How Can Municipalities Support Aging in Place using Technological

Innovations? A Single-case Study in a Canadian City

Mélanie Couture

, Aline Aboujaoudé

, Sylvain Giroux

, Hélène Pigot

and Nathalie Bier

Centre for Research and Expertise in Social Gerontology, CIUSSS West-Central Montreal,

Côte Saint-Luc (Quebec), Canada

Université de Montréal, CIUSSS South-Central Montreal, Montréal, Canada

DOMUS Laboratory, Université de Sherbrooke, Sherbrooke, Canada

{helene.pigot, sylvain.giroux}@usherbrooke.ca

Keywords: Smart Cities, Technology, Aging in Place, Homecare, Older Citizens, Caregivers.

Abstract: Governmental planning has to reflect the worldwide shift in demographics as the proportion of older adults is

rapidly growing. Concepts such as age-friendly cities and smart cities suggest that municipalities and

technologies have a role to play in supporting older citizens. Still, it is not clear how municipalities can

actually support aging in place via technology? This single case-study in the city of Côte Saint-Luc, Quebec,

Canada gathered via eight focus groups, the perspectives of older citizens, caregivers, and representatives of

the City regarding this subject. The approach of Miles et al. (2014) was used for data analysis. Stakeholders

believe the City could support aging in place by helping older citizens access existing services through

technology. Furthermore, the City could provide an existing infrastructure, maintain the trust of older citizens

regarding privacy issues and provide appropriate technology at a cheaper cost. Nonetheless, additional

resources and various partners are necessary to undertake this technological endeavour. The City’s main

responsibility would be related to the coordination of the new technological ecosystem comprising older

citizens, their caregivers, volunteers, and partners providing services. More research involving multiple

stakeholders is needed to conceptualize this technological ecosystem before implementing it in a real-world

setting.

1 INTRODUCTION

Worldwide governments have been facing a shift in

demographics as the proportion of older adults is

rapidly growing in many parts of the world (United

Nations, 2020). These changes are not only taken into

account within governmental planning at a national

level, but also at a municipal level. Cities contribute

to the development and maintenance of living

environments adapted to the needs of citizens as well

as promoting economic activity in their territory

(https://www.mamh.gouv.qc.ca/organisation-munici

pale/organisation-territoriale/organisation-territoriale

https://orcid.org/0000-0002-0088-3865

https://orcid.org/0000-0001-6142-3611

https://orcid.org/0000-0003-0602-5957

https://orcid.org/0000-0001-5520-5677

https://orcid.org/0000-0002-2940-694X

-municipale/regime-municipal-general/). More speci-

fically, they may have decisional power regarding

housing, roads, community and cultural development,

recreation, urban public transport, and wastewater

treatment.

Cities have the power to put in place initiatives to

facilitate the lives of older citizens. In 2007, the

World Health Organization (WHO) introduced the

concept of age-friendly cities to support active

ageing. The main idea is that cities adapt their

structures and services to the needs of older citizens

as a mean to promote health, participation, security

and consequently quality of life. In recent years, the

Couture, M., Aboujaoudé, A., Giroux, S., Pigot, H. and Bier, N.

How Can Municipalities Support Aging in Place using Technological Innovations? A Single-case Study in a Canadian City.

DOI: 10.5220/0010975400003123

In Proceedings of the 15th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2022) - Volume 5: HEALTHINF, pages 911-918

ISBN: 978-989-758-552-4; ISSN: 2184-4305

911

concept of smart cities has been also introduced as a

way of better planning and supporting older citizens

and optimizing the use of resources with

technologies. Smart cities combine the City’s

infrastructure with information technologies in an

effort to collect and analyze important quantities of

data to offer better services based on citizens’ needs

(Winkowska et al., 2019). According to a recent

systematic review, smart cities aiming to have an

impact on healthcare mainly use technologies to

support “population surveillance, active ageing,

healthy lifestyles, disabled people, response to

emergencies, care services organization, and

socialization” (Rocha et al., 2019; p.1). As for the

promotion of active ageing through technology, it can

involve assessing for frailty (e.g. Abril-Jimanez et al.

