Telehealth and The Elderly

Research in telemedicine and e-health has been mainly focused on clinical trials. There are few papers on the use of telehealth in older people using social sciences. What materiality for assistive technologies? How comfortable are older people with regard with assisted living technologies? How multiple illnesses affect older people’s capacity to use technologies? A group of 40 people aged 60 to 98 were interviewed and followed up to 3 years by ethnologists and anthropologists from the UK and Australia (Greenhalgh T et al. Social Science & Medicine, 2013, free access). Each participant had multiple impairments such as tremor, visual loss and stiff hands that were steadily worsening during the study course. It is noteworthy that participants often successfully arranged themselves with the new technologies through any form of “bricolage” (i.e. using pragmatic customization). The authors wrote: “With few exceptions, the current generation of so-called “assisted living technologies” does not assist people to live with illness.” They propose “a radical revision of assistive technology design policy“.

What were these assisted living devices? For most of them they were detectors, alarms or monitoring systems which were installed in older people after an acute health event, such as falls or stroke. At best, these technologies proved useful to health providers, since they delivered patients’ information and biometric data. However these technologies were almost of no help for patients in their day life: they were just not conceived for that purpose and did not address their needs!

Among drawbacks addressed to these assistive technologies for dependent older people, authors found: complexity in their use, inappropriate interferences in their daily lives (e.g. unintended alarms), or loss of these devices in people’s appartments when they were expected to be embedded and used as mobile health technologies (e.g. pendant alarms). In addition, these technologies were not as reassuring devices as they intended to be for older people. They often reminded them hospitalization or death spectrum.

According to the authors, it would be wrong to imagine older people to be systematically reluctant to using new technologies. Many of them, or of their caregivers, look for assistive technologies in their daily lives. But their needs are oriented to compensate their losses (due to their disabilities or handicaps). For instance, they often use iPad to write messages to their relatives when handwriting becomes uneasy. Or they mentioned appreciating available free wifi, particularly when it is unaffordable for them to subscribe to, since for these often secluded older people, the use of Skype and emails may represent a solution. Sometimes they are not looking for high technologies, for example a heavy knife may be overcome stiff fingers.

In France, where several millions of caregivers regularly take care of their disabled older relatives, assistive technologies may represent interesting options to solve many of their daily problems. However, due to complexity of their use, their inability to install them or to maintain them, they often neglect their use, even after having bought them. Or, as we do ourselves for many applications and devices, they only use them for a small fraction of their capacities. Most of existing devices which were sold to elderly, unfortunatly do not meet their needs: they were not built to address their users’ needs, particularly if users are disabled and ill people. This is the major paradox that assistive technologies cannot assist those who need them the most. Lack of training for caregivers, secluded customers, lack of resources sometimes, but also a clear lack of thinking among manufacturers which do not address properly needs of their most vulnerable customers. We often dream about a world offering new possibilities thanks to technologies, and this is so true in many aspects of our daily lives, but we most often forget physical and mental limitations our vulnerable and older people are facing and struggling against, which often withdraw them from assistive technologies they would need most. Our ageing society still needs to keep demanding on all these issues!

 

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