ASSISTING WELLBEING

The Challenges of using Technology to Improve Wellbeing in Older Adults

Douglas Millward

School of Computing and Information Technology, University of Wolverhampton

Wulfruna Street, Wolverhampton, WV1 1SB, UK

Wendy Nicholls

School of Applied Sciences, University of Wolverhampton, Wulfruna Street, Wolverhampton, WV1 1SB, UK

Keywords: Assistive technology, integration, psychosocial, telecare, user interface, wellbeing.

Abstract: Telecare is an increasingly important application of technology that is designed to increase the

independence of older adults, amongst other goals. The programme of research described below aims to

identify important issues with the deployment of this technology to the target group. It describes an on-

going programme of research that attempts to classify these issues, and posit solutions. It additionally

proposes a new area of research into the effects of telecare and related technologies on a client’s

psychosocial wellbeing.

1 INTRODUCTION

The UK Government has a published plan to provide

Telecare into every home that requires it by 2010

(Curry, Trejo-Tinoco, & Wardle, 2002). One of the

problems faced in requirements gathering and

analysis in the assistive technology (AT) field is the

number of stakeholders involved. These parties

include healthcare providers, social services, formal

and informal carers. The needs of these groups have

been studied (e.g., Lines & Hone, 2004). However,

few studies have tried to gather older adults

requirements and aspirations.

It is argued that the shift towards using technology

to provide or even replace services that promote

client independence should be accompanied by a

focus on addressing more holistic needs, such as

improving well being and quality of life. The

purpose of the current research programme is

therefore threefold:

1. Telecare is an emerging and increasingly

important aspect of AT (Barlow, Bayer, & Curry,

2003). However, although there is evidence to

support the view that telecare can assist in ensuring

the physical well being of clients, there has been

little research around the effect of such systems on

the psychosocial aspects of wellbeing. Aim 1 is

therefore to test the effect of contemporary system

provisions on the psychosocial well being of older

adults In order to achieve this aim the authors have

created a system that provides similar outputs to

those of other commercial offerings in the telecare

arena.

2. It is hypothesised that telecare systems will

have a greater effect on the psychological well being

of users if users are provided with increased

feedback on the information that these systems can

provide. To this end the prototype system discussed

above is provided with a user interface that is

capable of providing continual feedback on the

status of the system, and by inference the status of

the client’s home. The second aim is to investigate if

the provision of an easily accessible user interface

will improve on the effects measured above

3. The third aim of this programme is to identify

the needs of older adults with respect to future

developments, direction, and provision of an

Enhanced Electronic Assistive Technology System

(EEATS). Research (Dickinson, Eisma, & Gregor,

2003) indicates that the increasingly (over)complex

user interfaces associated with modern computer

applications (and systems) places a large burden on

a users cognitive abilities as they try to build a

mental model of the operation of the system and

164

Millward D. and Nicholls W. (2008).

ASSISTING WELLBEING - The Challenges of using Technology to Improve Wellbeing in Older Adults.

In Proceedings of the First International Conference on Health Informatics, pages 164-167

 SciTePress

this, combined with lower confidence makes it

difficult to master new technologies (Marquie,

Jourdan-Boddaert, & Huet, 2002). Training alone

will not increase confidence (Segrist, 2004), and as

anxiety about using computers is positively

associated with age (Ellis & Allaire, 1999) it may be

that pursuing the use of computers specifically needs

revision, and technologies, such as the telephone

(Reed & Monk, 2004), or other familiar technologies

need to be revisited as viable alternatives. White et

al (White et al., 2002) recognised that a simplified

interface would be of benefit to older adults. The

first stage of the present study therefore sought to

identify the current trends in IT and AT use in older

adults, with a view to establishing the ideal mode of

delivery for AT in the proposed intervention.

2 METHOD

2.1 Design

There are three stages to the present study.

Stage 1: The aim was to gauge established

practice with IT, AT and familiarity with household

technology using a postal survey.

