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BOOK REVIEW |
SPRY Foundation 10 G St. NE, Suite 600 Washington, DC 20002
Gerotechnology: Research and Practice in Technology and Aging, edited by David C. Burdick and Sunkyo Kwon. Springer Publishing Company, New York, 2004, 269 pp., $48.95 (cloth).
Impact of Technology on Successful Aging, edited by Neil Charness and K. Warner Schaie. Springer Publishing Company, New York, 2003, 352 pp., $49.95 (cloth).
Technology for Adaptive Aging, edited by Richard W. Pew and Susan B. Van Hemel. National Academies Press, Washington, DC, 2004, 320 pp., $49.00 (paper).
Overview
Two of the most significant global phenomena occurring in the 21st Century are widespread population aging and the rapid diffusion of technology. This is an exciting time for creative research on the relationships of these two dynamics. They are at the heart of the three books reviewed in this essay. All of us in the field of aging, and particularly those involved in research, need to understand and interpret the impact of the technology movement on our own research and professional work. The rapid advancements in computer-based technology in particular are having a profound impact on almost every aspect of aging. For example, this technology is altering the ways in which patients, their caregivers, and health providers interact and make decisions—a social revolution energized by technology. These three publications help provide us with the baseline knowledge of what is currently known in the field of technology and aging, and they also help us look into the immediate future.
Given the current state of flux in technology research the reader can easily become lost or at the least confused in reading these volumes if they are not conscious that two types of technology tend to dominate the current level of research discussion: computer-based technology and personal assistive technology. And, as both of these areas progress, there are now examples of where these two are becoming integrated, such as robotics. Often the research language flows in and out of these two areas and does not distinguish between them. However, you, as the reader and interpreter of these ideas, need to keep alert to the two different but complementary concepts.
The three publications focus on many of the same or similar themes, and a number of the authors overlap, in part indicating the newness of this field of work and also because earlier research work and methods are now being adapted to work in this new field. For anyone just entering the area of technology and aging, these three books provide a primer, both on research methodologies and on their application.
Gerotechnology is a new term. As suggested by David C. Burdick and Sunkyo Kwon, the editors of Gerotechnology: Research and Practice in Technology and Aging, in this fast moving field many ideas and terms either become obsolete or morph into next generation terminology. What is more important is that technology in today's society can contribute to productivity, intellectual work, comfort, and safety, all of which are matters of concern to older Americans. Technological innovation, the editors of this volume say, has inevitably and irretrievably altered the course of human lives. They also note that technology has led to increased sensitivity to the humanitarian aspects of science and technology in terms of their responsibilities to human existence and the environment. They speculate, for example, that the future association between humans and machines may well be in the form of a partnership. And, that the reciprocal relationship between technology and aging provides both challenges and opportunities. For example, they suggest that the lack of "fit" between the person and the environment is particularly striking in the world of the older woman and has resulted in premature aging and the escalation of disease states.
The five major themes in Gerotechnology provide an updated review of gerontology and its relationships to usability and design. The volume also covers application of computer-based technology for older adults in both communication as well as assistive technology, incorporating some current models and prototype applications. And it ends up with a discussion of ethical and other issues of concern for the consumer.
Impact of Technology on Successful Aging, edited by Neil Charness and K. Warner Schaie, two prominent researchers in the field of aging, represents the 14th volume in a series, based on working conferences. The three main themes of this book are presented with a strong psychological perspective and place heavy emphasis on human factors and cognitive impact. The early chapters discuss technology design, age-related deficits in sensory and cognitive functioning, and their relationship to applying working principles of human factors techniques and considerations. We are reminded that most of the advanced software and hardware design today is being done by younger professionals, many of whom need to be more sensitive and incorporate the concepts of human factors as they develop new products for use by an aging population. The authors point out that technology is becoming blended into everyday services—including banking, health, transportation, and communications—all of which affect our aging population. Because the goal of gerotechnology is to help older persons to remain independent and to retain their self-respect and ability to continue to learn and inquire, human factors must be integrated into the project design environment. In this context, the authors remind us of the everyday impact of technology over the ages and that it not only has a personal and family effect but a community, national, and global impact. For example, they note the profound impact on society, and particularly older adults, of the radio, television, washing machine, air conditioner, microwave, cell phone, and now the personal computer and Internet. In all of these examples, technology interfaces with aspects of aging in many ways. It helps foster fun in a person's daily life and provides further engagement with society, either directly through new forms of interaction or as a result of increasing an individual's "free" time.
