The Role of Technology in Promoting
Successful Aging among Older Adults
T.J. McCallum, Ph.D.
According to Rowe and Kahn (1998), there are three things older adults need to do to ensure successful aging; 1) avoid disease or monitor diseases acquired, 2) maintain cognitive and physical health, and 3) remain engaged with the world around them. Consequently, great deal of research has been conducted and a great deal written about different means to achieve these goals. A new area of study, gerontechnology, aspires to expand the field of technological applications to improve quality of life among older adults and facilitate successful aging. In order to do this, older adults need to be considered as a special category of users, whose unique abilities and needs at biological, psychological, and social levels have to be taken into account during the design process of relevant technologies (Burdick and Kwon, 2004). The goal of this paper is to discuss the impact of technological advances on older Americans within a successful aging framework. Further, because successful adoption of technology serves as a prerequisite to actual use, elder adoption of technology and other barriers will also be discussed.
Technological advancements pertaining to aging can be grouped into three main categories; health and wellness technologies, safety technologies, and social connectedness technologies. Health and wellness technologies include interactive “tele-health” technologies, medication management aids, and secondary prevention aids. Safety technologies are designed to enable independent living and include fall detectors and personal emergency response systems. Social connectedness technologies tend to focus on health and wellness through interpersonal cyber-connections and also serve to combat elder isolation.
A multitude of technologies presently exist designed to aid elders in avoiding disease (and injury) and monitoring disease states. These include fall prevention and fall detection devices, personal blood sugar and heart rate monitors, as well as personal emergency response systems (PERS). The oft mocked quote from the famed PERS commercial “I’ve fallen and I can’t get up!” may have crudely tapped into fears of falling among older adults, but nevertheless serves as an excellent example of the positive application of technology within the successful aging framework. The act of remaining connected to a 24-hour source of medical assistance helps older adults avoid aggravating fall-related injuries and may also serve more importantly as perceived support. The most recent form, tele-health technologies, allow direct contact between older adults and their health providers to address health related issues as they may arise. Tele-health technologies can be employed to diagnose various illnesses as well (Gomez et al., 2002). Health information collected through common (blood pressure and heart rate sensors) and specialized (electrocardiograms and blood oxygen levels) systems is transmitted to monitoring stations within health facilities or directly to caregivers.
the HomeCare and Telerehabilitation Technology (HCTR) Center at The Catholic University of America started a project using plain older telephone service (POTS) for health care communication and interaction between remote health care experts and elderly patients at home. Results reported are generally positive (Buckley, Tran and Prandoni, 2001, in Burdick and Kwon, 2004): high levels of tolerance and acceptance by patients, positive impact on the quality of care given, consistence of the support also from a psychosocial point of view.
Numerous studies indicate a rapid increase in the number of older adults using computers, through which a majority of technical applications are facilitated (). In fact, over 40% of the U.S. population over the age of 65 uses computers (US Department of Commerce, 2002), 35% of older Americans have regular access to the Internet (US Department of Commerce, 2002), and these numbers are expected to grow as more technologically-savvy cohorts age. The majority of older adults utilize the information gathering capabilities of computers to acquire health related and general information ()
Social engagement, generally defined as the carrying out of meaningful social roles for either productive or leisure activity was added to Rowe and Kahn’s successful aging list as an attempt to highlight the importance of both social support and social activity. Other social engagement researchers examine social networks, social integration and social participation (Mendes de Leon, 2005). It remains unclear by what means social engagement positively impacts aging, but numerous studies indicate this to be true. More specifically, elder social engagement has long been studied in relation to both positive and negative affect. In fact, social engagement has been associated with longer survival in older adults independent of physical activity level and health status confounds (Glass, Mendes de Leon, Marottoli, & Berkman, 1999). There is further evidence that social engagement is protective against declines in cognitive function (Bassuk, Glass, & Berkman, 1999) and self- reported disability (Mendes de Leon, Glass, & Berkman, 2003). Observational studies further indicate that the mental and physical stimulation associated with social activity is protective against cognitive decline (Abbott, Wong, Giles, Young, & Au, 2000). Further, social engagement is believed to facilitate active coping strategies that may lower the risk of negative mental health outcomes, such as depression (Billings, Cronkite, & Moos, 1983; Holahan, Moos, Holahan, & Brennan, 1997). It has also been suggested that social engagement reinforces individual patterns of interpersonal connectedness through which other positive psychosocial resources flow (Barnas, Pollina, & Cummings, 1991).