Stage 2: The aim is to explore the effect of AT

on mental health well being and to elicit an

evaluation of the system provided. Measures of

psychological functioning, quality of life,

relationships with others, and well being, will be

taken before and after a trial period of one week

using the AT.

Stage 3: The aim is to explore possibilities for

the type of applications older adults desired in order

to inform development and design. Three focus

groups will be conducted.

Thus far, stage 1 has been implemented and

results are discussed below.

2.2 Participants

There were 59 participants of which 20 were male

and 39 were female. With respect to age, 22% were

under 65, 42.4% were 65-75, 25.4% were 75-84 and

10.2% were 85 years of age and over Where n

values vary in the below analyses, this is due to

missing data. Thirty-one participants were recruited

from a supported housing project and 28 from an IT

club for older adults.

2.3 Materials

Participants were issued with a postal survey. The

purpose was to get an overview of the technologies

already in use by older adults and their preferences

for the medium through which assistive technology

should be provided. Items asked about the frequency

with which household technologies are used,

confidence with these technologies, and ease of use.

Participants were further asked what tasks they

completed on a computer, on the internet, on a

mobile phone, and on a TV. Finally, participants

were asked about the likelihood of their using a

variety of assistive technologies as a reminder

system for medication.

The following variables were derived:

Often – The frequency with which technologies

such as computers, mobile phones and televisions

are used. A higher score indicates a higher

frequency. The possible range of scores was 5 – 20.

Difficulty – The difficulty with which

participants rate using technology such as

computers, mobile phones and televisions. A higher

score indicates more difficulty. The possible range

of scores was 6 – 24.

Confidence – The level of uncertainty the

participant experiences when using technology. A

higher score indicates more uncertainty; a lower

score indicates more confidence. The possible range

of scores was 6 – 24.

Participants were also asked about the number of

tasks they completed on each of a computer, the

internet, a mobile phone, and a TV. Thus four

variables were created to describe the number of

tasks completed with each.

2.4 Procedure

Questionnaires were distributed and returned via

gatekeepers at the housing organisation and the IT

club. Informed consent was granted from all

participants. Data were entered into SPSS for

analysis.

3 RESULTS

3.1 Overview

There are two parts to the data analysis. To begin

with the relationships between the variables are

ASSISTING WELLBEING - The Challenges of using Technology to Improve Wellbeing in Older Adults

165

presented. This is followed by comparisons between

the age groups surveyed.

3.2 Correlations

The frequency with which participants used

technology was significantly correlated with the

reported difficulty of use (r =-.561, n= 18, p = .16),

and confidence in using technology (r =-.533, n =19,

p =.19). Those who use technology more frequently

find it easier and have more confidence (see table 1).

The easier using technology was perceived, the more

confidence participants reported (r =.947, n = 17, p<

001).

Table 1: Correlations between frequency, ease and

confidence of use with actual use of technology.

Often Difficulty

Difficulty

(n)

-.561*

(18)

Confident

(n)

-.533*

(19)

.947**

(17)

Key

* = p<.05

** = p<.01

3.3 Comparisons between Age Groups

Participants were grouped according to their age.

Three groups were created; below 65, 65-74, and 75

plus. These groups were contrasted on their

frequency of use, difficulty with technology, and

confidence with technology, as well as the mean

number of tasks completed online. See tables 2 and

3 for means and standard deviations.

Table 2: The mean (sd) frequency, difficulty and

confidence with using technology according to age group.

n Often n Difficulty n Confident

Below 65 13 12.92 8 11.75 8 12.13

(2.33) (4.53) (4.85)

65-74 17 14 8 10.38 9 11.22

(1.80) (2.07) (2.44)

75 + 19 10.74 2 13 3 12.33

(2.70) (0) (1.53)

Total 49 12.45 18 11.28 20 11.75

(2.69) (3.32) (3.42)

Of the variables described in tables 2 and 3

significant differences were observed between the

age groups regarding frequency of use (F = [2, 46]

9.21, p<.001), the number of functions used on a

computer (F = [2, 56] 4.18, p<.05), and the number

of functions used on a TV (F = [2, 56] 3.35, p<.05).

