Can assistive technology be a support to community living?
“Why are people afraid of getting older? You feel wiser. You feel more mature. You feel like you know yourself better. You would trade that for softer skin? Not me!”— Anna Kournikova, professional tennis player
Community living and assistive technology continue to be interconnected in the technologically focused world that we live in. In this blog module, we will analyze this interconnection, by exploring theories associated with aging and assistive technology (devices that “maintain or improve an individual’s functioning, well-being”) (World Health Organization [WHO], 2015). We will discuss how capacity (Iancu & Iancu, 2017), can affect the use of these technologies in our aging communities, how assistive technology can support the issue of aging in place, while bringing individuals together and mitigating social isolation. We will examine this and the new technological world available to support caregivers, families and patients to answer the question, “Can assistive technology be a support to community living?”
Older adult individuals with deficiencies associated with aging and illness (e.g. stroke, chronic disease) can experience functional decline, which decreases their ability to impact and stimulate their environment, and limits competency in an array of settings. (Segal et al., 2018, p. 396). Restrictions result as life spaces and optimal environments shrink in size, with advancing frailty, and age-related problems like fatigue, mobility and sensation impairments (Segal et al., 2018, p. 396).
Community settings can be key targets for technology as can caregivers and individuals with and without mental illness and aging impairments. When these elements of a community are targeted, technology can help elders to stay in an atmosphere that helps them to achieve maximum interdependence (Horgas & Abowd, 2004). Technology that targets caregivers can also help care providers with practical care in community settings and can facilitate communication and interactions that promote effective support (Segal et al., 2018, p. 197).
Although the continuum of the older adult living environment runs the gamut from independent living to long term care, for simplicity, this blog will highlight older adults who are living independently or with assistance in their own homes.
Theories and their connections to community living
The Cognitive Behavioural theory of mental illness connects to community living, because it helps us understand thoughts, emotions and behaviours that contribute to the resistance of technology that can improve the experience of community living (González-Prendes & Resko, 2012). Cognitions and behaviours can encourage actions of active participation with assistive technology, and perceptions of increased self esteem and worth within a community (González-Prendes & Resko, 2012). How we think about issues of community living and associated issues of aging and/or mental health, can also be altered with cognitive behavioural therapy. New thinking and behaviour can be reinforced with technology that identifies current behaviour patterns and malleable variables of the situational environment (Horgan, 2020).
Cognitive Behavioural therapy could also teach older adults cognitive reframing strategies, to adjust emotions and behaviours tied to mental health disorders (PTSD and depression). This would then allow older adults to see community living situations as modifiable (González-Prendes & Resko, 2012). Assistive technology can be developed to improve mood, enhance behaviour patterns, and maximize quality of life within situations of community living (Horgan, 2020). Theory presents technology as a tool to meet the needs of an aging, and it can help us to understand why there is an increased need for durable assistive devices of self care in today’s society (Iancu & Iancu, 2017).
Deficiencies associated with illnesses of aging (e.g. stroke, chronic disease) can impair the older adults ability to stimulate their environment, and limits competency in an array of settings. (Segal et al., 2018, p. 396). Restrictions result as life spaces and optimal environments shrink in size, with advancing frailty, and age-related problems like fatigue, mobility and sensation impairments (Segal et al., 2018, p. 396).
The social exchange theory posits that for older adults with normal mental health declines and for those with mental health issues, successful aging is dependent on interdependent reciprocal relationships within a community environment (Stafford, 2008).
Social exchanges of tangible “(money, food)” and intangible “(social, emotional)”, activities and resources found within the older adults environment drive relationships of exchange within a community, and satisfy needs of self interest while influencing the development of continuing reciprocal exchanges (Stafford, 2008).
The theory believes that we, as a society, should be creating opportunities to maintain these interdependent relationships. I agree. I feel that technologies such smart assistive devices and the internet should be made accessible to all populations. Advertisements and cost savings to older adults should be promoted, as the inclusion of older adults in the world of technology will generate a more cohesive community. Access can strengthen social networks, and improve the overall community wellness (Stafford, 2008).
The social exchange theory does call into question power dynamics (i.e. how power affects a relationship) that are based on health disparities (Stafford, 2008) and social expectations (and the question, “what do we owe each other?”). Power dynamics effects are compounded with older adults within institutions, more so than older adults who live in the community and they are intensified by mental illness involvement (e.g. if the older adult suffers from depression) (Brosnan, 2012). Solutions must be found that optimize reciprocal interactions, and to effectively use the social exchange theory in practice (Brosnan, 2012).
