The role of technology

In the future we can expect that technology will transform ageing and aged care just as it has done for other industries and other aspects of our lives. It will allow greater choice including remaining safe and healthy in our own homes and delaying or avoiding a move to institutional care, and choosing to remain socially connected and active.

Philipson & Roberts (2007) identified four key areas where digital technologies can be used to improve the lives of the aged, disabled and chronically ill. These include: self-management of health care in home settings with potential savings and other benefits; home automation, which will enhance security, safety and independence at home, and will help maintain quality of life and decrease the demand for carer support hours; communication technologies, which will provide important benefits for people whose mobility is limited, or who live alone; and finally, the various home automation and digital technologies can benefit the aged and the disabled, improving their quality of life by enhancing their independence. Technology has the potential to extend the physical independence of the aged, so they can stay for longer in their homes. It gives them a more dignified life, and it saves public and private money.

When we consider how pervasive computer controls are in modern cars or aircraft it is perhaps surprising that computer-aided technology is not already more readily available in our own homes. Cars commonly contain many intelligent controls for security, engines and braking. Displays can show global positioning, fuel consumption, distance calculation and can provide cameras or alerts to assist in reversing or parking. All doors can be locked remotely with a single press of a button and the car itself can turn off all interior and external lights. Much of the technology in cars has come from the highly sophisticated aviation industry.

There has also been increasing use of intelligent controls engineered into modern buildings. This includes smoke detectors linked to the building fire sprinkler systems. The elevators are often remotely monitored. Closed Circuit Television (CCTV) for security is ubiquitous in commercial and public places. The Department of Health in Queensland, Australia, has begun installing intelligent controls with remote monitoring for some of its hospitals. These control, for example, hot water systems that can monitor use and then reduce energy-consumption according to demand. Knowing the periods of peak demand allows scheduling the boilers to prepare in advance. These kinds of controls applied to heating, lighting, air-conditioning and other services can learn patterns of use and reduce energy consumption at quiet times and build up in preparation for periods of peak demand.

The use of technology within the home however is not so far advanced. Currently all doors, windows, curtains and light switches need to be operated individually. If we go out and forget to lock the doors there is no embedded intelligence that would recognise the house is vacant and turn off lights and lock doors in the way some modern cars can. Heating, lighting and air-conditioning systems cannot track the movements and numbers of people between rooms and ramp services up or down according to need.

Selection of assistive technologies

Whilst there are many examples of AT in use there is also a high rate of abandonment of existing AT (Reimer-Reiss & Wacker 2000). There is little research into the reasons for abandonment, however Reimer-Reiss and Wacker (2000) recommend that users be involved in any decisions on AT that they are expected to use. It will be important to learn from experiences in use of non-intelligent technologies in planning for the evaluation and adoption of intelligent AT. Issues to consider include: the availability of support for the technology; any stigma or embarrassment about its use; availability of people to respond to alerts such as a professional call centre or family carer; whether the potential user has been directly involved in the acquisition; whether it fits conveniently into the living arrangements of the user; and whether our care organisations are ready for the work practice and care model changes that may be necessary for adoption of the technology and realisation of the benefits. Older persons’ accommodation can be quite small and limit the introduction of, for example, lift chairs.

When considering the selection and implementation of AT one may be confronted by a plethora of vendor claims and glossy brochures for their products. To facilitate more judicious choices, particularly for care provider organisations, the following steps are suggested.

For the individual

Assistive technology products can support self-care, enable an individual to accomplish daily living tasks, assist them in communication, work or recreation activities and help them to achieve a level of independence that is necessary for them to remain outside of an institutional care environment.

There is growing evidence to show that supporting self-care leads to a number of positive outcomes:

Assistive technology can be useful for someone who is finding basic household chores difficult or impossible, or who is anxious about their ability to remember events and activities. It is also useful for family members who need to maintain regular contact to ‘monitor’ heath status, security and safety of the individual who is living alone.

Communication is particularly important for someone who has limited mobility, cognitive impairment or who lives a long way from family and/or friends. Assistive technology can provide many different ways for an individual to communicate, to maintain social networks, and to transmit and receive information. Family members and health professionals can monitor health and wellbeing daily and initiate intervention when necessary. Assistive technology can manage the risks associated with living alone as well as monitor lifestyle changes or changes in regular behaviour. Individuals report that they feel better because they can manage their symptoms and respond to changes with, for example, pain management, anxiety and depression.

The following vignettes provide examples of how AT devices can assist an individual who is living at home to manage their situation and monitor their health status.

Carers are usually partners or other family members. Their responsibilities for the dependent person can severely restrict their own activities. They may be unable to leave the dependent person alone if they are prone to wandering, falling or putting themselves at risk in other ways. As a consequence, they can become isolated. Carers often neglect their own nutritional needs and other aspects of their health as they may be too tired to prepare their own meals. They may also be at risk of injury through lifting the dependent person and assisting them in slippery areas like bathrooms.

Caring for someone with cognitive impairment can be particularly stressful. The need to give someone repeated reminders about activities of daily living (ADL) can be frustrating. The technology that can assist with providing reminders will never become stressed or frustrated. Carers can also use telehealth technology to assist in maintaining their own health as well as that of the person they are supporting.

Examples of AT that may assist the individual are outlined below.

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