Inclusion of Older Adults in the Research and Design of Digital Technology

Digital technology holds a promise to improve older adults’ well-being and promote ageing in place. However, there seems to be a discrepancy between digital technologies that are developed and what older adults actually want and need. Ageing is stereotypically framed as a problem needed to be fixed, and older adults are considered to be frail and incompetent. Not surprisingly, many of the technologies developed for the use of older adults focus on care. The exclusion of older adults from the research and design of digital technology is often based on such negative stereotypes. In this opinion article, we argue that the inclusion rather than exclusion of older adults in the design process and research of digital technology is essential if technology is to fulfill the promise of improving well-being. We emphasize why this is important while also providing guidelines, evidence from the literature, and examples on how to do so. We unequivocally state that designers and researchers should make every effort to ensure the involvement of older adults in the design process and research of digital technology. Based on this paper, we suggest that ageism in the design process of digital technology might play a role as a possible barrier of adopting technology.

[1]  S. Zwijsen,et al.  Ethics of using assistive technology in the care for community-dwelling elderly people: An overview of the literature , 2011, Aging & mental health.

[2]  Anna Essén,et al.  The two facets of electronic care surveillance: an exploration of the views of older people who live with monitoring devices. , 2008, Social science & medicine.

[3]  E. Loos,et al.  Visual Ageism in the Media , 2018 .

[4]  Ben J. A. Kröse,et al.  Assessing Acceptance of Assistive Social Agent Technology by Older Adults: the Almere Model , 2010, Int. J. Soc. Robotics.

[5]  L. Carstensen,et al.  Emotion Regulation and Aging. , 2007 .

[6]  Alan Walker,et al.  Why involve older people in research? , 2007, Age and ageing.

[7]  Jan van Dijk,et al.  The Digital Divide as a Complex and Dynamic Phenomenon , 2000, Inf. Soc..

[8]  B. Wellman,et al.  Dividing the Grey Divide: Deconstructing Myths About Older Adults’ Online Activities, Skills, and Attitudes , 2018, American Behavioral Scientist.

[9]  Tsipi Heart,et al.  Older adults: Are they ready to adopt health-related ICT? , 2013, Int. J. Medical Informatics.

[10]  Sylvia Rogers,et al.  Bridging the 21st Century Digital Divide , 2016 .

[11]  Pgs Paul Rutten,et al.  Ageing-in-place with the use of ambient intelligence technology: Perspectives of older users , 2011, Int. J. Medical Informatics.

[12]  J. Bargh,et al.  Automaticity of social behavior: direct effects of trait construct and stereotype-activation on action. , 1996, Journal of personality and social psychology.

[13]  Stefan Krumm,et al.  Ready to be a Silver Surfer? A Meta-analysis on the Relationship Between Chronological Age and Technology Acceptance , 2018, Comput. Hum. Behav..

[14]  D. Jeste,et al.  Enhancing Informed Consent for Research and Treatment , 2001, Neuropsychopharmacology.

[15]  A. Larsson,et al.  Researching Ageism in Health-Care and Long Term Care , 2018 .

[16]  A. Lowry,et al.  A systematic review of trends in the selective exclusion of older participant from randomised clinical trials. , 2017, Archives of gerontology and geriatrics.

[17]  E. Wouters,et al.  Perspectives of Stakeholders on Technology Use in the Care of Community-Living Older Adults with Dementia: A Systematic Literature Review , 2019, Healthcare.

[18]  K. Schwab The Fourth Industrial Revolution , 2013 .

[19]  Eveline Wouters,et al.  “Grandma, You Should Do It—It’s Cool” Older Adults and the Role of Family Members in Their Acceptance of Technology , 2015, International journal of environmental research and public health.

[20]  J. Delello,et al.  Reducing the Digital Divide , 2017, Journal of applied gerontology : the official journal of the Southern Gerontological Society.

[21]  Joost van Hoof,et al.  Factors influencing acceptance of technology for aging in place: A systematic review , 2014, Int. J. Medical Informatics.

[22]  C. Carpenter,et al.  Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities , 2017, Clinical gerontologist.

[23]  Elizabeth D. Mynatt,et al.  Developing technology to support the functional independence of older adults , 2001 .

[24]  M. Scherer,et al.  Assistive Technology Use and Stigma , 2004 .

[25]  P. Olivier,et al.  Keeping In Touch Everyday (KITE) project: developing assistive technologies with people with dementia and their carers to promote independence , 2009, International Psychogeriatrics.

[26]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[27]  Katie Brittain,et al.  Balancing rights and risks: Conflicting perspectives in the management of wandering in dementia , 2007 .

[28]  S. Borson,et al.  The Disappearing Subject: Exclusion of People with Cognitive Impairment and Dementia from Geriatrics Research , 2012, Journal of the American Geriatrics Society.

[29]  Arthur D. Fisk,et al.  Older adults talk technology: Technology usage and attitudes , 2010, Comput. Hum. Behav..

[30]  R. Petty,et al.  The effects of stereotype activation on behavior: a review of possible mechanisms. , 2001, Psychological bulletin.

