: What Can Learn from the Literature Lois Frankel, IDSA, Concordia University and Carleton University Diane Bisson, University of Montreal

Introduction

This paper focuses on the challenges the elderly have in relation to , in view of sensory decline and increasing physical and cognitive limitations. It also provides an overview of relevant academic literature on research and the transforming physical and mental processes that affect the experience of everyday life and daily interactions for the elderly. In particular, it probes more deeply into age-related research in the social sciences, especially in the area of cultural anthropology. The paper builds on the area of focusing on older people. It is and has been referred to as , , transgenerational design, rehabilitation design, and user pyramid design (Benktzon, 1993; Coleman, Bendixen, & Tahkokallio, 2003; Connell et al., 1997; Keates & Clarkson, 2003; Pirkl, 1994; Vanderheiden, 2007). Each of these various themes has involved a functional approach to design to ensure a ‘good fit’ between people, and the objects, the environments and the services they engage with to complete their tasks. The paper looks into academic perspectives on socio- cultural considerations that might influence the design of technology enabled interactive products.

Background

Frequent improvements in technology (Bohn, Coroama, Mattern, & Rohs, 2004; Hirsch et al., 2000; Ostlund, 2007), and the escalating technical complexities of everyday life (Dourish, 2004; Hirsch et al., 2000; Tenner, 1996; Varela, Thompson, & Rosch, 1993) are challenging for older people (Coleman, 2003; Coughlin, 2007). In the Western world, research indicates that this may especially be the case for the very old, where technology advances seem to ‘fly in the face of’ sensory decline and increasing physical and cognitive limitations (Czaja et al., 2006; Forchhammer, 2006).

There is extensive and valuable design literature documenting academic research related to making homes, computers, vehicles, and public spaces more accessible for the older and/or disabled user (Bauer, Streefkerk, & Varick, 2005; Bennett, 2007; Clarkson, Coleman, Keates, & Lebbon, 2003; Clarkson, Langdon, & Robinson, 2006; Coughlin, 2007; Czaja et al., 2006; Dorsey, 1997; Fisk & Rogers, 1997; Forchhammer, 2006; Forlizzi, 2005; Hirsch et al., 2000; Mann, 2005; McCarthy, 2005; Norman, 2002; Pirkl, 1994; Wright, 2004). Most of this literature focuses on human factors requirements for physical mobility and computer use, and much less on subjective experience requirements (Hirsch et al., 2000). It is also limited by its primary concentration on low technology aids for daily living rather than on high technology interactive systems such as wearable computing devices.

Social science literature about the shifting physical and mental characteristics of aging and provides valuable insight into the cognitive and bodily changes that contribute to the subjective of the elder population (Cunningham-Burley, Nettleton, & Watson, 1998; Goffman, 1959, 1963; Sherman, 1991; Strickler & Neafsey, 2002; Stuart-Hamilton, 1991; Williams, Nettleton, & Watson, 1998). This literature seems to support the notion that the perceived quality of an older person’s life corresponds directly to his or her altered mental and physical capabilities in particular ways that design might be able to accommodate (Bowling, Seetai, Morris, & Ebrahim, 2007; Ostlund, 2007). In addition, studies in the field of cultural anthropology shed light on the subjective views of aging adults in relation to the artifacts, clothing, environments, and social interactions in their daily lives (Ballard, Elston, & Gabe, 2005; Bytheway & Johnson, 1998; Featherstone, 1991; Hecht, 2001; Miller, 2001, 2005; Rabinow, 2003; Twigg, 2007).

Mental and Physical Characteristics of Old Age

The elderly have traditionally been seen as retaining their wisdom (crystallized intelligence) while losing their wits (fluid intelligence) (Stuart-Hamilton, 1991). Fluid intelligence refers to functions that require processing novel information and concurrently dealing with other complexities that “require the rapid assimilation of new information” (Huppert, 2003; Salthouse, 1992). Huppert explains that the decline in fluid intelligence can present problems with speed-related or complex information processing, such as in computer games. On the other hand, according to Huppert, crystallized intelligence remains relatively stable and data collected over a long time such as knowledge of facts and strategies remains easily accessible to the older person.

Both Huppert and Stuart-Hamilton quote the oft-used expression, “My memory is not what it used to be” and confirm it as true. While it is easier to remember things that require less processing load, there are certain tasks “with which older individuals have particular difficulty [such as] remembering context and remembering to carry out an intended action” (Huppert, 2003; Stuart-Hamilton, 1991).

