a “health professional shortage area” (Health Resources and Services Administration, N.D.). From this ruling, many privatized insurance companies erected similar reimbursable guidelines. The cause for this is how Telehealth remains separate or as an experimental project, instead of existing as an aspect of healthcare services (LeRouge & Garfield, 2013).

With many seniors possessing minimal if any computer knowledge, Telehealth services must incorporate training for seniors to be successful. Two methods to achieve this goal is to implement the Telehealth kiosk within senior centers or conduct video and telephonic training sessions. Resnick et al. )2012) employed kiosks located within senior living centers. Their findings indicate that seniors and staff fully adhered to the Telehealth regime to manage blood pressure. Additionally, seniors reported a willingness to share this information within their social networks. The Telephonic and video conferencing training program received similar responses (Lai, Kaufman, & Starren, 2006). Regardless of the training, older adults will require additional time and approach before they integrate Telehealth services.

Supporting the Telehealth initiatives are a range of technologies that are grouped under the category of smart home technologies. Most predominate are stations that gather vitals, sensors that detect falls, and medicine management protocols. In order to be successful, smart homes will have to meet the demands of three individuals, the end user, caregivers and healthcare professionals, and politicians and insurance companies (Reeder, 2013). During a pilot study, participants stated that they desired their smart home to assist with preventing falls, assist with hearing and visual impairments, improve mobility, reduce isolation, manage medications, and monitor health and fitness goals (Demiris et al., 2004). . Counteracting these includes concerns from seniors for ease of use and training, devices that were not aesthetically appealing, Affordable, and stigmatizing (Chan, 2009). Caregivers and healthcare professionals desire smart home systems that enable them to receive realtime updates on the status of the individual and communicate through video, voice, or text channels. Finally, politicians and insurance companies require proof that smart homes are an evidence-based treatment modality, reduce hospitalizations, and more cost effective than nursing home placement (Reeder, 2013).

Recommendations for Encouraging Technology’s Adoption

“The Prime Directive” provides the Star Trek universe with a code of ethics whenever approaching technologically inferior beings and cultures. This principal prevents one from imposing their own views upon other lifeforms (“Prime Directive,” 2014). It’s through these concept medical providers, caregivers, researchers, manufacturers, and others must approach those individuals who have yet to incorporate the digital lifestyle.

Simply mandating or prescribing a device without addressing ones needs and desires, only hinders the adoption process. Four points must be addressed when discussions around technology transpires. These include Lack of information and training, financial costs, regulatory concerns, and fear managing the change (Thielke et al., 2012).

Watching commercials, product advertisements showcase the multitude of features that separates their products from others. Many of these features appear complex to seasoned users, thus creating feelings of uncertainty by seniors who never touched the gadget before. To reduce unnecessary stress navigating these features, universal design practices with older adults and disabled populations in mind must lead development efforts. Next involves easy to access community based technical support and other marketing strategies that promotes awareness (Tobias, 2003). The support bars at Apple Stores and Best Buy showcases this consumer centered model, by erecting a safe zone to ask any questions and receive hands on assistance (Lustig & Olson, 2013).

Related to cognition, social media created a host of distractions one must deal with either through cultural shifts or legislative processes. An example of this is the recent adoption of no texting or even holding a mobile device while driving. These trends must change as younger generations who grew up with these distractions may prefer a technological solution to maintaining the connectivity without missing the alerts (Waterston, 2011).

Conclusion

Steve Saling enthusiastically is quoted, “until medicine proves otherwise, technology is the cure, (Ferrell, 2014).” While this statement might be congruent with those where technology perforated every aspect of life, the baby boomers and their parents approach such interventions slowly, if not cautiously. In order to empower these older generations to incorporate technologies in their plans to age in place, a multi facet approach needs to account for barriers related to individual perceptions and societal stigmas, lack of community based training and technical support, cost, and complex interfaces. Despite this hurdles, technology today offers many benefits, regardless if it is low or high tech. The wide range of new adaptive aids, assistive technologies, and mainstream devices and services enhances the quality of life, even for seniors with multiple disabilities.

Recommendations for Future Research

Future research will need to examine technological adoption and usage across the lifespan. The current cohort of 50 to 64 year olds witnessed the business world’s evolution from reliance on paper and landline phone calls to emails and video conferencing. This generation may unlock new paradigms for the adoption of technological solutions (O’Keeffe, 2014) as age related conditions being to limit their capabilities. These findings will pave the way for learning how future generations may incorporate technologies within aging in place goals.

Secondly, this evaluation failed to locate research and recommendations for aging with severe disabilities. Most articles examined standard age related conditions, like cognition, visual impairments, hearing, and motor, but searching Google Scholar and Psychology and Behavioral Sciences Collection failed to locate research that examines technological adoption amongst seniors who were blind, deaf, blind and deaf, or even developmentally disabled. Medical science has enabled these populations to live beyond advance ages, and possess different values and goals in order to age in place.

Finally, new typing languages, like “textese,” emoticons, and stickers, create new language and sentence rules for communicating through Twitter, Facebook, and text messages. Kemp’s (2011) study disproved the myth that “textese” negatively impacts literacy skills amongst high school and college students, but he concluded by stating the need for follow-up researchers to analyze changing in behaviors with “textese” and literacy skills over the lifespan. Similarly, research needs to examine how seniors fair with learning these new written languages and literacy affects, especially amongst those with cognitive impairments. Powering this research is the need for inter-generational conversations through these networks.

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