Modern technologies promote social engagement by helping older adults keep in touch with families and friends, ensure more safety at home, and assist in facilitation and utilization of health care (Czaja, 1996, in Mikkonen Vayrynen, Ikonen, Heikkala, 2002), bringing new stimuli into their lives and providing more access to information (Lehto, Tekniikkaa, 1998, in Mikkonen et al., 2002). Numerous studies confirm the role of technology in increasing social interaction (Kautzamann, 1990), self-esteem (Lustbader, 1997), life satisfaction (Sherer, 1996), and perceived autonomy (McConatha, McConatha and Dermigny, 1994). Regarding health support, communication technologies and wireless systems enable health consultations, physiological data collection, safety and environmental control in order to avoid disease, maintain physical and cognitive function, and maintain engagement during life (Burdick and Kwon, 2004).
With respect to the first objective, avoiding disease, the HomeCare and Telerehabilitation Technology (HCTR) Center at The Catholic University of America started a project using plain older telephone service (POTS) for health care communication and interaction between remote health care experts and elderly patients at home. Results reported are generally positive (Buckley, Tran and Prandoni, 2001, in Burdick and Kwon, 2004): high levels of tolerance and acceptance by patients, positive impact on the quality of care given, consistence of the support also from a psychosocial point of view. Tele-health technologies can also be employed to diagnose and monitor chronic illnesses, such as heart failure (Fulmer et al., 1999, in Burdick and Kwon, 2004), respiratory diseases (Kinsella, 2000, in Burdick and Kwon, 2004) and diabetes (Gomez et al., 2002, in Burdick and Kwon, 2004). Data collected through common (blood pressure, temperature, heart rate sensors) and specialized (electrocardiograms, heart and lung sounds, blood oxygen levelsÖ) systems is transmitted to monitoring stations or directly to caregivers.
An example of the second objective, maintaining cognitive and physical functions, is provided by a ìconsumer toolkitî of home automation and monitoring developed by HCTR center with the objective to collect environmental information during daily life activities. In this system there are sensors that continuously collect data about an individualís location and activities; this information is then used to monitor changes in everyday behaviors, which are probably related to changes in health status.
Finally, the third objective, lifelong engagement, is illustrated by technologies that facilitate communication, for they are especially appreciated in case of people who suffer from physical and cognitive disabilities, isolation, frustration and depression (McColl and Skinner, 1995, in Burdick and Kwon, 2004). They give older people the possibility to share their experiences in social networks, perhaps with others who have the same diseases or disabilities who can provide suggestions and emotional support, but could not possibly move from their home or live alone (Charness, Schaie, 2003). For instance, the University of Oulu and Nokia Mobile Phones (Mikkonen, Vayrynen, Ikonen, Heikkala, 2002) are engaged in the implementation of products, services and complete systems for disabled and elderly communication.
Flow is an intrinsically rewarding state in which people immerse themselves in an activity, lose a sense of time and the awareness of self. Flow states more commonly occur when individuals freely choose activities, goals are clear, performance feedback is immediate and concrete, and challenges are high but the performer has the skills to meet the challenges (Csikszentmihalyi, 1990; Csikszentmihalyi & Larson, 1987). Anxiety, boredom, or apathy result when challenges and skills are unbalanced. As we age, we are more likely to experience various forms of functional disability (Fauth, Gerstorf, Ram & Malmberg, 2011). Increases in functional disability can erode basic skills and create greater challenges in carrying out activities of daily living. Depression has been shown to result from the onset of functional disability among older adults (Yang & George, 2005; Fauth, Gerstorf, Ram & Malmberg, 2011). Furthermore, social support is strongly predictive of levels of depression related to disability onset. Social engagement, considered an active aspect and reciprocal part of social support has been thought to increase positive affect and decrease negative affect.
Baltes and Baltes (1998) developed their Selective Optimization with Compensation Model (SOC) to describe the manner in which older adults can successfully adapt to the world around them and achieve successful aging. By shifting goals (selection), taking steps to improve the likelihood of meeting those goals (optimization), and using aids and assistance when needed to meet those goals (compensation), older adults can take proactive measures to thrive in the world around them.