2019), platforms that facilitate community

engagement (e.g. Gomes et al., 2017; Righi et al.,

2015) and applications to support daily activities (e.g.

Liming et al., 2015; Villarrubia et al., 2014).

Torku et al. (2020) considers that age-friendly

initiatives can be integrated in smart cities but more

research is needed as their recent systematic review

identified many barriers that can hinder their

implementation: social, financial, political

physical/environmental, and technological. For

example, even if the integration of technologies is

central to the concept of smart cities, their adoption

by older adult is not guaranteed. A systematic review

by Benoit-Dubé et al. (2020) concludes that older

adults are more inclined to accept technology if they

perceive benefits related to the technology, they know

they can use it efficiently and safely, it is affordable

and it will adapt to their physical and cognitive

declines in the coming years. This means that the

perspectives of older citizens have to be taken into

account when choosing which technologies may be

integrated in smart cities.

Garon et al. (2014) also notes that successful age-

friendly initiatives are grounded by members of the

communities such as community organizations, as

well as representatives of private and municipal

instances. The combination of these different

perspectives is crucial in understanding the older

adults’ situation and needs. Furthermore, sharing

power is also important. Righi et al. (2015) stress the

importance of agency in the process of developing

smarter cities and older adults should be able to

suggest scenarios and not only respond to those

developed by other stakeholders. Regarding the

socioeconomical aspects of smart cities, Winkowska

et al. (2019) reports that: “The role of inhabitants and

local stakeholders stands out, meaning their

participation in managing public affairs and decisions

making processes. There is a strong need for creating

transparent principles of collaboration between local

government and residents” (p.77).

These studies suggest that the development of

smart cities has to be grounded in the perspectives of

stakeholders and use a collaborative approach from

the beginning. Before undertaking age-friendly

initiatives, City officials and other stakeholders must

first deliberate together on the following question:

How can this city help older citizens stay at home

using technological innovations?

2 STUDY SETTING

In 2017, Infrastructure Canada challenged

municipalities and Indigenous communities across

Canada to improve the lives of their residents through

innovation, data and connected technology

(https://www.infrastructure.gc.ca/cities-villes/index-

eng.html). In this challenge, the winning projects

selected by Infrastructure Canada would receive

between 5 and 50 million in funding to implement their

initiative depending on the size of the population. The

City of Côte Saint-Luc (about 35 000 residents)

submitted a proposal in 2018 (SHARED: Senior

Health and Real-time Environmental Data) that was

selected among the 10 finalists in the category of cities

comprising between 30,000 to 500,000 residents.

Therefore, the City received funding to develop a more

in-depth proposition for the final phase of the contest.

To develop the final proposal for the Smart Cities

Challenge, the City partnered with the research team to

do a pilot project (2018-2019) aiming to: 1) identify

facilitators and barriers to aging in place; and 2)

understand the perspective of multiple stakeholders

regarding the use of technology to support aging in

place. Part of the pilot project aimed at better

understanding the role of the City in helping older

citizens stay at home using technology.

In 2019, the City of Côte-Saint-Luc submitted the

final proposal intitled the VillAGE Initiative that

aimed at implementing a connected framework using

technologies to help older adults: (1) live more safely

and independently in their homes; (2) be better

connected to their communities and city services; (3)

be more socially engaged. » (p.3) (City of Côte St-

Luc, 2019). Unfortunately, the VillAGE Initiative

was not selected in the final round of the competition.

Nonetheless, this collaboration with the research team

was an opportunity to further advance scientific

knowledge on the conception of smart cities. Rooted

in the perspectives of multiple stakeholders from the

City of Côte Saint-Luc, the present study aimed to

Smart CommuniCare 2022 - Special Session on Smart Living Environments to Support Aging-in-Place in Vulnerable Older Adults

912

understand how can municipalities help keep senior

citizens at home using technological innovations.