Technology for Adaptive Aging, edited by Richard W. Pew and Susan B. Van Hemel, is the result of a National Academy of Sciences project commissioned by the National Institute on Aging. The goal of the project was to improve the quality of Small Business Innovation Research (SBIR) proposals in the area of technology and aging as they apply to people who develop disabilities and impairments in old age and those who do not. The conference targeted six potential areas of impact: communication, employment, health, learning, living environment, and transportation. However, as the editors note, the original goal of this project was not met. (Perhaps in the future such initiatives might involve as lead partners the U.S. Chamber of Commerce, the Conference Board, or similar business groups that are focused on the SBIR marketplace goals.) The first part of the book resulting from this conference presents a review of current research methods in aging and their application to technology-related projects. The remainder of the book is a basic primer that focuses on various aspects of the application of technology, mostly computer-based, in the six areas noted above.
Perhaps this book, more so than the other two, exemplifies some of the problems in today's research on aging that tries to focus on the impact of technology. There are enormous opportunities to capitalize on the research interests of complementary sectors that have interests and skills in applying technology to aging problems, but these are being held back by traditionalism in aging research domains. Increased subspecialization and a lack of management mechanisms to coordinate the old and new components of research have often resulted in the status quo instead of new collaboration. The fact that technology is changing so rapidly means that nearly every aspect of aging will be impacted now and certainly more so in the future. The gerontological research community has yet to adapt itself to this new environment so it can be an effective player.
Understanding the Context of Technology and Aging: "The Silver Tsunami"
We are reminded nearly every day that our society is changing, and this in turn is impacting how we age. We are increasingly becoming an ownership society that clearly stipulates individuals are responsible for their own futures. To be successful as we age in this changing environment we need to develop an informed and proactive citizenry.
During the time these three books were being written, several private foundations were exploring the extent to which older Americans have become involved in computer and Internet-based technology and what impact this has had on their lives. In her 2004 report, Susannah Fox (2004), director of research of the Pew Internet and American Life project, noted that the percentage of seniors (persons aged 65 and older) who go online has jumped by 47% between 2000 and 2004. In 2000 about 60% of these "wired" seniors were men, and about 40% were women. However, in an exciting change, by February 2004 gender participation had become equal. In another study conducted by the Kaiser Family Foundation, Victoria Rideout and Tricia Neuman (2005) note that there is still much to be done based on the fact that less than one third of all seniors have ever gone online, and fewer than half have ever used a computer. They also report that there is a digital divide among seniors using computers and the Internet that is based on income, education, age, and gender. Nevertheless, they also note that during the next 10 years, as the baby boomers get older, the proportion of seniors using the Internet will increase dramatically. Health is one of the key Internet search areas for today's older adults, and keeping in touch via e-mail is also a major area of usage.
These observations provide important insights into the impact of the increased involvement of computer-based technology in the field of aging. The rapidly changing demographics illustrate some of the potentially difficult policy issues that will impact the future research in this field.
Who Are the Targets of Studies and Interventions?
One of the key research concerns in this field deals with who are the targets for study and interventions. In each of the books there is discussion about older adults and the very old. For some working in the field, people beyond 85 years, described as the oldest-old, are a frequent target. Others clearly break the cohorts into two categories: those who are the young-old (65 to 75 years) and the old-old (75 years and older). This division works fine at the moment while we are in the midst of the demographic transition, but authors of many of the articles as well as those of the demographic reports note that the future generation of older adults will clearly be more computer literate and dependent on this technology for many of their daily life activities, and it is not clear how this will impact longevity. This may present a complication in the future in comparison studies.
