RESNA 28th Annual Conference - Atlanta, Georgia
Alex Mihailidis, Ph.D. P.Eng., Amy Cockburn, B.Sc. and Catherine Longley, B.Sc.Kin.
Intelligent Assistive Technology and Systems Lab, Department of Occupational Therapy, University of Toronto, Canada
This pilot study will explore the views and preferences of baby boomers and older adults with respect to various types of home monitoring technologies and the various technological components that comprise these systems. A concurrent nested, mixed methods design is being used in this study. Face-to-face interviews will be conducted with 15 baby boomer participants and 15 older adult participants. It is expected that this research will inform engineers and designers in the development of more effective and acceptable home monitoring technologies for older adults, thereby supporting age-in-place.
KEYWORDS: home monitoring technology; aging-in-place; acceptance; older adults; baby boomers
Older adults are searching for ways to live independently within their own homes for as long as possible. In response, home monitoring technologies (HMT) have been developed to support older adults as they age-in-place. These technologies perform functions such as reminding a person to attend an appointment, medication adherence, as well as more sophisticated functions such as monitoring the completion of activities of daily living and providing step-by-step prompting and guidance during a specific task. Technologies in such systems range from simple devices, such as motion sensors, to complex systems that involve the use of computer vision and artificial intelligence. Despite the onset of these new technologies, designers have largely neglected to consult potential users on their perceived needs and preferences with respect to HMT. It is imperative that older adults accept these new technologies, if they are to assist older adults safely and independently in occupations within their home environments for longer periods of time.
The purpose of this pilot study is to learn about the views and preferences of baby boomers and older adults with respect to various types of HMT and the technological components of these systems. We feel that it is important to compare the views and opinions of these two groups, as there may be differing opinions between the current older adult user population and the future user population, namely baby boomers. Interviews will be used to determine these populations’ acceptance of HMT as well as to develop a theory on the acceptance of HMT among these users. This data will inform the future design of HMT and in selecting appropriate types of technologies.
Statistics show that older adults, individuals 65 years of age and older, are the fastest growing subpopulation in Canada (1). As the baby boomers age, the older adult population is estimated to increase from 3.92 million Canadians in 2001 to 9.2 million Canadians in 2041. As individuals grow older, they tend to experience increasing restrictions in their activities due to chronic health problems (1). Despite these limitations, older adults are expressing a desire to age-in-place, that is, to live and age within their own homes (2). However, aging-in-place with chronic illnesses can create safety issues. Several HMTs, also known as ‘telecare’, have been developed to support older adults’ desire to age-in-place. Some examples of these new monitoring devices are fall detection systems, lifestyle monitoring systems, physiological health monitoring systems, and systems that aid in the completion of a variety of tasks (3).
Recent studies have focused on user acceptability of HMT. For example, Mann et al. (2002) examined older adults’ acceptance of home-based health monitoring devices through face-to-face interviews. A strong acceptance was found of home health monitoring and of the devices to make the system work (3). However, health monitoring systems are only one type of HMT currently being developed. Other types of HMT have not been studied in this depth.
Brownsell, Bradley, Bragg, Caitlin, and Carlier (2000) investigated whether 176 community-dwelling alarm users would be interested in telecare. Questionnaires were administered via interviews and examples of the equipment were shown to prevent confusion. They found that 77% of users were interested in automatic fall detection, 68% in lifestyle monitoring, 57% in telemedicine, and 46% in videoconferencing (4). These results suggest that older adults were prepared to accept new technologies that would support their independence. Although this particular study examined the different types of telecare together, it did not query users on their acceptance of specific design characteristics of these technologies and did not determine the specific reasons why the technologies would not be accepted.
Demeris, Speedie, and Finkelstein (2000) examined patients’ impressions of the risks and benefits of home monitoring. After testing 32 individuals, they found that participants showed overall positive attitudes toward home telecare and agreed that it could improve their health. Concerns regarding privacy and confidentiality as well as reliability of the equipment were identified (5). However, although perceived benefits have been shown to lead to greater levels of acceptance of this technology, this does not necessarily predict acceptance.
There is a need for more in-depth studies on user acceptance to HMTs among community-dwelling older adults. Furthermore, this issue needs to also be examined with current baby boomers, as this population will be the future user group of these new technologies. Studies that examine the spectrum of HMTs are needed, as well as studies that look at the acceptance of specific design characteristics of these technologies. It is imperative to determine older adults’ acceptance of the specific design characteristics of various HMTs, as this will guide the development of monitoring technologies that users will accept in their homes to support them as they age-in-place.
A concurrent nested, mixed methods design is being used in this study. There will be one data collection phase where both quantitative and qualitative data will be collected simultaneously. This type of mixed method design will provide us with a broader understanding of the acceptability of HMT among the study participants.
Convenience samples of 15 older adults (over the age of 65 years) and 15 baby boomers (born between 1946 and 1965) will be recruited. This sample size will be large enough to gain initial insight into participants’ views and opinions on the this type of technology, while keeping the study a manageable size for this stage of work.
A questionnaire and interview process will be used to collect the required data. The questionnaire will address: 1) the forms of technology participants currently use in their homes, 2) the types of HMT they will accept in their homes, 3) the locations within their homes that the participants will accept HMT, and 4) overall perceptions of these HMTs.
Data collection for the questionnaire will be achieved through face-to-face, one-on-one interviews that will be audio-taped and transcribed for analysis. Researchers will administer the questionnaire, completing and recording all of the participant’s answers to both the closed-ended questions (including associated quantitative scales), and open-ended qualitative questions.
Data analysis will be completed by the researchers for the data sets. SPSS will be used to manage quantitative data analysis, focusing on descriptive and correlational statistics. N’Vivo will be used to manage the analysis of qualitative data, and to assist in theme identification. These identified themes (e.g. acceptable location of technology, type of acceptable sensors, etc) will help to make conclusions about the views and preferences of the participants with respect to the technology being tested, and to identify future improvements to the questionnaire for larger-scale studies.
Data collection for this study is currently underway. We anticipate a statistically significant difference (P < 0.05) between the older adult and baby boomer sample groups with respect to the acceptance of HMT, with the latter being more accepting of such technologies. It is expected that current baby boomers will be more accepting of this type of technology, as they may be more comfortable with using technology on a daily basis as opposed to current older adults who may not be as familiar with technological systems.
This research has potential implications in two areas. Firstly, this data will identify key design issues in the process of developing more effective and acceptable home technologies for older adults. Secondly, this study will have important implications for the field of rehabilitation and its practice. If accepted by older adults, HMTs could enable this population to live and age independently within their own homes for longer periods of time, allowing people to engage in their own meaningful occupations. This could result in an increasing proportion of older adults whose cognitive or physical limitations would have previously required them to move into institutions, such as retirement and nursing homes, to have the opportunity to age-in-place.
Alex Mihailidis, Ph.D. P.Eng.
Department of Occupational Therapy
University of Toronto
500 University Avenue, Toronto, Ontario, M5G 1V7