Aging in Place and Universal Design
The majority of older adults do not wish to transition to an assisted care facility, different from their long term homes (Touhy et al., 2019, p. 460), as stereotypes of institutional settings include that views that they are dehumanizing places of social, structural and cultural isolation (WHO, 2015, p. 36). A common view of the home as a place of identity and security must be balanced against the view that advancing frailty makes home spaces less convenient and more dangerous (Segal et al., 2018, p. 397).
Segal et al. (2018) posits that older adults struggles with mental illness be weighed into the debate over whether or not the long-term existing home is the ideal space for the last decades of life. Segal et al. (2018) has proposed that mental health in later life can be enriched by any spaces that are constructed to be efficient, and supportive.
Aging in place could potentially enhance mental health, as an efficient and supportive action that supports older adults individual needs.
By exploring the concept of universal design (the idea of intergenerational/ accessible home for all (Tuohy et al., 2019)), we can also argue for aging in place. Aging in place with digital modifications that target individual needs (e.g. a wheelchair elevator at the entryway of a home (Hensrud, 2017)) can be a means to improvement of a community with universal design. The connection between aging in place and the devices of technology that can bring the dream of aging in place into fruition.
These assistive technologies (ATs) can improve daily functioning and quality of life in a variety of environments (Zanwar et al., 2020). Assistive home systems that use assistive technologies have been suggested to be cost-effective, as construction of a smart home can lead to increased quality of life, personal safety, perceptions of comfort and a desire to live in a community neighbourhood (Ferreira et al., 2017).
Even with the mainstream wish to stay within a familiar environment, aging in place without appropriate assistance can give rise to living situations of loneliness and social isolation (Zanwar et al., 2020).
Variable needs of the older adult population means that aging in place requires appropriate supports. (Touhy, 2019, p. 460). These supports should “provide the highest level of independence, function and comfort for the older person” (Touhy et al., 2019, p. 460). AT is used to maintain or improve functional capabilities of older adults with cognitive, physical or communication impairments associated with mental health or issues of aging (Sriram et al., 2020) with products such as talking clocks and door exit alarms (Sriram et al., 2020) that ease inevitable cognitive, physical and sensory declines (e.g. hand eye coordination, agility, and memory) (Iancu & Iancu, 2017).
Manifestations of memory loss – difﬁculty recognizing familiar people, and disorientation to time, space, and location” can also be prevented with technologies such as hearing aids, and image based electronic displays of personal schedules and the time. These devices support aging in place home designs for the cognitively impaired, and assistive electronic modifications like voice activated appliances can minimize physical deficiencies of age that impair fine motor functioning and manipulation of machines and standard home technologies (e.g. hot and cold taps).
(Dolby Professionals, 2020b) (Jackson, 2018)
Sensory enhancement modifications such as the Dolby® CaptiView enhances the closed captioning experience for the aging individual with hearing and/or visual impairment (Dolby Professionals, 2020a). An easy to read LED display with a flexible support arm that attaches to a seats cup holder, can be used at home or in a movie theater to provide closed captioning and an enhanced personal experience (Dolby Professionals, 2020a). These enhanced experiences can improve social interactions and encourage aging in place; as it lessened individual need for outside support (Dolby Professionals, 2020a).
Another assistive device that provides sensory assistance is the YOO.MEE LED thermometer shower heads. This device displays the water temperature in all levels of lighting.
Scolding from hot water is a problem and water temperatures can rise rapidly, I think everyone could benefit from one of these (EasyTech Seniors, 2020a).
If vision is an issue, there are also aging in place technologies that sense movement around important areas of your home. The toilet motion night light senses movement within the area around the toilet bowl and then illuminates the bowl so that you can clearly see where the object is, in the dark. The lit up area is incredibly useful, as it can prevent injury and promotes mobility, continence and confidence with an important ADL (EasyTech Seniors, 2020a).
Aging in Place technologies can be dual function tools of older adults as well. Touchless faucets and soap dispensers create an easier handwashing experience, and automatic toothpaste dispensers (yes they exist), can help the individual improve their oral hygiene routine and dental care (EasyTech Seniors, 2020a). In home elevators and adjustable raised countertops can also improve home accessibility and assist older adults with functional limitations that can arise with aging (Tuohy, 2019).
Yes, some of the monitoring, GPS, and video camera technologies can threaten the autonomy of older adults, and isolate the individual by restricting privacy and “freedom of movement”, however a person centered approach and case by case considerations, can minimize risk and increase independence in individuals that otherwise may not be able to be independent in their homes (e.g. those with dementia who may wander throughout the home) (WHO, 2015, p. 137).