A related issue is that of technophobia of older adults now and how it will play out in future cohorts, as soon as 5 years from now. Some of the researchers believe that it should be no surprise that older adults take more time to adjust and adopt this new computer-based technology and that as the newer populations age, this will be an issue that will not be as prevalent. Others note that technology is in constant change and that there will always be a learning curve for the older population. From this perspective, some groups, such as the Setting Priorities for Retirement Years (SPRY) Foundation (2005), have been working with older adults and middle school children to explore the effects of their learning new information together, as pairs, and how such learning might be facilitated by computer-based technology.
Broadening the Research Agenda
It is clear from the authors' presentations in these books that in dealing with traditional aging research issues, such as cognition, we really do not know what role, for example, access to a computer or the Internet has, either positive or negative, on learning new information, enhancing memory, decision-making skills, and problem solving. This will become even more complex as virtual learning becomes more prominent with older populations. Furthermore, when research into these areas is completed, findings need to be conveyed to technology experts so they can be incorporated in the next generation of hardware and software.
Pushing the boundaries, for example, is the research work currently underway designed to help stroke victims in reconstructing mobility and speech processes which relates to cognitive and sensory motor interactions. Complex algorithms are being designed to reconstruct these processes, and this research work is pushing the entire field of aging and technology into the area of artificial intelligence (Cole & Sutton, 1998).
Research in the field of technology and aging therefore needs to focus on multi-levels. But it is the macro-level that provides relationships with policy, and will enable researchers in the field of aging to apply their greatest input into the future design process.
Design Concerns for Older Adults
Perhaps one of the most pervasive and consistent concepts integrated into each of these publications is the importance of human factors techniques and considerations. The authors note that in order for older adults to benefit from advances that technology brings, but not be harmed by potential for technological failures, we must ensure that systems are designed with the capabilities and limitations of the older user in mind, provide proper training, and consider the needs of the older user in the development of future technologies. It is further pointed out that a central factor in abandonment of new assistive technology development is the lack of consumer involvement in the design and delivery process. This is particularly true for new technologies designed for older adults ranging from grab bars in bathtubs to computer-based automated medicine reminder systems.
As a result of the lack of consumer involvement, some authors point out that, in their view, technology has diminished social interaction of older persons with service providers and perhaps with family members, as well. Moreover, it is suggested that technological determinism has frequently driven rather than responded to the needs of the consumer—in essence, making the consumer adapt to the technology.
The emphasis on human factors considerations brings out the tension in this field between gerontological researchers and manufacturers. The former are seeing an opportunity to construct technological sophistication that can greatly augment the adaptability and functionality of the older adult, while the latter are viewing the cost of developing a safe device and its potential market value. This is particularly apparent in the assistive technology field, where new technologies enable older adults to compensate for impairments and continue to age in place in their community. However, the development costs can be so expensive to prohibit mass production without guaranteed sales potential.
Creating Motivation and Demand
One of the key research challenges in this field is getting older adults, family caregivers, and those intermediaries who work with them to understand that adoption of this new technology will help improve their lives, be cost effective, and will help increase personal control over their decision making. But this goal requires translating the new technology into potential benefits that are meaningful to the target population. Little research is currently directed to this agenda, particularly the value and cost-savings aspects.
There is great debate in this field surrounding a number of items that are considered barriers. It is noted, for example, that availability of new technology is not synonymous with accessibility and usage. There are examples where computers have been purchased and are still in their boxes or not set up in local senior facilities for a variety of reasons. It is generally believed by those involved in manufacturing new computer equipment that older adults, because they often have fewer financial resources or have older children with computers, will hold back on purchasing new computer equipment and software or acquiring basic training. As a result, there are very few companies who see a market in developing computers that are user friendly for older adults. This presents a significant challenge to researchers in gerotechnology who are eager to see their evidence translated. Nongovernmental groups, such as Generations On-Line, CyberSeniors, SeniorNet, and AARP, as well as government-sponsored programs, are reaching out to older persons to provide basic computer and Internet training. Once the individual has acquired these skills, he or she can then become linked into the vast network of resources available. The fact that the Internet is available 24/7 means that anyone can find a time to access information and contacts at their convenience and often within the privacy of the home. Once these values begin to be realized, an important step toward greater adoption of the technology is achieved, thus demonstrating the fusion of scientific theory and practice and its potential to enhance the quality of life as we age.