Specifically, when compared to the 65-74 group, the

over 75 group used technology less frequently and

fewer functions on a TV. They also used fewer

functions on a computer than the under 65 group.

Table 3: The mean (sd) number of tasks completed with

each technology according to age group

†

n Computer Internet Mobile TV

Below 65 13 2 1.08 1.85 2

(2.24) (1.49) (2.03) (1.47)

65-74 25 1 .52 1.12 1.96

(1.38) (1) (1.48) (1.27)

75 + 21 .48 .38 .48 .95

(.98) (1.07) (1.36) (1.63)

Total 59 1.03 .59 1.05 1.61

(1.58) (1.16) (1.63) (1.51)

†

The possible range of scores were as follows; computer use = 0

– 12, internet use = 0 – 8, mobile phone use = 0 – 11, TV use = 0

– 8

4 DISCUSSION

The present study indicated the frequency and ease

of use are related to increased confidence. We

therefore need to select a technology that is used

frequently, and is easy to use. Of the technologies

that were asked about, participants used the most

functions on their TV. However, when considering

the type of devices that could provide a suitable

interface for older adults and mediate the assistive

technology, the personal computer (PC) may be

perceived as the ideal device. Currently, pre-

installed operating environments (Windows, Mac

OSX, and Linux) are too complex for untrained

users to manage effectively, and as Oksanen-Sarela

(Oksanen-Sarela, 2000) observes “(the) more

complicated the technology, (the) less it gives space

to different ways of using it as the user doesn’t have

the skills or knowledge (to change its

functionality)”. Furthermore, it is unlikely that the

providers of AT systems will be able to provide the

levels of training required by some users, as

Dickinson et al (Dickinson et al., 2003) observe,

“why should the user be re-educated and redesigned

when it is the software that is inappropriate for their

needs?”

It was found that that the technological artefacts

that were used most often were the mobile phone

and television. Given that frequency of use is

associated with ease of use and confidence, these

technologies have clear potential as applications for

the AT. It has already been discussed (Millward &

Nicholls, Submitted) that the telephone is not an

acceptable medium to present the variety of data that

can now be made available. For the proposed

intervention, the television was chosen as the mode

of delivery as it was the next most familiar. The

group of participants with the least familiarity and

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most difficulty with the technologies were those

over the age of seventy-five. However, confidence

levels were roughly equivalent between the three age

groups which shows potential for training.

5 CONCLUSIONS

This paper has introduced a new programme of

research that seeks to explore the use of assistive

technologies (in particular telecare) in evaluating the

psychosocial aspects of wellbeing. Barlow et al

(2003) discuss that Telecare has been split into two

areas – information provision and risk management.

This split may be historical in nature, based on the

evolution of Telecare systems from community

alarm systems (Doughty & Williams, 2004), or it

may be based on such systems originating from

common requirements agreed between stakeholders

from the health and care providers fields (Lines &

Hone, 2004). Whatever the reason the result is that

systems appear, at least to the end user, to be clinical

in nature (Blythe, Monk, & Doughty, 2005). It is

argued that it is time that the two facets of Telecare

systems come together to form an EEAT system.

The benefit of this type of system is that it may

make Telecare systems more acceptable to older

adults by being more attractive to older adults. This

attribute could be stimulated by enhanced usability

(this resonates with the definition of social

dependability posited by (Blythe et al., 2005),

(Dewsbury, Sommerville, Clarke, & Rouncefield,

2003). The specific aspirations of the client group

will be assessed in stage 3 of the research plan.

Further research will then be directed towards

relating these ‘future requirements’ to the

capabilities of the technologies currently available.

The contribution of this research to the field is in

identifying a potential new application of electronic

assistive technology.

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