Older people , ICT and Quality of Life - PowerPoint Presentation

1. Older people, ICT and Quality of LifeDr Jacqueline Damantj.damant@lse.ac.uk

2. What are the effects of older people’s use of ICT - in varying contexts - on their quality of life?Based on: Damant, J (2015) Older adults, e-inclusion and access to ICT-based care. PhD thesis: London School of Economics and Political ScienceDamant, J., Knapp, M., Freddolino, P., Lombard, D. (2016) Effects of digital engagement on the quality of life of older people, Health and Social Care in the Community

3. Definitions: Older person65+“younger-old”: 65-74“older-old”: 75+Arbitrary, too young?Widely accepted by International Organisations e.g.:UNWHOOECDDG for Financial and Economic Affairs of the EC

4. Definitions: Mainstream Information Communication Technology (ICT)Range from telecommunications networks to devicesInternetPersonal (and Apple)computers DesktopsLaptopsTablets (e.g. iPad, Samsung Galaxy)Mobile phones: smartphonesGames consoles

5. Definitions: ICT-based careTelecare: fall alarms, GPS location devices, medicine remindersTelehealth: vital sign monitoring devicesE.g. BP, HR, oxygen, temperature, weight, blood glucoseTelemedicine: remote consultation services E.g. video conferencingSmart home technology: automated home and passive environmental control devicesE.g. smoke alarms, presence alarms, temperature alarms

6. Definitions: Quality of LifeAdult Social Care Outcomes Toolkit (ASCOT)1Capability approach (Sen, 1985)3Emphasises capabilitiesSocial capital (social, financial, political resources)Choice and control over social careBasis of research framework; some domains less fully defined:e.g. dignity, physical capabilityWorld Health Organisation Quality of Life (WHOQOL)2Functionality approachAssesses function across different living environmentsMultidimensional perspective of QOLApplicable to varying circumstances and cultures throughout the worldComplement ASCOT domains

7. Quality of Life DomainsWHOQOLASCOTLevel of IndependenceEnvironmentPsychologicalSocial RelationshipsPhysicalSpiritualityControl over one’s lifePersonal cleanliness and comfortFood and drinkAccommodation cleanliness and comfortPersonal safetyOccupationDignitySocial participation and involvement}}

8. Combined FrameworkDomainsFacets1.Control over one’s lifeIndependence: Activities of Daily Living (ADLs)Personal Cleanliness and comfortFood and DrinkAccommodation cleanliness and comfort2. Personal safety and securityFeeling safe, secure, freedom from abuse and harmFreedom from crimePrivacy3. OccupationPaid employment/work capacityCaring for othersVolunteer workRecreation and leisureInformation seeing/opportunities for learning

9. Combined Framework cont’DomainsFacets4. Social involvement and participationPersonal relationships with family, friendsFeeling part of the communitySocial support5. Psychological wellbeingDignitySense of personal significancePositive and negative feelingsSelf-esteem, self worthBody image and appearanceObtrusiveness6. Physical capabilityIndicators of health statusPhysical activityIndependence: MobilityMemory and cognitionHealth-related behaviourHealth-related awareness and knowledgeSpiritualityNot included

10. MethodsRealist review of the literatureQuantitative data analysisOffice for National Statistics (ONS)Oxford Internet Survey (2003-2011)MonAMI trialEC FP6 project: 2006-2011Open source platform for ICT-based services for older people “Living Scale” trial in 3 countries:Kosice, Slovakia n=18 Zaragoza, Spain n=14Stockholm, Sweden n=30Interviews Individual interviews people >= 65 n= 8Focus group people >= 65 n=6key experts n=34University, research centres, think tanksThird SectorLocal and National governmentsNHSPrivate consultancyMonAMI participants n=62 (interviews conducted by local researchers)

11. 65+ and using ICTIncreasing consistently over timeIn 2017:65+: 61.4% users, ↑ from 37.4% in 201175+ men: < half of 75+ men, ↑ from 30% in 201175+ women: > third of 75+, ↑ from 13% in 2011Smaller proportion of women use internet compared to proportion of menall age groups, each year Source: ONS, 2017

12. 65+ and using ICTIn 2016 ONS, 201665+:Laptop and tablet computers most used devices to access internetAll adults: Mobile/smartphone and laptop most used in general Between 2014 and 2015 OfCom, 201665+: little change in device usage rateAll adults:Computer (laptop and desktop) use to access internet decreasingSmartphone, tablet use increasing