Aging changes the playing field, according to Dr. Edmund Sherman. He explains that as people perceive themselves aging or changing, they focus more inwardly “so as to minimize stress, conserve ego energy, and ensure a better ‘fit’ or balance of self with environmental factors.” In other words, they begin to slowly accept that they cannot remake the world to fit them better, and so begin to think about how to better fit into the world as they are. A simple outward acknowledgment of the process might be getting (and wearing) a hearing aid (Sherman, 1991).

A tendency to withdraw or feel stigmatized by being different was identified by sociologist Irving Goffman in his seminal work entitled Stigma: Notes on the Management of Spoiled Identity (Goffman, 1963). This is a key finding for designers. For example, one of the most frequent findings in the literature is the seemingly paradoxical information that many elders will not use assistive devices even if they need to because they do not want to rely on a device that “makes them feel embarrassed or incapable” and “they will do this even at the expense of independence or social interaction” (Hirsch et al., 2000) .

The literature confirms that cognitive decline and sensory decline go hand in hand in old age, affecting all of the sense organs and resulting in deficiencies in processing incoming sensory information (Glass, 2007; Huppert, 2003). Age-related physiological changes lead to a decline in people’s ability to see detail, to focus on near-objects, to discriminate differences between levels of contrast, to adapt to changes in brightness, and manage in extremely bright or dim light, as well as to differentiate color vision and depth (Huppert, 2003). While 75 percent of older people need spectacles, “many will not have full vision even with this aid” (Stuart-Hamilton, 1991).

Aging is also related to a gradual decline in hearing that could “have an effect on the ability to interpret and respond to complex auditory information” (Pattison & Stedmon, 2006a, 2006b). Stuart-Hamilton paints a picture of the elderly person who, ‘hard of hearing,’ withdraws into “submission and silence rather than risk the anger or ridicule of normally hearing individuals.” As a person ages there is also “ a reduced ability to differentiate between shapes and textures by touch” and to perceive high frequency vibrations (Huppert, 2003).

Quality of life for a very old person is highly individualized, and changes from day to day as a person’s capabilities change (Hirsch et al., 2000). The senses and cognitive functions do not operate solely and independently. According to Dietmar Winkler:

Homo sapien does not experience the world through just seeing, hearing, or speaking. The body with its total sensing apparatus assesses the environmental conditions on a cathectic basis (that is, intuitive, emotional, uninformed judgment) feel good or feel bad, adumbration, making benefit or loss assessments, adjusting and readjusting … .What is clear is that for the sake of survival what one sense cannot apprehend another must, even if the brain has to abstract the experience and translate it through another sense’s memories (Winkler, 2002).

This challenge underscores the need to design for multimodal sensory experiences: one that is minimally addressed in the design literature. There is a need for more research into the complexity of multimodal features that include older adults and facilitate their ability to use the multi-modalities of interactive products.

In Designing for Older Users , Felicia Huppert provides an excellent overview of physical and sensory changes in old age and suggests design criteria that address issues in on-screen computer environments, as well as in physical environments (Huppert, 2003). Much of the available information related to the elderly and technology is related to computer use, primarily web site use, and secondarily to the use of technology-enabled products for medical and work applications. In addition, it is mostly focused on physical features that affect the design of assistive products in the home as seen in Smart Technology for Aging, Disability, and Independence edited by William C. Mann (Mann, 2005).

Computing/Technology Competence

Studies indicate that older adults are increasingly using technology, but their adoption rates are far less than those of younger people (Czaja et al., 2006). A number of factors negatively affect the adoption of technology, such as the complexity of the interaction, speed of the interaction, and lack of familiarity with the technology (Czaja et al., 2006; Salthouse, 1992). As technology becomes more integrated into everyday life, [elder] people with less use of technology are more likely to become more disenfranchised and disadvantaged (Czaja et al., 2006) .

The literature indicates that elder users are highly receptive to new technology if it “fulfills a perceived need” (Bauer et al., 2005). Researchers are beginning to identify emotional needs as worthy of design consideration in addition to the more traditional human factors needs like design specifications that provide better visual acuity or longer cognitive processing times. For example, Bauer et al. point out that geriatric psychiatrists have identified “a need for products and services that provide comfort, communication and companionship for seniors” (Bauer et al., 2005). In fact, the need to maintain contact with others to combat loneliness comes up in other literature as a motivation for using technology (Caprani, Dwyer, Harrison, & O'Brien, 2005; Mann, 2005; Sherwood, Mintz, & Vomela, 2005). Another international study demonstrated the value of communication to maintaining relationships, but noted that ‘presence’ overrides the importance of communication. The report states, “most of the current are made for direct communication and it looks like there is a clear opportunity for a subtle and elegant way to create presence between elderly and their often distant family” (Rose & Vinay, 2007).