Cognitive orthotics (technological support for cognitive aging), such as the COACH (cognitive orthosis for assisting activities in the home) is a system device that acts as assistive technology to an individual with mild cognitive impairment or mental illness associated cognitive disability (Horgas & Abowd, 2004). It does this by helping older adults perform ADL tasks (e.g. washing their hands) with verbal and visual reminders (Mihailidis et al., 2008). It was suggested to be a tool that reduced caregiver burden and a device that promoted user independence and less dependence on caregivers (Mihailidis et al., 2008).
The Dwell website integrates several essential assistive technologies with a daily routine so that you can get a cohesive understanding of how easy it is to integrate assistive technologies into community living (Tuohy, 2019). Click the link above and check it out! I will be showing this first video to my parents to show them how the simplest light sensors can prevent falls and can keep them in contact with the rest of the family for everyone’s peace of mind (Tuohy, 2019). It discusses how smart ovens can help older adults cook safe, nutritious meals independently, and how safety voice activated programs can connect us to loved ones and our communities to keep us in our homes for as long as possible (Tuohy, 2019).
Since social isolation is essentially the absence of fulfilling and quality relationships on an individual and societal level (Alspach, 2013), age-friendly environments should be encouraged, as they pave way for personal development and community contributions and relationships (World Health Organization [WHO], 2017). Age friendly environments can enhance ageing in place, with technologies that promote the continuation of employment (through online work) and volunteering. These technologies support integrated care, capacity building and can prevent social isolation (WHO, 2015, p. 136).
Creation of age-friendly environments will also cause a manifestation of an information platform that can improve information sharing (World Health Organization [WHO], 2020). Improved connections between families, older adults and caregivers promotes public participation and active partnership (Touhy et al., 2014, p. 7). AT can provide support and comfort to caregivers (Sriram et al., 2020), and access to technology can lead to greater social involvement that can motivate caregivers, to increase their self-esteem, life satisfaction and social interactions (Khosravi et al., 2016).
Social communication aids such as email, social media sites (facebook, snapchat) and on-line forums can also connect individuals and caregivers with skill building resources that promote social integration within the community (Khosravi et al., 2016). By improving the functioning, autonomy and social participation of seniors with community members, mobile applications that are matched with smart watches can also support social engagement (Hodge, 2019). The aids can also provide emotional support to caregivers and can improve reciprocal exchange between individuals with or without mental illness and caregivers or other community members. (Horgas & Abowd, 2004).
Social relationship groups such as Silver Sneakers (Segal et al., 2018, p. 415) prevent social isolation by encouraging interactions within an online community of older adults. Silver Sneakers has home work out videos, and the website has links to videos of motivation and encouragement that will leave you speechless.
If communities do not integrate seniors into communities with assistive technology, we will not have the benefit of the senior population’s knowledge and experience (Khosravi et al., 2016). These technologies can decrease loneliness, depression, and social isolation, and can cause emotional shifts (that follow the social cognitive behavioural theory), and prevent maladaptive cognitions and behaviours associated with social isolation. (Khosravi et al., 2016).
Promotion of the existence of these innovations is a first step to public interest in these new technologies (WHO, 2015, p. 137). Future technology development should address the changing needs of older adults and should tailor individualized support to those with and without mental health illnesses. Technology should also generate opportunities for continuing reciprocal exchanges within a larger aging population as “social isolation and loneliness dramatically affect older adults’ mental and physical health, and health technologies can play an important part in reducing the physical and emotional distance … between older people and their caregivers and other members of the community” (WHO, 2015, p. 111).
If you are interested in the research, I would like to mention that cognitive orthotics (technological support for cognitive aging), is a very promising direction for research that could potentially promote aging in place and active engagement (Horgas & Abowd, 2004). Better technology that prevents cognitive decline could maximize these technologies.
Our understanding of individual needs can be perfected with the promotion of opportunities and options that allow older adults and caregivers to better assess their level of functioning within their environment. Emerging devices such as wearable smart watches, cleaning robots, robotic pets, virtual social networks and aging in place technologies can facilitate communication and engagement, and lead to better assessments of functioning status, personal safety and of the surrounding environment (WHO, 2015, p. 111).
I believe that active participation and aging in place is enhanced and supported with assistive technology. There is a variety of internet resources, podcasts and smart technology services that can be explored through the links in this article. Hopefully this will help caregivers, older adults and interested care providers to find care solutions to improve the quality of life of those aging with and without mental health issues. Next, we will focus in on caregivers and how assistive technology can influence their role in care for older adults, as we continue our conversation about assistive technology and the aging population.
All the best,
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