A barrier frequently noted is lack of access to broadband by older Americans (Adler, 2005). This is especially critical if older adults are to access any of the new information on line that enables them to use activities such as on-line banking, view travelogues, or become an interactive participant in health discussions. WiFi and other innovative approaches to provide free or community Internet access are being pioneered by entrepreneurs and increasingly by many local communities around the country. This has become a good example of how exposure of nonaging researchers to an aging sector problem results in reaching across disciplines and motivating other researchers to take on a broader societal cause.
Another barrier identified by the authors is the lack of involvement of older women in the Internet. Yet, as the Pew survey noted, this is quickly becoming equalized, especially as newer cohorts of older women near retirement age are much more familiar with the Internet often because it was part of their previous work experience. Many older women have the additional burden of not having been involved much in science education as part of their earlier formal educational experience. Recognizing that nearly 90% of our learning in life occurs through informal learning approaches, researchers developing new technology training programs for older women must be particularly sensitive to these background issues (Falk & Dierking, 2002). The National 4-H Clubs, for example, have become involved in this agenda and teamed school children with older adults to help provide a supportive computer and Internet training environment. This program has proved to be most successful and has now branched out across the country (National 4-H Web, 2005).
Ethics and Privacy
Authors in all three of the books reviewed in this essay are concerned about the ethical and privacy issues that can arise from increased interaction between technology and aging. One of their key interests is the relationship of increasing use and design of technology and its impact on the individual and society with regard to the process of life-span development and active aging in particular. This is an area of research that has not received widespread attention, and, as noted, "a comprehensive theoretical approach for understanding the dynamic relationship between secular changes in society and technology, on one hand, and human aging, on the other, is still to be developed."
Another ethical issue of concern that is not well defined, perhaps for obvious political reasons, is the issue of how much researchers should invest in developing computer-based technology solutions that are designed for the very old. Should software and hardware be modified to accommodate the needs of very old individuals, many of whom are not familiar with computer technology? This needs to be differentiated from usage of assistive technology that may not require extensive cognitive input but indeed may need physical input from older adults to operate effectively. Almost by default, it appears that the computer-based technology research community has de facto determined it is not a wise investment and instead moved on to the younger generation of family caregivers, focusing attention on how they can help their older parents with the use and application of this type of computer-based technology.
There are, of course, the mainstream ethical issues of privacy and confidentiality of information, but these issues are ubiquitous to the entire population using computer-based technology for banking, health, and other daily activities. Most recently this has become an issue in the health sector with regard to the promotion and implementation of electronic personal health records (e.g., Medinotes, 2005). The Centers for Medicare and Medicaid Services (CMS) and other government agencies are now aggressively promoting the use of such approaches in their drive to improve quality and reduce costs (e.g., CMS, 2005a). How well older Americans will respond is yet to be determined, but the value of potentially reducing medical errors and allowing an individual's medical record to be portable will, for many older adults and their family members, be a reasonable trade-off for the potential of possible invasions of privacy and confidentiality.
One omission in all three of these books is the lack of attention to the application of new technology to the increasing diversity of our aging population, particularly to individuals who have low incomes and comparatively little education or who belong to ethnic minorities with special cultural backgrounds. The field of gerotechnology frequently refers to the digital divide, most often meaning the divide between older adults and the younger population as computer users. However, the uniqueness of technology, and particularly the application of technology for information and communication, is that it provides a bridge for people of all social and economic backgrounds to access parts of the world they might not have ever known existed. Thus by opening up these new opportunities, technology plays a significant role in society by helping to equalize the opportunities for personal growth and decision making throughout the life span, including opportunities for seniors who are limited in their activities of daily living. Clearly, more research work needs to be done in this area, with the goal of using technology to bridge the socioeconomic digital divide.
Another related ethical issue is the policy of providing old, used computers to old people. Many believe that unless these older computers can be modified to use the new user-friendly software and access broadband Internet such an approach is a disservice to older adults by preventing them access to new, user-friendly technology products and services that can improve their lives.