3 METHODS

A case-study design is relevant when the research

question requires a comprehensive description of a

social phenomenon (Yin, 2014). The perspectives of

multiple stakeholders regarding the role of the City of

Côte Saint-Luc in supporting aging in place via

technology was explored using a qualitative single

case-study designed. More specifically, multiple

focus groups were used to explore the perspectives of

stakeholders.

3.1 Participants

Purposeful sampling was used to identify participants

that could bring in-depth information regarding the

social phenomenon (Patton, 2002). Three groups of

stakeholders were recruited to represent multiple

perspectives: older citizens, caregivers and

representatives of the City of Côte Saint-Luc. Older

citizens and caregivers were recruited through

community organizations by a member of the

research team. As aging is a heterogeneous process,

older adults 65 years and over from both genders and

with varying levels of functional autonomy were

purposefully recruited for better representativity. The

project was approved by the CRIUGM Ethics Review

Board (CER VN 16-17-22). All of the participants

signed a consent form before taking part in the data

collection process.

3.2 Data Collection

A focus group can be defined as "a group interview,

centred on a particular subject (focus) and

coordinated by a moderator or facilitator, who seeks

to generate primarily qualitative data, by capitalizing

on the interactions that occurs within a group setting"

(Sim & Snell, 1996 p.189). Eight focus groups

comprising a total of 46 participants were completed

in November 2018:

‐ FG1: City directors (n = 3 women and 2 men);

‐ FG2: City counsellors (n = 2 women and 5

men);

‐ FG3: City staff (n = 4 women and 1 man);

‐ FG4: Older men from a social group (n = 6);

‐ FG5: Older women from a social group (n = 7);

‐ FG6: Active seniors (n = 6 women and 1 man);

‐ FG7: Vulnerable seniors (n= 4 women and 2

men);

‐ FG8: Children of seniors’(caregivers) (n = 3

women).

All focus groups were digitally recorded and took

place in a meeting room at City Hall. They lasted on

average 60 minutes and were facilitated by a

researcher specialized in qualitative research. The

interview questions were used in prior studies about

the use of technology for aging in place. The main

interview question were as follow: 1) Can you

describe the obstacles you encounter in keeping older

adults at home?; 2) What strategies have you tried to

keep this population at home? And what are the

impacts of these strategies?; 3) How do you think

technology could help keep seniors at home? In

addition, an observer accompanied the facilitator and

took notes regarding the main topics discussed. At the

end of each focus groups, they validated, with the

participants, the main ideas that were expressed.

3.3 Qualitative Data Analysis

Qualitative data from the recordings of the eight focus

groups were transcribed to facilitate data analysis.

Miles, Huberman and Saldana’s method (2014) was

used for data analysis including coding and matrix

building. First, descriptive codes were created, which

labelled units of text (words, sentences, paragraphs)

that encompassed a distinct meaning with regards to

how the City could play a role in using technology for

aging in place. The coding grid emerged from the

data. A brief definition of each code was developed

as the coding process progressed. A list of codes, each

supported by excerpts from interviews, was created.

Codification was performed by two research

professionals and revised by a researcher specialized

in qualitative research. Second, matrices were used to

further analyse the main areas where the City could

contribute by creating overarching themes to regroup

multiple codes.

4 RESULTS

From the focus group data representing the

perspectives of older citizens, caregivers and City

representatives, the City’s main responsibility in

aging in place would be to help older citizens connect

with people through technology. More specifically,

four themes emerged to represent the City’s main

roles : 1) helping older citizen connect to their

community and existing services; 2) providing an

How Can Municipalities Support Aging in Place using Technological Innovations? A Single-case Study in a Canadian City

913

existing infrastructure; 3) maintaining the trust of

senior citizens regarding privacy issues; and 4)

providing appropriate technology at a cheaper cost for

older citizens.

