Web Posted on: August 24, 1998

Assistive technology - the older people's perspective

Framework of presentation by Christine Marking, Eurolink Age

I Societal aspects in general

a. Demographic developments

Society is ageing. At the end of 1994 the EU comprised 70 million people over the age of 60. This represents almost 20 % of the total population, and projections indicate a situation whereby one quarter of the population will be over 60 by the year 2020. In several Member States general dependency rates will have almost doubled between 1980 and 2020.

Not only are older people making up an increasing percentage of the overall population. In addition, the number of people over 80 - particularly at risk of frailty and dependence- will increase even more. In this context, a 300% increase in the period from 1960 until 2020 is forecast. In addition, the family composition is changing. An increasing number of women is entering the labour market and family members are increasingly more widely dispersed. As a result, the burden on social protection and care systems is increasing dramatically.

b. Common societal issues in relation to older people:

1. general improvement of standard of living
2. persistency of low incomes and poverty among older people
3. inequalities in incomes between pensioners
4. new developments in pensions/social security policies
5. increasing number of older people living alone
6. poor housing conditions
7. family care on the decline
8. older population is ageing
9. negative stereotypes prevailing: positive role hardly recognised

c. Health and social services:

Most older people are living in fairly good health: at 60, women have on average 22.1 years ahead of them, with an average of 18.8 years for men. Most of these years are spent in reasonably good health, with plenty of possibilities to participate actively in all aspects of society. There are sizeable minorities, however, which vary around one quarter to about one third of those aged 70 and over who do require some sort of assistance. due to health problems or impairments. So, dependence on help and assistance increases sharply with age. Differences between Member States exist but the crucial findings remain clear: the proportion of severely incapacitated people is below 5 % in the age group 60 to 69, the proportion increases to around 30 % among those aged 80 and over (that means, however, that 70 % of this group is healthy and independent!).

The societal demand for care and assistance will continue to grow, as outlined above.
New services, new ways of offering services and different services and care structures are required.

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II Current policy priorities:

1. To contain the heavy growth in health expenditure
2. To develop specific policies for the rapidly growing group of older people
3. To provide adequate coverage of the growing need of long term care
4. To reorganise residential care
5. To introduce new incentives for development of community care and family care

Health expenditure is the most rapidly growing expenditure field in social policy since the beginning of the 60ies. All Member States are trying to rationalise thier expenditure in this area, but a number of economic as well as ethical questions need to be faced. Apart from this, it is obvious that the self-help potential of older people needs to be stimulated.

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III Needs of older people:

a. Age related needs:

Older people do not form a heterogeneous group. However, a few general statements can be made: ageing does tend to go hand in hand with a decrease in levels of functional ability. Also, older people tend to be prone to various role changes: retirement, interpersonal loss, becoming more dependent on other people etc.

b. Social needs:

Various theories exists, which contradict one another: disengagement theory, activity theory, continuity theory. Which one is true? In general, it can be said that there is a need for the individual to participate in society as well as a need for socio-emotional support - at any age.

c. Health needs:

The vast majority of older people reports good health. Professionals are often more negative about the individual's health than the individual - interestingly enough. Here the individual differences are enormous as well, but in general one can say that there is a general slowing down of bodily functions, a reduced capacity to respond to disease with advancing age and that many older people suffer multiple pathologies.

Main complaints: 'the geriatric giants': arthritis, cardio-vascular, hearing impairments, urinary incontinence, digestive complaints. So, there are needs for therapy and rehabilitation, needs to monitor and assess health, needs for services and needs for information. Rehabilitation is crucial, overcoming the consequences of illness and impairments.

d. ADL needs:

The level - or rather, experienced level- of functional ability is what counts, much more than the actual presence of illness or impairment. This will determine the types of assistance needed by older people in carrying out their activities of daily living. These activities are the primary activities aimed at fulfilling needs relating to personal care (such as nutrition) and secondary activities instrumental to sustaining these (such as shopping).

e. Security needs:

Feeling secure is a fundamental human need. In order to live a normal life, to actively participate and to remain integrated it is of crucial importance.

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IV Potential contribution of technology

Ideally, technology should offer support towards independence and choice. In older people both the need to compensate for impaired functioning as well as the need to fulfil the positive potential of the person are important.

There should be a fit between the needs of the older person in question and the technological possibilities on offer.

By making use of technological applications:

• quality of life should be improved
• a contribution to supporting independence should be made
• the capacity for older people to care for themselves better should be increased
• there should be better access to care from others, always keeping the specific and personal needs of the individual concerned in mind.

a. Opportunities:

Technological applications can

• bring out the positive resource of older people
• increase the possibilities for older people to live independently
• decrease the burden of care on both family and professional carers
• stimulate and facilitate integration and participation
• decrease the cost of care
• enhancing remaining capacities
• compensate for impaired functioning contribute towards the creation of an inclusive society

b. Risks:

• dehumanisation of care
• anonymous care
• too much focus on physical needs with too little attention for social/emotional needs
• ethical considerations (choice, privacy)
• addressing non-existent needs
• create needs

The range of relevant applications includes inter alia interpersonal communication, remote access to information and transactions, remote access to care and support, new forms of work and education and to services specifically designed to support accessibility.

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V The users themselves

Little is known about the usage of older people of assistive technologies. Older people themselves are slowly starting to realise that these applications can be of benefit to them.

Key words should be

• - user involvement
• - user needs and acceptance

For users, the famous 5 A's are important: accessibility, appropriateness, affordability, availability and awareness. Not to overlook 'anxiety' or 'attitude'. Developers of technology need to be aware of this - the gap between developers and end-users is very large still.

Family carers as end -users of assistive technologies is often overlooked. Community care is great in theory but incredibly difficult in practice, in need of lots of attention

User concerns:

1. Full participation
2. Support for independent living and integration into society
3. Anti-discrimination
4. Equal opportunities
5. Fighting (negative) stereotypes

Guiding principles:

• should aim to address real needs: market pull
• research into needs and requirements is badly needed
• research should involve users from the start
• redefine the concept of user involvement
• resources should be created for proper user involvement

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