Self-determination of seniors -- a product design framework

Many products and services want to help mitigate aging issues.  The great news is that I meet and hear new vendors tackling one or more opportunities emerging from our 'longevity revolution'. As I just heard AgeWave's Ken Dychtwald describe yesterday, we are in the midst of the first global societal experience in history of what it means when people live as long as they do today. And so it is a great experiment -- what is needed, what helps seniors and caregivers, what works and what doesn't, and as such, more firms, both large and small, will launch products and services.

But are they the right products and services? Yesterday at an event sponsored by the Philips Center for Health and Well-Being, one of the participants noted that for technology to be accepted in the home, it needs to match a senior's right of 'self-determination' -- not override that right because adult children are nervous about their well-being. So are fall-detection, sensors in the home, PERS devices, telehealth and biometric monitoring really technologies for self-determination? Probably not as they exist today.

We're stuck in a fear-based model.  Today's tech products in the X-monitoring and safety space -- fill in your own X, including Philips, GE, Intel, Bosch as well as PERS, activity monitoring startups and stalwarts -- are fear-inspired. They target point problems that are disaster-avoidance, whether it is mismanagement of meds, falling at home, or avoiding re-hospitalization after rehab discharge. For the 'health' tech world, the person is a patient, for the activity and safety world, the person is at risk. The 'health' tech industry complicates purpose further by being mired in the Medicare/Medicaid reimbursement morass -- making it very difficult to think about individual self-determination in setting features, function, or price.

But tech adoption may depend on rethinking fear.  I have published studies that noted how seniors appreciated standing on a weight scale and answering a few telehealth questions because they viewed it as contact with the outside world. Remember that 95% or more of the calls to the Philips Lifeline call center are not an emergency -- the caller is checking in to initiate a human contact. How difficult would it be for every vendor of a disaster-avoidance technology to position it within a larger service framework, providing or referring seniors to human contact?  Facilitating or conducting free conference call conversations among subscribers? If reimbursed 'health' monitoring vendors, these become support groups for those with the same chronic disease.  If activity or fall-related, add a small service fee to facilitate social calls. Consider fitting danger-avoidance technologies into a social -- or even entertaining -- framework.  In the context of self-determination, vendors can help seniors move beyond danger-avoidance and out of isolation -- a first step towards self-determination.

fear-based

Dear Laurie,
how very appropriate to point to the domination of fear and risk in the design of technology. I am currently investigating technology for people with dementia and there it is the same thing. Sensors sense falling, flooding, exposure to gas, but not e.g. whether someone would like to turn the TV or some music on, but doesn't know how to handle the equipment etc. Self-preservation is implicitly defined in very limited terms.
So your comment is right on target.

Design for the User

This is a problem of product design in general. Companies are in love with what they can do, then they squeeze humans into their vision, and force us into a vertical model that benefits them at our expense, literally in terms of dollars, and figuratively, in terms of not being user friendly. While we only make a TV / cable remote, we increase independence, which reduces frustration, which improves quality of life. We have over 50 5 star reviews in only a few months in operation. Like it or not, people become home bound and use the TV for many different reasons. Does grandpa (in California) really care if his kids (in Pennsylvania and Florida) know when he opens a cabinet?

Does Grandpa care...?

I Like your mission:  "we increase independence."

Keep in mind, however, that while grandpa may not care...his children may be very concerned that he isn't taking medicines everyday..and risking stroke or worse.

Good luck with your interesting product!

 

Fear-based services vs Enhanced Design

Laurie -Great posting - you hit on the long-term necessity of shifting focus from alleviating family fears to enhancing the lives of elders. This approach absolutely reflects my experience working as a designer in aging-in-place contexts. Although there is ample support for what I call the "post-traumatic' model of home modification (which is mostly fear-based) expanding the conversation to include preventative as well as life-enhancing changes (as your blog mentions) is key. The seniors I've worked with are mostly concerned with maintaining their status-quo but in the long-term, that position can shift beneath our feet without notice. This situation is as much about education as technology and design.