Some researchers also have ethical concerns that older adults may be more vulnerable, for multiple reasons, to fraud and misinformation because of their increased exposure to such activities online. In this area, one of the unique transitions occurring in the field of communication technology and aging is the role of government in becoming the most valid source of quality information. Nonprofit groups, such as the SPRY Foundation (2001), have focused on this issue, providing guidance to seniors on how to determine what is quality information. Many government Web sites have now become the gold standard. For example, in the health sector, the National Institutes of Health (2005) and the U.S. National Library of Medicine (2005) have developed two specialized Web sites for older adults and family caregivers, as well as professionals who work with them. Similarly, CMS (2005b) has developed its own specialized Web site for providing information on the quality of nursing homes. Groups such as Consumer Reports and AARP have recently entered this research area and begun a process of assessing the quality of specific Web sites in both the public and private domains (Chisnell & Redish, 2005).
Impact on Society
Perhaps a point that all three publications make, but not in an explicit way, is that when technology is made available to older adults it is a way of changing how they relate to themselves, their families, and society and how their families and society can relate to them. As a mechanism of social change, both computer-based technology and assistive technology are unique instruments that produce important social benefits. Although some have charged that computer-based technology may diminish social isolation, there are others who see just the opposite—how this technology enables individuals to renew or develop new relationships with their family and establish a new circle of friends with common interests. Such networks can be made in their community, as well as globally. This empowerment of individuals to determine what they would like to do to enhance their lives is one of the key social impacts of this computer-based technology.
The authors in these volumes also point to the impact of new technology on the older adult's environment. A critical step taken in this direction is the work being done in a variety of settings around the United States in the development of smart homes (Stelluto, 2004). Using a combination of building materials to provide adequate lighting, sensory devices to monitor movement and functional status, and computer-based technology to assist older adults in communicating with the world outside their home, these structures are a precursor to the future development of housing for older adults. For older adults, these applications of technology will help them continue to live independently, as well as maintain their personal integrity and creativity and at the same time continue their relationships within their community. They also present, however, a number of ethical concerns, such as privacy when older adults are monitored with 24-hour video cameras.
Clearly, the applications of computer-based technology and caregiving for older adults are rapidly expanding fields and of interest to the government and nonprofit and for-profit communities (see Hudson, 2004). And, although each of these sectors has a similar goal—improving the quality of life of older adults—each also has a different strategy for using technology to achieve that end. And all of these approaches mentioned previously are in a transition based on current research outcomes. Other new challenges will continue to arise to push the boundaries. For example, will the new "Cash and Counseling" approach to create consumer control of family caregiving financially support the use of technology as part of the caregiving process? Here again, important ethical and social issues arise, such as the discussion in the field of aging regarding human support systems versus technological support systems for home-based caregiving. With a limited number of persons, even neighbors, willing or able to help, the technological alternative (i.e., robot) may be a better choice (if not, perhaps, the only choice) for many older adults in our community.
Finally, as several authors in these books have noted, this technological revolution is having a positive impact on the way older, mature workers can continue to participate in the labor force beyond normal retirement age. Not only is it providing more sophisticated interactive on-line learning that can be specifically tailored to older adult learning approaches, but technology translates work into telecommuting, accommodating a range of disabilities and impairments and, of course, impacting traditional accounting practices regarding the interpretation of office hours and traditional retirement.
Future Directions
There are several important issues for the immediate future of technology and aging. Above all, we as researchers and professionals must not be of the belief that the digital divide is an impenetrable barrier. We must find innovate ways to solve or go around this barrier. One of the more exciting possibilities to help conquer this challenge is free broadband access in communities, particularly for low-income, high-risk older adults. The U.S. Department of Housing and Urban Development and other government agencies, for example, have been cooperating with local senior housing organizations to set up model programs with total broadband access in each apartment in the housing unit and a computer training facility on site. Complementing this is the push to develop a wireless society. Many cell phone manufacturers are promoting this agenda and are researching the integration of cell phones with health monitoring devices that can be completely portable. This technology, combined with the establishment of electronic personal health records, will provide the aging and caregiving community with an entirely new set of tools to both manage diseases more effectively and access and reinforce techniques to establish preventive health strategies, ranging from immunization to pharmaceutical compliance, to adopting new behavior models to help prevent hypertension and high blood pressure on a personal "virtual coaching" basis. As is noted by one of the authors in Gerotechnology, "the virtual love permitted by the sensory feats of cybersex may well have dire consequences for human demography. The computer and Internet, in this sense, can be regarded as a universal condom" (p. 252).