4.1 Helping Older Citizens to Connect

to Their Community and Existing

Services

According to city directors, some of the older citizens

are not engaging with city services or their

community. It is reported that individuals with a

higher socio-economic status are the ones who

participate in events and have their voices heard.

Individuals in poorer areas of the City have a low

attendance rate to city activities and they are not the

ones calling to complain. The City can help older

citizen to stay connected to their community and city

services by helping them to find the adequate place to

fulfil their need.

"I think it’s not necessarily more services; it’s

connecting them to existing services, which

will require more programs, and ways to do it.

We have so many wonderful programs that

they are involved in now – and as they get

older and more isolated, we want to connect

them to it." (FG2; M1)

To support aging in place, the main responsibility

of the City would be about communicating

information regarding available resources.

Caregivers mention that it gets harder with age “to do

all that research that is involved in finding out what

the services are, and where to go and get them on your

own” (FG8; W2). In response, many mentioned

different technological means by which they could be

informed by the City of available services. Emails

from the city mailing list has proven useful for older

adults to get general information about things that

could be of interest to them. A city helpline has been

suggested by an older citizen as an alternative to

going to the local community service centre (CLSC)

to get information about services.

City directors and counsellors warn against

putting too many responsibilities on the municipality

and suggests instead a reference service where older

adults can call and learn where their needs could be

met.

As one director explains:

“What is the role of the city? I think it’s almost

to facilitate putting the right people in contact

with the right places. (…) It has to be delivered

in such a way that it’s easy to receive and

digest. But at the same time, I don’t think we

as a municipality… We have certain

obligations. We must clear the snow. We must

collect the garbage. We must provide certain

services and make sure that people have

drinking water and sewage disposal. But we

can't do everything. So, we need to identify the

right partners that are able to deliver at the

speed and pace of the recipient. Whatever it is

that they need… and kind of help tailor it.”

(FG1; M1)

As the City cannot provide every type of services

and answer all needs, structuring partnerships is

important to respond to the demand. For example,

partners can include the public social and health care

system that provides care. However, when creating

partnerships, keeping all partners satisfied can be a

barrier. As a City counsellor illustrates, promoting

access to services can have its downfalls:

“To get a partnership with health government

organizations (e.g. CIUSSS), the project must

prove it can bring money to the government.

However, the project might instead bring even

more "traffic" in healthcare organizations.”

(FG2; M1).

The City is perceived as the interface between

partners to create and organize the ecosystem around

older citizens.

« Everyone comes to it from their own

perspective. We are a city. And our challenge

is… we were given this challenge: how are

you going to advance services, what is the

challenge for residents in your community,

through data-driven technology?” (FG2)

4.2 Providing Existing Infrastructures

The City of Côte Saint-Luc provides services through

multiple infrastructures and some could be further

used. For example, it has its own emergency system

comprising technologies to manage and share

information efficiently.

"We already have a lot of the infrastructure.

We have, for example, a 24-hour, 7 days a

week dispatch centre. Integrating some

technology or monitoring service is feasible."

(FG1; M1)

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According to participants, the implementation of

technology requires more than buying and providing

the technology itself, but it also means relying on

existing human resources to support users. The

library already provides educational activities for

older citizens including some for the use of

technology. A municipal counsellor also suggested

the possibility of involving an existing group of

volunteers in order to help implement technology, so

as to bring a human aspect to it: "they would be real

people helping people, to communicate and talk with

them." (FG2; M1)

Still, there are limits to using existing

infrastructures and resources. Library staff sometimes

feel overwhelmed by some of the demands older

adults have regarding technology as some exhibit

difficulties in learning and come back with the same

questions multiple times. Some City counsellors

point out that existing city resources are not enough

and that human resources specialized in technical

support are key to a sustained use of technology:

" We would need almost an IT Geek Squad, as

I mentioned – where if something goes wrong

and they don’t know what to do…" (FG2; M3)

Older citizens agreed with the idea that:

“You have to have someone experienced, who

is technically knowledgeable to set it up, and

literally put it in a casket that they can’t touch

any buttons. I mean it when I say that! ‘Don’t

pull the wires out.” (FG4; M2)

Indeed, implementing technologies for ageing in

place requires more human resources and

consequently a need for an additional budget.

