ABSTRACT

The world’s population is aging. Current societal approaches, such as assisted living, fall short of meeting the needs of this aging population on a number of accounts. Not only do aging adults prefer to remain in their own homes, aging in place is important for social and cognitive reasons. There are a host of issues that threaten a person’s ability to remain in the family home. While many of these issues have been adequately addressed from a clinical, physical and medical perspective, there remain a number of issues that are principally social in nature that should be addressed from a social perspective. Our view is that technology in the home, which is intended to support aging in place, should address these principally social issues.

INTRODUCTION

The world’s population is aging, and this aging will have far ranging social, emotional and financial effects. Soon there will be an unprecedented percentage of the population past retirement age. One of the prominent issues facing this aging population is that of where to live as they age. Maintaining independence and remaining in one’s own home is the preferred choice for a great majority, but this choice must be weighed against both perceived and real issues of safety. The desire of older adults to remain in the familiar setting of their family home frequently must be balanced with their extended family's desire to keep them safe. Clearly this balance becomes more precarious as age increases (Naleppa, 1996). If safety can be reasonably assured then remaining in the family home would likely result in a greater quality of life. While moving to some form of assisted living can more reasonably assure safety, there are quality of life concerns that must be considered in addition to the massive financial commitment required by such a choice.

Current societal practices are inadequate for an aging population

Current societal approaches to dealing with an aging population (assisted living is one example) fall short on a number of accounts. Assisted living facilities are prohibitively expensive for the majority of the population while living in one’s own home has definite financial advantages even for those that can afford to move. Data from a study in the United Kingdom suggest that private residential living costs only 55% of the cost of full-time residential care (reviewed in Tang & Venables, 2000). Also associated with the change to institutional living is a “profound sense of loss” (Mynatt et. al., 2001) which arises partially from institutional rules that have a powerful impact on a resident’s quality of life. For example, pets are generally prohibited, as are overnight stays by grandchildren. At a time when mental capabilities are declining, a move to unfamiliar surroundings deprives older adults of critical environmental reminders of who they are, what they do and how they do it that are provided by those familiar surroundings.

The family home is especially important to an aging population.

Research has shown that older adults prefer to remain in their own homes for as long as they are able to take care of themselves (e.g., AARP, 2000; Shafer, 2000). Given this preference and the financial advantages, being allowed to age in place has, from a societal perspective, additional cognitive, social and emotional advantages.

There are definite cognitive advantages to remaining in familiar surroundings as one ages. Unfamiliar surroundings can confound the normal mental changes associated with aging. While it is true that the structural aspects of memory gradually decline with age, it is not true that older people are less likely to be able to remember to do a particular thing at a particular time (Hertzog & Hultsch, 2000). This seemingly contradictory statement is explained by understanding that older people realize that their memories are not infallible and therefore engage in compensatory behavior that supports memory. One of these compensatory behaviors involves the use of environmental reminders placed in strategic places in the home. For example, if Mom sits in the same chair in the morning, placing the phone by that chair reminds her that she should call her daughter in the morning to check in. If one is removed from these strategic places, unfamiliar surroundings can damage an aging person’s ability to remember.

Long standing social connections to church and community would be broken by a move out of the neighborhood. At a time when aging adults are vulnerable, having suffered a “profound sense of loss” associated with moving from the family home, the aging adult is left with the task of developing new social connections in unfamiliar surroundings with people of unfamiliar backgrounds.

DESIGNING TECHNOLOGY TO ADDRESS SOCIAL CONCERNS

There are a host of issues that threaten a person’s ability to remain in the family home. While many of these issues have been adequately addressed from a clinical, physical and medical perspective, there are a number of issues that are principally social in nature and should be addressed from a social perspective. These issues include communication, awareness, privacy and self-representation. Our view is that technology should address the key issues in aging in place that have this strong social component: peace of mind for extended family members, social isolation from grandchildren, and socially appropriate self-presentation of medical reminder aids.

Peace of Mind

Extended families are no longer co-located and members of an extended family no longer remain in the same community all their lives. By denying the casual daily contact that would naturally occur when families are co-located, the geographic distance between extended family members makes casual, lightweight observation or “keeping an eye out” for family members impossible. (Mynatt, Rowan, Craighill, & Jacobs, 2001). Technology that reconnects geographically distant extended family members by allowing them to remain aware of each other in a non-obtrusive, lightweight manner can provide the peace of mind required allowing aging family members to age in place.

Cross-Generation Communication

One function historically performed by aging adults (grandparents) in an extended family is that of the care and nurturing of grandchildren. Clearly, geographical distance disrupts all forms of this function. Technological support that reconnects the grandchildren and the grandparents can not only restore this historically significant function and therefore be of benefit to both parties, it can also address issues of social isolation.

Symbols of Identify and Infirmity

The home is not only a personal, private space it is also a performance stage onto which neighbors and friends are invited. Technology for use in the home should therefore also address the self-representational needs of the aging adult by being designed to preserve dignity and self-respect while providing the necessary support.

METHODS FOR EFFECTIVE HOME DESIGN

While in our research we grapple with a host of challenges, from working with cutting-edge technology to designing interfaces useable by senior adults, in this workshop we would like to exchange ideas regarding methods for designing home technologies. For example, some of the issues that we must address are:

How to combine laboratory and field methods? When possible, we would like to use laboratory evaluation methods to pinpoint usability concerns taking advantage of the carefully controlled setting of the laboratory. For example, while designing the digital family portrait, we used laboratory studies to validate the sizes of various icons. However it is difficult to assess the usefulness of new technologies in the laboratory and focused experiments do a poor job at simulating casual daily use of home technologies.
How to simulate long-term deployment? Ideally we are interested in deploying our technologies and understanding their long-term use. For example, would our designs enable people to stay in their homes for years longer than expected? However, in our field, such evaluations are rare and costly. We are interested in the experiences of other researchers as they also grapple with understanding the strengths and limitations of learning from short-term field trials of home technologies.
How to recognize and represent the power relationships of family stakeholders? The eventual acceptance of new home technologies depends on more than their overall usability and usefulness. The shifting family dynamics that surround the aging of senior adults creates complex relationships among the key stakeholders. For example, although an adult child may embrace a new technology due to its utility, the older adult due to privacy or self-presentation concerns may circumvent the goal of the technology. Alternatively concepts accepted by older adults may be rejected by their children. These relationships do not mirror hierarchical work constructs, but are much less clear-cut and can vacillate over time.

REFERENCES

AARP (2000). Fixing to stay: A national survey on housing and home modification issues - Executive summary. Washington DC: American Association of Retired Persons.

Hertzog, Christopher, & Hultsch, David F., (2000). Metacognition in Adult and Old Age. In F. I. M. Craik and T. A. Salthouse (Eds.), The handbook of aging and cognition (second edition, pp. 417-466). Mahwah, NJ: Erlbaum.

Mynatt, E.D., Rowan, J., Craighill, S., & Jacobs, A. (2001). Digital family portraits: Providing peace of mind for extended family members. Proceedings of the 2001 ACM Conference on Human Factors in Computing Systems (CHI 2001), 333-340.

Naleppa, M. J. (1996). Families and the institutionalized elderly. Journal of Gerontological Social Work, 27, 87-111.

Shafer, R. (2000). Housing America’s Seniors. Executive Summary. Cambridge, MA. Joint Center for Housing Studies, Harvard University.

Tang, P., & Venables, T. (2000). ‘Smart’ homes and telecare for independent living. Journal of Telemedicine and Telecare, 6, 8-14.