Technology and Aging

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TECHNOLOGY AND AGING

The term ‘‘technology’’ embodies a broad variety of concepts. In The New Industrial State, John Kenneth Galbraith described technology as the ‘‘systematic application of scientific or other organized knowledge to practical tasks.’’ Within this broad definition technology may intersect with the lives of older persons in a variety of ways. Technology may include new knowledge gained through basic research on the biology of cellular aging or the development of new vaccines, as well as advances in communications between patients and physicians that enhance the goal of increased mobility and functioning. Technology also encompasses such processual developments as the emergence of new social institutions and complex organizational structures to accommodate changing health care needs of the older population. This includes not only changes in the clinical application of geriatric medicine and reform of the formal health care system, but also the ways in which kin structures evolve and adapt to the changing needs of their members (Litwak and Kulis).

The most familiar forms of technology for most people, however, are those referred to as ‘‘hard technology.’’ In this form technology comprises any product or device designed to enhance the well-being of the individual. Of greatest importance to the older population are innovations in three forms of technology: medical technology (including diagnostic and therapeutic devices such as CAT scans, or MRIs); ecological technologies (including environmental modifications and assistive devices); and information technology (comprising communications technology, computers, and the Internet).

Medical technologies

One of the most striking changes in the nature of medical care that has resulted from recent technological innovations has been the movement of medical treatment from predominantly hospital settings to physicians’ offices, freestanding specialty clinics, urgent care centers, and even the home. This transformation has resulted from the advent of minimally invasive surgery, new pharmaceutical treatments to replace surgery, and the development of increasingly sophisticated diagnostic and monitoring equipment for people to use in the home (Wilson; Stoeckle and Lorch). This movement might be even more pervasive but for the fact that many medical technologies are not designed for use by patients, but require trained professionals to operate them (Charness and Holley). As an increasing number of technologies are adapted for home use, the sophistication of community-based medical care should increase.

Another important innovation has been the development and use of biomaterials in medical treatment from gene therapy to prostheses to transplantation. Recent innovations in the use of biomaterials include the use of bioadhesive material to deliver drugs through the skin; the use of donor cornea cells as cornea replacements; and the application of bioengineered materials as bone grafts in hip replacement procedures or arterial replacements.

Now that technology has made it possible to map the human genome (or almost all of it), the understanding of the genetic, behavioral, and environmental origins of later life diseases is opening up rapidly. The potential of gene therapy to change the future of medicine has only begun to be perceived. Gene therapies are largely experimental, and testing and development of further therapies are presently complicated by scientific, legal, and ethical hurdles.

Advances in information technology are also helping to improve medical care for older persons in the community and in institutions. In general the use of computers and other communication equipment to connect patients and health care providers is referred to as telemedicine. There is relatively little evidence as yet to show whether telemedicine either improves or worsens health (Heathfield et al.), but the number of pilot programs is rapidly increasing. The use of telemedicine is generally thought to be effective for one-time emergency evaluations, follow-up contacts, medication checks, and primary care in isolated areas, but its usefulness for more extensive diagnostic applications or for long-term chronic disease management is not yet known. Telemedicine can improve patient access to physicians, improve communication among health care providers, reduce transportation costs, and eliminate some of the environmental barriers deterring patients from seeking care. In addition, access to computers and the Internet may make it possible for older persons to view their own medical records, may provide reminders for medication and other home treatments, and may distribute medical information that is individually tailored to the patient’s comorbidities and medications (Deatrick).

The adoption of new medical technologies by physicians, hospitals, and patients varies by patient and provider characteristics and across geographic regions. There is often a perception that older patients do not desire to receive aggressive or high-technology treatments for serious illnesses, but there is substantial evidence that the opposite is true (Mead et al., 1997). High-tech interventions also can be high-cost interventions, and thus will likely drive an increasing concentration of such interventions into a limited number of large medical institutions. Similarly, increasingly complex surgical procedures require investment in the training of physicians and other staff, and consequently are often concentrated in particular locations (Wilson). To some extent the problems engendered by the increasing localization of treatment options could be lessened by the growing use of telemedicine, leading eventually to savings. However, the acceptance of telemedicine faces hurdles related to patient privacy and confidentiality, liability, and licensure issues.

Ecological and assistive technology for the disabled

Assistive technologies may be defined as ‘‘any item . . . that is used to increase, maintain, or improve the functional capabilities of an individual with a disability’’ (Brandt and Pope). According to this definition, assistive technology may include assistive devices, environmental modifications, prosthetics, personal response systems, and other ‘‘smart house’’ technology. About two-thirds of disabled older Americans use some form of assistive technology to assist then with limitations in the activities of daily living; the most common items are simple devices that assist with mobility, such as canes and walkers (Agree and Freedman), and this number has been growing (Manton et al.).

The use of assistive technology is highly task-specific, and the successful adoption and retention of assistive devices has been shown to depend largely upon three main factors: the nature of the disability and its severity, the design of the device, and appropriate training of the user (Sanford et al.; Kohn et al.). Environmental barriers also may impede use of equipment, particularly for older persons in aging and/or substandard housing. Though the perceived stigma of using a device also may be a significant factor (Gitlin; Covington), it may depend upon the availability of alternative forms of coping, and not enough is known about these informal adaptations.