[31]  E. Wouters,et al.  Sociodemographic Factors Influencing the Use of eHealth in People with Chronic Diseases , 2019, International journal of environmental research and public health.

[32]  Boaz M Ben-David,et al.  Effects of aging and noise on real-time spoken word recognition: evidence from eye movements. , 2011, Journal of speech, language, and hearing research : JSLHR.

[33]  J. Hughes,et al.  Electronic tagging of people with dementia who wander , 2002, BMJ : British Medical Journal.

[34]  Everett M. Rogers,et al.  The Digital Divide , 2001 .

[35]  S. Buttigieg,et al.  Technology implementation in delivery of healthcare to older people: how can the least voiced in society be heard? , 2018, Journal of Enabling Technologies.

[36]  Heather L. Urry,et al.  Emotion Regulation in Older Age , 2010 .

[37]  Yi-Ru Regina Chen,et al.  The Effect of Information Communication Technology Interventions on Reducing Social Isolation in the Elderly: A Systematic Review , 2016, Journal of medical Internet research.

[38]  J. Carmody,et al.  Barriers to Qualitative Dementia Research , 2015, Qualitative health research.

[39]  A. May,et al.  Towards digital inclusion - engaging older people in the 'digital world' , 2005 .

[40]  F. Jouen,et al.  “Are we ready for robots that care for us?” Attitudes and opinions of older adults toward socially assistive robots , 2015, Front. Aging Neurosci..

[41]  G. Nejat,et al.  Acceptance and Attitudes Toward a Human-like Socially Assistive Robot by Older Adults , 2014, Assistive technology : the official journal of RESNA.

[42]  Martha E. Pollack,et al.  Intelligent Technology for an Aging Population: The Use of AI to Assist Elders with Cognitive Impairment , 2005, AI Mag..

[43]  C. Tesch-Römer,et al.  Contemporary Perspectives on Ageism , 2018 .

[44]  Stephen Lindsay,et al.  Engaging older people using participatory design , 2012, CHI.

[45]  Boaz M. Ben-David,et al.  A Sensory Origin for Color-Word Stroop Effects in Aging: A Meta-Analysis , 2009, Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition.

[46]  Louis Neven,et al.  'But obviously not for me': robots, laboratories and the defiant identity of elder test users. , 2010, Sociology of health & illness.

[47]  I. Riphagen,et al.  Ethical and practical concerns of surveillance technologies in residential care for people with dementia or intellectual disabilities: an overview of the literature , 2010, International Psychogeriatrics.

[48]  M. Grypdonck,et al.  Living with early-stage dementia: a review of qualitative studies. , 2006, Journal of advanced nursing.

[49]  B. Levy Improving memory in old age through implicit self-stereotyping. , 1996, Journal of personality and social psychology.

[50]  B. Schneider,et al.  Implications of perceptual deterioration for cognitive aging research. , 2000 .

[51]  N. Charness,et al.  Factors Predicting the Use of Technology: Findings From the Center for Research and Education on Aging and Technology Enhancement (CREATE) , 2006 .

[52]  M. Nolan,et al.  Ethical and Methodological Issues in Interviewing Persons With Dementia , 2007, Nursing ethics.

[53]  C. E. Oude Weernink,et al.  Real-Time Location Systems for Asset Management in Nursing Homes: An Explorative Study of Ethical Aspects , 2018, Inf..

[54]  M. Skubic,et al.  Findings from a participatory evaluation of a smart home application for older adults. , 2008, Technology and health care : official journal of the European Society for Engineering and Medicine.

[55]  Arthur D. Fisk,et al.  Designing for Older Adults: Principles and Creative Human Factors Approaches , 2004 .

[56]  B. Klimova,et al.  The use of ICT devices by older people with a special focus on their type and respondents’ age: A Czech case study , 2017 .

[57]  Sara J. Czaja,et al.  The Potential Role of Technology in Supporting Older Adults , 2017 .

[58]  Carol C. McDonough,et al.  HSOA Journal of Gerontology & Geriatric Medicine , 2022 .

[59]  Beatrix Vereijken,et al.  Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy , 2016, Int. J. Medical Informatics.

[60]  D. Abrams,et al.  An age apart: the effects of intergenerational contact and stereotype threat on performance and intergroup bias. , 2006, Psychology and aging.

[61]  K. Walsh,et al.  Social exclusion of older persons : a scoping review and conceptual 3 framework 4 , 2018 .

[62]  Ian Hughes,et al.  Internet Use and Loneliness in Older Adults , 2008, Cyberpsychology Behav. Soc. Netw..

[63]  Anna Strömberg,et al.  Exergaming in older adults: A scoping review and implementation potential for patients with heart failure , 2013, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[64]  John C. McCarthy,et al.  The Value of Experience-Centred Design Approaches in Dementia Research Contexts , 2017, CHI.

[65]  James Flory,et al.  Interventions to improve research participants' understanding in informed consent for research: a systematic review. , 2004, JAMA.

[66]  S. Czaja,et al.  Advancing the Aging and Technology Agenda in Gerontology. , 2015, The Gerontologist.