Going back to Goffman, one is reminded that a person with a stigma, such as the inability to recall friends’ names or incontinence problems, may shy away from contact with others rather than break the social consensus of normality (Goffman, 1963). The literature also indicates that such behavior isolates the older person from the world, which is experienced as a loss, adding to lack of self-esteem (Hirsch et al., 2000; O'Connor et al., 2007). Elders with dementia also make efforts to preserve their self-image in activities that enable them to remember people, tasks, things, situations, places and other significant things (O'Connor et al., 2007). Remembering is showing up as an important activity for maintaining a positive self-image.

Research Considerations

It seems obvious that increased involvement of older people in the design research process would result in products that fit their needs, capabilities, and desires more closely. However, the literature shows that generally there is minimal consulting about opinions on consumer products, although sometimes there is active participation in research. In his article Why Involve Older People in Research, Alan Walker makes a case for the latter:

If researchers want to produce findings that might contribute to the quality of life of older people or the quality of the services or products they use, then it is essential to involve them so that they can contribute their own understandings about aging and service use which can often be far removed from those of scientists and service professionals. The well-documented partial and precarious take-up of assistive technologies is just one example of the inadequacy of attempts to involve older people in identifying needs and appropriate solutions (Walker, 2007).

Perhaps the needs that influence design solutions should be more than merely functional. For example, much of the literature emphasizes the role of treasured objects in linking the older person with feelings of comfort, safety, security and satisfaction (Hecht, 2001; Jordan, 2002; Sherman, 1991). Daniel Miller states that the fear of loss can accompany such an integral connection to an object to such a degree, “that to touch or do harm to these inanimate objects is considered indistinguishable from taking the same action against the person” (Miller, 1987).

Not unexpectedly, the literature also refers to the gender differences in the types of meanings associated with the “cherished object.” For example, men identify with personal performance and activity related objects and women with objects that symbolize relationships (Malnar & Vodvarka, 2004; Sherman, 1991).

Conclusions

As older people’s capabilities change so do their perspectives about themselves, their social relationships, and the things in their lives. There is a feeling of loss, not just of bodily capability, but also, with declining memory, of past experience. Sensorial experiences are also in flux in old age; with the potential for technology enhanced products to support sensory experience and add meaning to an elder’s self-image.

This paper has provided an overview of the challenges the very old have in relation to technology that have been addressed in academic research for the purpose of adding to the criteria that are so well documented in existing design literature. The escalating technical complexities of daily life are intensified by the escalating mental, physical, and cognitive complexities of aging. Changing fluid intelligence and stable crystallized intelligence must both be treated as important design criteria. These cognitive factors have an effect on complexity and speed of the interaction, and lack of familiarity with the technology as well as steps to complete tasks. Sensory factors such as visual and auditory limitations have been addressed in the human factors literature, but there is a need for more research according to experts from the Canadian National Institute of the Blind (Marjeram & Herie, 2005). Screen-based design has benefited from human factors guidelines about vision and hearing, but physical computing products, such as cell phones, mp3 players, and other related personal devices have more complex requirements. There is much opportunity for design research in addressing the sensory challenges for very old users.

Other areas for potential research include multimodal interaction in technology-enabled . This is important for the older person, as one sense often takes a more prominent role when another one declines. These changing sensory modalities can either contribute to feelings of stigmatization and withdrawal if poorly addressed in design solutions, or eliminate them if well addressed. Filling a perceived need can make all the difference in older users receptivity to technology.

One strategy for fulfilling the perceived needs of older users is to involve older users earlier and throughout the design research process. The perceived quality of an older person’s life corresponds directly to his or her altered mental and physical capabilities in particular ways that design might be able to accommodate. For example, the very old contributors to a design research study are likely to be more empathetic to issues such as criteria for products that support ‘remembering’ and help maintain contact with family and friends. Sociocultural concerns such as these have been well researched as the reference list demonstrates. This paper has begun to identify the opportunities to build bridges between the established design research about the very old and the existing sociocultural research. The goal is to identify and address the challenges very old people have in relation to technology, in view of sensory decline and increasing physical and cognitive limitations.

References

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