Whereas assistive technology is used to enhance the capabilities of the user, environmental modifications serve to reduce the disabling effects of the physical environment, eliminating barriers and increasing the ability of assistive devices to work properly. Recent developments in adaptation of the physical environment have focused on universal and transgenerational design. Universal design is intended to make products useful by persons of all abilities, without expensive or hard-to-find special features (Story). Transgenerational design is a form of universal design specifically developed ‘‘as a strategy for eliminating design discrimination against older members of the population’’ (Pirkl). It is intended to address the needs of ordinary individuals as they age and to create products that are useful across generations and over time.

The growth in assistive technology use and the increase in barrier-free environments in public spaces may be directly linked to political developments since 1960. The growth of advocacy groups for the disabled during the 1960s and 1970s in the United States contributed to major changes in the understanding and treatment of disabled persons. The return of disabled veterans from Vietnam, as well as a general political climate focused on civil rights, generated the independent living movement. This political movement promoted a new paradigm by which disabled individuals have been elevated from a status as deviants who are either tolerated or hidden away, to members of a disadvantaged minority group to whom the state owes a responsibility for full participation as citizens (Albrecht). The ultimate result of this shift in attitudes was the passage of the Americans with Disabilities Act in 1990. This legislation may have been mainly the result of activism by younger persons with lifelong disabilities, for whom incapacity has a very different meaning than that experienced by older persons, but both groups have benefited from greater access to public spaces and protection from discrimination as a result.

Information technology and older adults

One of the most exciting areas of development in new technologies is information technology, specifically the role of the Internet. Computer use among the older population has grown dramatically but still lags behind that of other age groups. In 1984 only 1 percent of Americans age sixty-five or older used a computer anywhere; by 1997 use was up to 10 percent and as of August 2000, 28 percent of Americans over age sixty-five owned a computer (author’s tabulations from Current Population Survey). Nevertheless, the gap between older and younger adults in use of both home computers and network services widened between 1993 and 1997.

About two-thirds of persons age sixty-five and over have no computer in their household, and many of these persons say that they do not want to become ‘‘connected’’ (Russell). According to a study by the Pew Internet and American Life Project, 74 percent of those over fifty who do not presently have Internet access have no plans to get online, and the majority of them feel they are not missing out on anything (Lenhart).

A good proportion of this age gap may be a cohort effect, and as younger, more computer-literate cohorts age, the gap in technological use will likely shrink dramatically in the near future. About 64 percent of those age fifty to fifty-four in 2000 use a computer, compared with 28 percent of those sixty-five and over (tabulations from August 2000 CPS), and the older age group is the most rapidly growing segment of the computer-using population (Bucur et al.).

Design issues also contribute to age differences in computer use. Poorly designed computer and Internet interfaces can be particularly difficult for older persons to use (Bucur and Kwon). Across many studies older persons report more difficulties in mastering computer technologies, and these problems are not corrected merely by improvements in training. System design must also be taken into account to increase the usefulness of computers for the older population (Mead et al., 1999).

The Internet offers a tremendous potential for older persons. Although only a small proportion of persons over sixty-five currently use the Internet for anything other than E-mail (Bucur et al.), it can be an important source of health and investment information, as well as a resource for purchase and delivery of goods such as prescriptions and groceries, and can facilitate the location and purchase of specialized assistive technologies for the disabled. Post-retirement careers can be launched, and cognitive capacity can be maintained, through online educational programs—more and more colleges and universities are offering courses and degrees via distance education over the Internet (Morrell et al.). It is also an important virtual community that can provide support to caregivers or persons whose mobility is impaired. In addition, conquering the brave new world of computing can increase feelings of efficacy and mastery (McConatha). Sherer, and McConatha et al., have shown that the use of personal computers by nursing home residents is associated with both mental and emotional benefits.

Conclusion

The future of technology is vast and largely unforeseeable. Many of the innovations described in this entry were unimagined in the 1980s or 1990s, and undoubtedly future developments will be equally surprising. Some features will certainly become a more important part of the technological solutions applied to everyday aspects of aging. The increasing use of ‘‘intelligent’’ systems, and eventually of robotics, seems assured. Even now, technologies such as specially designed global positioning systems, to reduce wandering among Alzheimer’s patients, and intelligent wheelchairs are being tested. Further research is needed to understand the limitations of technology. For example, an increased dependence upon assistive technology should not replace rehabilitation therapy, and no number of ‘‘smart’’ devices can assure complete independence for an older person with advanced dementia. In addition, the broader use of computers for day-to-day tasks, such as shopping and banking, has yet to resolve problems related to the reliability of information on the Internet, privacy concerns, access to technology for low-income persons, and the needs of the disabled elderly.

Emily M. Agree

See also Americans with Disabilities Act; Home Adaptation and Equipment; Human Factors.

BIBLIOGRAPHY

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