[67]  Trisha Greenhalgh,et al.  What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare. , 2013, Social science & medicine.

[68]  Myra A Aud,et al.  Dangerous wandering: Elopements of older adults with dementia from long-term care facilities , 2004, American journal of Alzheimer's disease and other dementias.

[69]  W. Tadd,et al.  Unjustified exclusion of elderly people from studies submitted to research ethics committee for approval: descriptive study , 2000, BMJ : British Medical Journal.

[70]  Owen Johnson,et al.  Digital circles of support: Meeting the information needs of older people , 2009, Comput. Hum. Behav..

[71]  S. Holm Autonomy, authenticity, or best interest: Everyday decision-making and persons with dementia , 2001, Medicine, health care, and philosophy.

[72]  Richard Schulz,et al.  Disability, Age, and Informational Privacy Attitudes in Quality of Life Technology Applications: Results from a National Web Survey , 2009, TACC.

[73]  Elizabeth A. Yost,et al.  Getting Grandma Online: Are Tablets the Answer for Increasing Digital Inclusion for Older Adults in the U.S.? , 2015, Educational gerontology.

[74]  G. Bugeja,et al.  Exclusion of elderly people from clinical research: a descriptive study of published reports , 1997, BMJ.

[75]  E. Palmore,et al.  The ageism survey: first findings. , 2001, The Gerontologist.

[76]  Michael I. Norton,et al.  This Old Stereotype: The Pervasiveness and Persistence of the Elderly Stereotype , 2005 .

[77]  Jacob O. Wobbrock,et al.  In the shadow of misperception: assistive technology use and social interactions , 2011, CHI.

[78]  Stephen J. Cutler,et al.  Ageism and Technology , 2005 .

[79]  Jos V. M. Welie,et al.  Patient decision making competence: Outlines of a conceptual analysis , 2001, Medicine, health care, and philosophy.

[80]  A. LaCroix,et al.  Patterns of technology use among older adults with and without disabilities. , 2015, The Gerontologist.

[81]  Anthony F. Norcio,et al.  A Systematic Review of Technologies Designed to Improve and Assist Cognitive Decline for Both the Current and Future Aging Populations , 2009, HCI.

[82]  J. V. Dijk Digital Divide: Impact of Access , 2017 .

[83]  Boaz M. Ben-David,et al.  Ageism and Neuropsychological Tests , 2018 .

[84]  U. Lindenberger,et al.  Exploring structural dynamics within and between sensory and intellectual functioning in old and very old age: Longitudinal evidence from the Berlin Aging Study , 2005 .

[85]  Katherine L. Roberts,et al.  Perception and Cognition in the Ageing Brain: A Brief Review of the Short- and Long-Term Links between Perceptual and Cognitive Decline , 2016, Front. Aging Neurosci..

[86]  Lynn Rochester,et al.  The role of exergaming in Parkinson’s disease rehabilitation: a systematic review of the evidence , 2014, Journal of NeuroEngineering and Rehabilitation.

[87]  T. Salthouse Selective review of cognitive aging , 2010, Journal of the International Neuropsychological Society.

[88]  Joseph Sharit,et al.  Factors predicting the use of technology: findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE). , 2006, Psychology and aging.

[89]  K. Walsh,et al.  Correction to: Social exclusion of older persons: a scoping review and conceptual framework , 2018, European journal of ageing.

[90]  J. Myers,et al.  Ethical Guidelines for Counselors Working With Older Adults , 2000 .

[91]  Claudine McCreadie The perspectives of people with dementia: Research methods and motivations , 2004 .

[92]  Thomas N Friemel,et al.  The digital divide has grown old: Determinants of a digital divide among seniors , 2016, New Media Soc..

[93]  Kathryn Summers,et al.  Bridging the Digital Divide: One Smartphone at a Time , 2018, HCI.

[94]  Alex Mihailidis,et al.  The Acceptability of Home Monitoring Technology Among Community-Dwelling Older Adults and Baby Boomers , 2008, Assistive technology : the official journal of RESNA.

[95]  Anne Marie Piper,et al.  A Critical Lens on Dementia and Design in HCI , 2017, CHI.

[96]  Lucy R. Betts,et al.  Older adults' experiences and perceptions of digital technology: (Dis)empowerment, wellbeing, and inclusion , 2015, Comput. Hum. Behav..

[97]  Donna M. Zulman,et al.  Examining the Evidence: A Systematic Review of the Inclusion and Analysis of Older Adults in Randomized Controlled Trials , 2011, Journal of General Internal Medicine.

[98]  Antonio Cherubini,et al.  The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. , 2011, Archives of internal medicine.

[99]  A. Barrett,et al.  Drawing on Stereotypes: Using Undergraduates' Sketches of Elders as a Teaching Tool , 2007 .

[100]  Alexander Peine,et al.  From Intervention to Co-constitution: New Directions in Theorizing about Aging and Technology , 2018, The Gerontologist.

[101]  D. Abrams,et al.  Agisem in the European Region: Finding from the European Social Survey , 2018 .