13. 65+ and using ICT2011 OxIS data (n=165):98% access internet from home 8.4% access via public library5.8% access via Internet CaféInternet “on the go”:65+: steadily increasing from 10%* in 2011 to 33% in 201655-64: increased from 41% in 2013 to 66% in 201616+: increase less marked, 61% in 2013 to 75% in 2016Higher baselineSource: *Oxis, 2011; ONS, 2017, 2016, 2015, 2013

14. Source: Ofcom, 2016

15. Control over one’s live: mainstream ICTPositiveInternet use → “perceived control”4Moderate computer use → “sense of control”5Mobile phone ownership → and “sense of freedom and independence”6ICT use → keeping house in order and shopping ICT-use pre-emptive for when less able to do ADLs7

16. “I can do my shopping online and I can get it delivered by Sainsbury’s. It is spot on when I can’t get out [to the shop].” M2, aged 78 Wife with dementia, living in a care home. Visited her almost daily

17. Control over one’s live: mainstream ICTNegativeNo significant relationship: internet use → satisfaction with physical environment8Internet shopping and banking deflects social stigma of dependencyDependency: an intrusion on others, shameful, unacceptable965% of older people do not shop online (2010 – US data)10

18. Internet activities by age groupONS, 201711

19. Online shopping over time (ONS, 201711)55% of older population do not do online shopping (2017)% of older people online shopping consistently ↓ compared to general adult populationBUT ↑ older people shopping online over time% ↑ at a greater rate than general adult population

20. Control over one’s live: ICT-based carePositiveTelecare and smart home services overall positive effect on independence and IADL12(REVIEW)ICT-based care → empowers older people with disabilities, compensates for some physical impairments → helps manage ADLs13, 14, 15MonAMI trial: Telecare → participants’ perception of effect on performing day-to-day tasks16:Significant number helpful > unhelpful

21. “[Being able to see who is at the door with a smartphone] is good for me who is sitting in a wheelchair” Sweden, Female, aged 67 (MonAMI sample)

22. Control over one’s live: ICT-based care Negative***Evidence limited***Telecare ø significant effects on older people’s ability to carry out ADLs17Less “in control” because of reminders, pressures to use devices18, 19Concern about encouraging independence at all costs through ICT could affect other aspects of QOL18Risk older people become dependent on ICT → no longer take independent decisions without an ICT application or device, become less vigilent20

23. “If the [telecare] services do too much they are going to disable people. Your technological solution needs to be adaptable to that person’s needs, promote their independence, and encourage them to carry on doing things. You don’t want someone sitting there all day pressing a button. They need to keep mobile, to keep doing things, and to keep remembering to do things. Otherwise you are just going to make them more and more dependent.” Telecare commissioner

24. Personal Safety and Security: mainstream ICTPositiveMobile phone ownership and usage → positive effect on sense of personal safety6, 21, 22“I’ve got a mobile phone, but I only use it for emergencies.” W4, aged 68

25. Personal Safety and Security: mainstream ICTNegativeNegative effect on sense of privacy and personal security23, 4, 24Fears of becoming victims of crime when using ICT24, 25, 26Analysis of OxIS 2011 53% “agreed” or “strongly agreed” that: “present use of computers and the internet are a threat to privacy in this country”27

26. “I find [mobile phones] are an intrusion.”M14, male in his 80s“I have actually been quite worried about doing the wrong thing [on Facebook] because you can so easily start saying something to the whole world that you think is private.” M1, aged 78

27. Personal Safety and Security: ICT-based carePositive“ageing in place” → improving personal safety and security is fundamental principle of ICT-based care28, 14, 21, 29, 30Fall detection and lifestyle monitoring services improve feelings of safety17Pendant alarm servicesreassurance22Video monitoring services ensures personal safety at home 31Telehealthhigh ratings of “feeling safe in daily life”32MonAMI servicesimproved sense of safely and security in termsFallingintrusion in the homeprotecting their belongingmaintaining their privacy16“[DoorVue] appears to have frightened away two young males who used to frequent the building on weekends and at night.” Sweden, female, aged 86

28. Personal Safety and Security: ICT-based careNegative“Big Brother is watching”Impinge sense of person freedom32, 33, 34, 35, 36, 28, 15, 14, 24Video-monitoring equipmentSense of intrusiveness31Email consultation serviceConcerns about level of privacy3824-hour monitoring serviceslack of privacyfear of crime and maleficence when sending data to non-medical staff37“An application which tells [patients] that their heart is racing can be useful. But what do [care practitioners] do with [the vital sign information]?” Telehealth commissioner

