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Needs and requirements for independent living for older people

Final Report Summary - NARILOP (Needs and requirements for independent living for older people)

NARILOP: Needs and requirements for independent living for older people

Improvements in health and health care, together with a higher standard of living mean we have an ageing population. As a result there is an increased market for both assistive technologies and mainstream technologies, which can support older and disabled people to live independently. However, it is clear that very often the abilities and constraints of older users and users with disabilities are not taken into account in the development of either assistive or mainstream technologies.

The United Nations [6, 7] estimates that in 2012, there were 841 million older people (defined as people aged 60 years or older) worldwide and that by 2050 the proportion of older people will increase to 21 per cent of the total population, or more than 2 billion people. If this prediction is born out, it will be the first time in history that the proportion of the population aged 60 years and over will be larger than the proportion of young people aged under 15. The ratio of people of working age to older people, known as the “age dependency” ratio, is also very important. For example, in the European Union, for every person of 65 year or over, there are currently four people of working age (15 – 64 years); however, by the year 2060, it is estimated that there will be only two people of working age for each person of 65 for over [3].

These changes in the population have many implications, but of particular interest here is the consequences for the care and independent living of older people. Increasingly there will be far fewer younger people to help care for the older population. Technology has a vital role to play in filling this growing personnel gap. More technological support will be needed to enable older people live independently in the community for longer, and to support their care in residential homes. We must also remember that older people are not a homogenous population and include people who are able bodied, those with varying degrees of health problems, as well as those who have minor or major disabilities. Technological changes are happening at a rapid pace and can result in improved access to services, and enhance independent living options. However, in many cases older people and people with disabilities are not maintaining familiarity with these changes, creating a “digital divide”.

The NARILOP Project undertook a major critical review of recent technology research and developments for older and disabled people. If technological support is likely to be used by older and disabled people, it needs to be useful and usable to the target users. To ensure this, it needs to be developed in a user-centred manner, taking into consideration the needs of users throughout the design process. The methods employed are critical to the success of satisfying user needs. Our review investigated what problems faced by older and disabled people are being addressed by current research; whether the research is motivated by user needs; the methodologies used; the levels of target user involvement in the research; and the outcomes achieved.

The critical review covers relevant research published between 2005 and 2012. The review has been inspired by work carried out by Rogers, Stronge and Fisk [4] as they published a major survey of research on technology in relation to older people in 2005 which built on an earlier review by Czaja in 1990 [2]. They reported that very often the abilities and constraints of older users were not taken into account in the development of technology. Research published in a range of peer-reviewed conferences and journals was included in the review. Sources included mainstream outlets in human-computer interaction and human factors, as well as specialist outlets in gerontology, geronotechnology and rehabilitation technology. Journals and conferences were selected for inclusion based on their Impact Factor [5] and rankings by the Australian Research Council’s ranking of journals and conferences [1]. From a list of possible conferences and journals, a random selection was made to reach a manageable number. A list of journals and conference included in the review can be found at the review website: www.yorkhcicriticalreview.wordpress.com/.

Papers from the journals and conferences were selected for review if they included words relevant to older people and technology in the title, abstract or keywords. Terms included “older people”, “older adults” and “elders” in mainstream conference or journal papers (which were by definition about technology) and in addition “computer/s”, “assistive technology” and “online” in the specialist journals. A full set of the terms and how they were used is available at the review website. To ensure accuracy of selection of papers, either two researchers reviewed each conference proceedings or journal or the same researcher reviewed the proceedings or journal at least three months apart. Inter-coder reliability on the selection of papers was calculated on several sets and averaged over 90%.

A total of 5143 papers were reviewed, 3823 in mainstream outlets and 1830 in specialist outlets. The number of papers found relevant to technology for older people is 187, made up of 170 relevant solely to older people and 17 relevant to older people and people with disabilities.

The papers can be divided into three types of research and development:
Development of new technologies/systems: research and development that proposes emerging technologies or new uses of technologies for older people;
Understanding users: This is research that seeks to understand the use of technology by older people and their attitudes to technology;
Methods for working with older people: This research proposes methodologies for working with older people in the development of new technological solutions, or reflects on this area of research and development.
Just over three-quarters (75.6%) of the papers were about understanding older people, their use of technologies, experiences with technologies and attitudes to technology. The remaining papers were split evenly between proposals for new technologies and systems (11.5%) and methods for working with older people (12.9%).

In addition, we found that the research could be categorized into 11 major topics: Mobility and wayfinding, Access to and use of information, Communication and social interaction (e.g. encouraging socializing, supporting communication, collaboration), Interacting with/using technology (e.g. input/output, interaction techniques), Attitudes to/experience with technology, Specific technology issues (e.g. security), Education, the Web (e.g. use of the Web, assessing Web accessibility, teaching developers about Web accessibility), Tasks of daily life (e.g. memory support, home monitoring, cooking, banking, exercise), Games and gaming, and Methods for working with disabled and older people.
The analysis of papers has shown that there is a wide range of research on technology for older people. It is encouraging that so much of the research is about understanding older people’s use and attitudes towards technology. This shows that researchers and developers are taking user-centred approaches, investigating older people’s issues around technology. This research is also creating a growing body of knowledge for researchers and developers entering the area to draw on. The analysis of topics also shows that there is research on a wide range of different issues. Some of the common topics are to be expected: the most common area of research (19.1% of papers) is “Tasks of daily life”, which is a very broad topic, but also reflects the interest in supporting older people in living independently and supporting them in a wide variety of tasks of daily life. However, at the other extreme, it is surprising that there is so little research on web accessibility for older people (only 3.1% of papers), as the web is such an important source of information, commerce and leisure. Researchers may not be aware that the Web Content Accessibility Guidelines (WCAG) [8] do not cover the needs of older web users, and this is definitely an area that needs further research.

As a result of this critical review we now have an overview of the state of the art of technologies for promoting independent living and wellbeing of older people, which should be useful for researchers, developers and practitioners in the field.

References
1. Australian Research Council. (2010). Excellence in research for Australia. Available at: http://www.arc.gov.au/era/era_2010/era_2010.htm.
2. Czaja, S. (1990). Human factors research needs for an aging population. National Academy Press.
3. Giannakouris, K. (2008). Population and social conditions. EuroStat Statistics in Focus 72/2008, Office for Official Publications of the European Communities.
4. Rogers, W.A. Stronge, A.J. and Fisk, A.D. (2005). Technology and aging. Reviews of Human Factors and Ergonomics, 1(1), 130 – 171.
5. Thomson Reuters. (2013). The Thomson Reuters Impact Factor. Available at: http://thomsonreuters.com/products_services/science/free/essays/impact_factor/
6. United Nations. (2002). World Population Ageing: 1950-2050.
7. United Nations. (2013). World Population Prospects: The 2012 Revision, Highlights and Advance Tables.
8. World Wide Web Consortium. (2008). Web Content Accessibility Guidelines 2.0. http://www.w3.org/TR/WCAG20