“Without extra resources, nothing else is

possible."; " it’s not something that could be,

“Oh here, now do this,” without extra money

for the manpower." (FG1; W2)

4.3 Maintaining the Trust of Older

Citizens regarding Privacy Issues

Overall, stakeholders report that privacy risks are

manageable and are worth it considering the benefits

technologies could offer. Caregivers and older

citizens explained that technologies may be

acceptable when considering that the objective is to

ensure well-being and safety of older adults.

“We all give up a certain amount of our

privacy in order to benefit from all the

technology that’s out there. But we try to do it

in a way that makes some kind of sense, and

not just leave ourselves completely open to

anything." (FG5; W6)

The organization or the person who offers

technology needs to be deemed trustworthy by older

adults for them to accept using it. Many older citizens

already trust the City and use the technology offered

by the library.

"W3: They use the online services [of the

library]; they are not quite worried. I haven’t

had any experience with it. Moderator: But it’s

a trust thing, company environment. W3: Yes.

Moderator: That's why they are not worried?

W1: They know the library." (FG1)

As one City counsellor explains, the City already

manages sensitive data through their emergency

system and recognize the importance of privacy:

“The privacy issue certainly is front and centre

whenever we look at technology. And how do

we as a city take that responsibility? I do think

that when you talk about our responsibility as

a city – and being a new councillor, I am

learning what these things involve. But I see

this as an extension of our EMS service,

almost. So, the will of the city to help the

people in need, at this point. (FG2; M2)

One important issue is who has access to sensitive

information. Potentially, specific people as

designated by older adults could have access to that

information. In fact, some older citizens have showed

to be reluctant to have City employees share their

personal information with their family members, even

when they are in a vulnerable situation because they

don’t want their family members to know what is

happening.

“Just for us, from what I see on a daily basis,

it’s a little bit more basic in terms of privacy.

It’s more on the physical end of things. We

will get a lot of older adults that come to the

centre frequently. Some of them spend their

days there, and often will shower at the centre.

And things will happen; either they will fall in

the shower, or they need help. We are going to

help them in a very vulnerable situation. And

I am always a little bit reluctant as to how

How Can Municipalities Support Aging in Place using Technological Innovations? A Single-case Study in a Canadian City

915

much interaction we should be doing. And we

always do end up helping; but then when we

offer to call someone that can help them, either

a child or someone that we can call to assist,

they flat out refuse. They don’t want us to

contact their children, their family members.

They don’t want them to know about it. "

(FG1; W3)

Similarly, caregivers would not want to be

overloaded with information about their loved one’s

personal daily life:

“It’s a slippery slope, you know? Having

access to information about where my father is

in the house, what is he doing, how long is he

spending there, with whom is he spending

time? You know, I wouldn’t want… it’s like

Big Brother.” (FG8; W3)

4.4 Provide Appropriate Technology at

a Cheaper Cost for Older Citizens

Participants acknowledge that technologies can be

expensive. Interestingly, even when older citizens do

have the means to buy technology, they can be

reluctant and question why they should spend that

money.

“Again, from experience – and I’m talking as

an ex-advocate for the patients. A lot of our

problems were that the clients refused to spend

money for the expenditures to do these things

[technology]. And we used to tell them,

“Look, you have the money.” “It’s not that.

Why should I spend the money?” (FG4; M2)

Some caregivers and older citizens have suggested

that technology could be provided by the City as a

public service. It is mentioned that the library already

provides technologies. Moreover, the City could have

more power negotiating bulk price and having

companies compete against each other for the

contract.