Post-traumatic model

Marcie,

I wholeheartedly agree. The design for aging should be integrated with general thinking about environmental design. Communities designed to be age-friendly are just generally well-designed communities.

Human Contact

Laurie,

I would like to add to your last point about social interaction and human contact. You have touched on an important point about the potentials for isolation within the home. But, why limit ourselves to thinking about technology as a conduit for merely reaching into the home as a solution? Our true goal should be preserving a person's place in and connection to their community as well as their independent life at home. We need both that public and private side to our lives.

Having a sense of independence and self-determination is critical but it falls short in preserving our sense of self and identity. We understand our self by our role in the larger world. As the elderly lose their friends, retires and no longer goes to work, loses their mobility, they lose that larger world. We should not just be looking at how the world can be brought into their homes but also how technology can bring them out of the house to participate, in however limited a fashion that may be perceived to be by us, into their communities.

The first step in that I think is simple and fundamental one. We like to see and be seen. We like to be where other people are. Technology can perfectly replicate a symphony to listen to you in your home but there is still something unique and irreducibly human in going to the symphony. We never feel more human then when we are with other people. We should recognize that and look for ways that technology can make that possible.

Being together...

I agree with your statement: "We never feel more human then when we are with other people. We should recognize that and look for ways that technology can make that possible."

Do you have some tech ideas on how to make this possible?

Certainly, any "model" of aging in place must deal with this need "to be with others" and provide/facilitate some sort of transportation solution-public or private.

»

Being Together

Peter,

I think it requires a holistic approach that looks to integrate technology with thinking about how we design, physically retrofit, and develop places.

For instance, in my work designing adult day care centers, we added toilet paper dispensers to both sides of the toilet stalls. If you had partial side paralysis from a stroke, you would have needed assistance to clean yourself otherwise.

Let's take this experience of adult day centers and apply it to a family taking their grandmother to the symphony on her birthday. Any outing begins with better bathrooms. Many families despair of taking their loves ones out because of dealing with this issue. The dual toilet paper dispensers deals with one issue of the physical bathroom itself. I think our solutions to this problem begin with using technology to better help understand how we perceive, process information, and navigate the environment as we age. But there are other issues.

How about the issue of finding the bathrooms? I can download a phone app that has a built in compass pointing to any business I am trying to go to. Its not directions. I just follow the arrow as I walk down the street. Why should it be different for finding a bathroom even when inside a building?

What about getting to the bathroom in time or even knowing that you need to go before an accident happens? Certainly with a baseline of data based on toileting habits in the home (monitored discreetly) the same app that help me find the bathroom could send a reminder to me discreetly or a caregiver.

Its no different for transportation For instance, lets take a public bus. If I am on a bus at night, I can request a stop between stops for safety reasons. Why cant I as an elderly person make the same request for the bus to pick me up between stops from my home? The technology exists. It is a question of good system design, outreach, and political will.

Or take senior shuttles, one of their major issues is the time spent loading and offloading. It makes it very inefficient. Rapid transit bus systems have the same inefficiencies because of the time taken to pay fares. In some cities their solution was to convert the bus stop into a secure platform that you pay the fare to enter, instead of paying the fare when enter the bus. When the bus stops you walk right onto it without the delay of fumbling for a fare care or swiping it again and again. I am sure we could design a similar platform for both the home and public places so someone could 'preload' if with a disability, for in stance being in a wheelchair. They could be wheeled right in at the shuttle's floor level without having a driver having to get off the bus, extend a ramp, etc and so on.

My proposals might not be the right solutions at all. But I do not think this is an issue of the right killer technology but having a holistic, but local and diversified approach to using technology. Its a question of good design and looking at technology not as "in a lieu of" but as "in support of" of places, caregivers, and services.

Self-determination = Self-actualization?

Thank you again for your helpful insights!

You and Joe Coughlin are the most perceptive observers of the aging in place space.

Thinking about potential adopters of AIPT from your "humanistic" perspectives should guide the marketing efforts of all exiting and new aging in place products and policies!

See: http://web.mit.edu/coughlin/Public/Publications/Coughlin-Lau%20Public%20...

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