Pushing the research agenda even further is the work being done to link artificial intelligence and robotics. "Pearl," a 4.5-foot robot designed by the University of Pittsburgh and Carnegie Mellon University, can provide human-like facial expressions and voice responses and assist older persons in walking, much like a personal human assistant. "Kismet," a humanoid avatar designed by the Massachusetts Institute of Technology, has become one of the first robotic social agents, responding to interactive questions. "NeCoRo" is the robotic cat that has body movements similar to a real cat in responding to human voice, movement, and touch. It has been used as a mental health robot in research with Alzheimer's patients (see Libin & Libin, 2004).
Other research in this area needs to explore whether using variations in computer-based technology affects cognition levels in older adults. Recognizing that there is now a better understanding of how older adults learn, based on understanding brain plasticity and response mechanism, researchers are beginning to ask: What role can technology play in helping to reverse or stop decline in memory and other aspects of learning for older adults? This work has particular relevance to early diagnosed Alzheimer's patients.
Unfortunately, little research work has been done to determine if new advances in computer technology or virtual environments can help in either preventing or alleviating certain mental health problems that occur as people advance in age. For example, could electronic games developed for older adults or new types of interactive networking either between individuals or with members of their community help address symptoms that are precursors to development of depression in older adults or help reduce the level of depression?
Each new generation in our society will be involved in creating new types of technology to improve the overall quality of peoples' lives. This in turn will place a "technology lag" on the older generations who will need to learn how to adopt this technology into their lives. Perhaps one of the most positive social aspects of the current development of computer-based technology is that it has been an opportunity to build new relationships between the generations. Today, intergenerational learning is becoming much more accepted and developed as a way to increase learning capacity for both youth and older adults. This intergenerational approach also provides a better understanding of the strengths and needs of society in a much more purposeful and supportive manner. Computer-based technology has the ability to present this type of information in a creative and compelling manner. And this understanding of societal issues can then be translated into important intergenerational policy and political power directed toward improvement of society as a whole. Extrapolating this concept further, these intergenerational relationships not only help individuals make better decisions for themselves and their communities, but also to become more sensitive to and participate in the understanding of national and global issues as concerned members of a civil society. Underneath this social change process, computer-based technology has been and will continue to be the driving force.
Technology will continue to move forward, and we do not know where it will venture next in helping improve our lives. However, as our society ages, we all have the opportunity to benefit from these new advances. This is the great challenge to us as researchers in the field of aging.
Postscript
Computer-based technology can help research in the field of aging become more effective. Gerontology has become increasingly specialized during the last several decades as more needs and issues are realized that will impact the quality of life of older adults. As this review of technology and aging has clearly demonstrated, there is now an even larger interdisciplinary approach in which architecture, engineering, finance, medicine, public health, and other specialty disciplines will be intersecting more with traditional disciplines that study aging. As more emphasis is placed on research that translates new basic scientific evidence into practical applications to help improve the quality of life for older individuals and/or communities, there is also a need to establish new management mechanisms to maximize the excellence of these different areas of expertise. Since today these loci of expertise are often located around the country, computer-based technology can play an important role in this management process. Government and private sources have the opportunity to begin developing the nonprofit expertise in this management role, which has traditionally been allocated to consulting firms. The nonprofits have the necessary ongoing personal links with the community and older Americans and their family members. Thus, when discussing the translation of evidence-based findings to individuals, families, and communities so they can make informed choices, a first major step in the achievement of this goal should be the identification of key nongovernmental groups and their use of computer-based technologies to facilitate brokering this new information in a cost-effective way. The research community would then have established channels to share its evidence-based findings with all of society and, in a more direct and more concrete way, help improve the lives of all older Americans.
References
This article has been cited by other articles:
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  E. Hanson, L. Magnusson, H. Arvidsson, A. Claesson, J. Keady, and M. Nolan Working together with persons with early stage dementia and their family members to design a user-friendly technology-based support service Dementia, August 1, 2007; 6(3): 411 - 434. [Abstract] [PDF]
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
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