“W5: I mean, if you’re going to have that

equipment, someone has to pay for it. I was

just thinking, I know that at another Centre,

you can get better telephones that are more…

and you know, they provide them. Are we

getting into a time frame where the services

actually provide equipment for people to use,

and help them use it? I mean, it would be

equipment that should be returned when… it

belongs to the community. But that they can

use… W3: The library now has iPads that you

can borrow. I don’t know if you can take them

out…” (FG8)

The City could also have access to subsidies and

means to identify the best products available to buy.

“If they are subsidized and they can say “Hey,

come on over, we will give you this deal.” Or

if somebody working with the city can

standardize what we are having, because you

don't need a million different things that can't

work, that would be really, really great.”

(FG4; M4)

5 DISCUSSION

The present study aimed to describe how can a

municipality support ageing in place using

technological innovations from the perspectives of

multiple stakeholders living or working in the City of

Côte Saint-Luc. Stakeholders believe the City could

support older citizens by helping them to access

existing services via technology. More specifically,

the City could provide an existing infrastructure,

maintain the trust of older citizens regarding privacy

issues and provide technology at a cheaper cost for

older citizens. Nonetheless, additional resources and

various partners are necessary to undertake this

technological endeavour. The City’s main

responsibility could be related to the coordination of

the new technological ecosystem comprising older

citizens, their caregivers, volunteers, and partners

providing services.

Existing literature shows that few the age-friendly

initiatives in smart cities have focused on connecting

older citizens to resources through the use of

technology. Righi et al. (2015) report two case studies

in Barcelona, Spain aimed at: 1) designing innovative

services for older citizens by enhancing social

interaction between neighbours; and 2) co-creating

geo-located content for informal learning scenarios.

These authors concluded that not only was this type

of endeavour feasible but it also empowered older

citizens and helped them develop new social

behaviours within their community. For the initiative

to succeed, they report that it is important to develop

technologies that can easily communicate with

existing technologies such as social media. Many

older adults and most partners are already using some

of them and were concerned about the integration of

the whole technological ecosystem. Still, these

Smart CommuniCare 2022 - Special Session on Smart Living Environments to Support Aging-in-Place in Vulnerable Older Adults

916

projects only involved active and independent

citizens.

In 2015, Liming et al. described the

SHINESeniors project in Singapore aimed at making

community care services effective using information

and communications technology and sensor-enabled

homes for older adults with chronic diseases. Liu et

al. (2016) explains that this smart city project required

an interdisciplinary approach and the consideration of

the values of both the older adults and their caregivers.

Success was based on integrating the perspectives of

stakeholders in the development of the system.

As there are few examples of age-friendly

initiatives within a smart city context, it is important

to continue research in this domain. The present

study’s is part of the first phase in the development of

a smart city initiative in the City of Côte Saint-Luc.

Results cannot be generalized to other Cities, but give

an insight on the role that a City can be expected to

play to keep senior citizens at home using

technological innovations. However, even with eight

focus groups comprising more than 45 participants,

saturation was not reached and further consultations

with stakeholders are planned as funding was by

obtained by the research team for a living lab in Côte

Saint-Luc to develop a support model for older

citizens around the telemonitoring of activities of

daily living.

6 CONCLUSIONS

When it comes supporting aging in place using

technology, this exploratory study shows that older

citizens, caregivers and City representatives

conceptualize the City as a structured and trusted

matchmaker. These stakeholders expect the City to

provide infrastructures but also negotiate

collaboration with public and private partners to

provide technologies at a reasonable cost and services

that fulfil the needs of elderly citizens. Still, humans

must remain at the heart of the smart city.

ACKNOWLEDGEMENTS

We would like to thank the City of Côte Saint-Luc,

all the participants, and Erica Botner for all their

valuable support in the project. NB is supported by a

salary award from the Fonds de la recherche du

Québec – Santé.

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