29. Social Involvement and participation: Mainstream ICTPositiveInternet, mobile phones, Skype, email:Maintain relationships with friends and familyGain social support39, 6, 40, 4, 41, 26, 42, 43, 25, 44, 10, 45, 29Improve inter-generational relationships46, 42 Reducing loneliness4, 47, 40“I’ve got a lot of nephews and nieces who are scattered throughout the world. I know I can write to them but if I email them then it is done instantly. [Email] is invaluable in being able to contact my relatives.” M2, aged 83

30. Social Involvement and participation Mainstream ICT: NegativeMinority use ICT to keep in contact with familyReluctant users → contact grandchildren48Ø significant relationship between:Internet, email and contact with family and friends8“+ve” correlationTime on internet and social and family loneliness 45“-ve” associationhigh internet use and well-being49(meta-analysis)Reinforces existing relationships, Ø expands social networks: Ø use email to make new friends, rely on traditional, safer (non-ICT) methods42Using internet to communicate with new people ↑ loneliness45

31. “It could make you quite lonely and isolated. I know people who don’t communicate with people in any other way. Face to face contact is very important.” W2, aged 75

32. Social Involvement and participation: ICT-based care Positive***Limited evidence***Face-to-face patient/GP appointments improved with electronic patient records (n=11)50TelecareSlight improvement in social functioning (SF-36) at follow-up compared to baseline17 MonAMI Remote alarm and monitoring services:Helpful in terms of speaking to people and receiving visitors16

33. Social Involvement and participation ICT-based care: NegativeConcerns of losing the “human touch”51, 32, 44, 36, 15, 14, 38, 52, 31, 22↑ false alarms, conviviality calls14 Promoting independence and cost savings↓ pursuit of human contact and social involvement54Complement NOT replace traditional services20:“Telecare doesn’t provide any personal care to the individual. It is not going to replace any human contact care.” Programme manager

34. Occupation: Mainstream ICTPositiveStrong evidence “+ve” effect on ability to work, leisure, hobbies and information activities55, 26, 44, 10, 21, 7, 5Internet usersLeadership roles in social and community club/organisations8Significantly more likely to be members of political, relationship, environmental, tenant and resident associations/groups4Email usersVolunteering activities9, 56Computer usersSignificantly more likely to join community organisations, do volunteer work57

35. Quite a few people [who come to the Age UK centre] use [the Internet] to look at their family history.” W4, aged 68

36. Occupation: Mainstream ICTNegativeMinority of older people who use ICT for leisure activities (at time of publication)55, 58, 7, 59 Update needed…***Little evidence identified***

37. Occupation: ICT-based carePositiveSeeking health and medical informationOnline health information helpful Gaining knowledge about illness, treatment and therapies26One study (n=2/4 participants):“+ve” effect on leisure activitiesNegativeLiterature focuses on barriers to online health searches:Level of health literacyLevel of ICT-literacyAccessibility of websites***Little evidence identified***

38. Psychological Wellbeing: Mainstream ICT: PositiveQualitativeEmailing loved onesSense of purpose and enjoyment42Email and the internetSense of accomplishmentFeelings of empowermentIncreased self-esteem25, 26, 44Feeling mentally alert and challengedFeeling more youthful44Quantitative“+ve”rel’ship: Internet, email and overall wellbeing8, 58 video-conferencing equipment ↓ depressive status47Interest in and use of computer ↓ level of anxiety5Computer users ↑ levels of “senior optimism”57

39. You get to 80 years old, you’ve done a lot in your life that you’ve been pleased with and then you can’t do it anymore. So even a little thing that is a bit of a challenge and you’ve overcome it: that’s quite a big boost [to your morale]. W5, aged 80

40. Psychological Wellbeing: Mainstream ICT NegativeWeak association between anxiety and internet use4Anxiety more likely amongst non-internet usersø improve in depression levels participants started with low levels of depression41***Limited evidence***

41. Psychological Wellbeing: ICT-based carePositiveQualitativeTelecareIncreased psychological wellbeing13, 51Reassurance15, 60, 22QuantitativeMonAMI remote monitoring services helpfulfeel optimistic about the future, Reduce anxiety16Whole Systems Demonstrator (WSD) telecareSmall, sig effect on ∆ decline of mental health-related QOL (SF-12) and depression62Telecare (no sig. test done)Less anxiety, less “–ve” feelings63***Limited evidence***Few, small-scale studies

42. Psychological Wellbeing: ICT-based careNegativeTelehealth (WSD)Ø sig. effect on anxiety or depression61Telecare and tele-monitoringØ sig. effects on mental health score (SF-36)17,64 Ø anxiety (WSD)62

43. Psychological Wellbeing: ICT-based careDefinition: Disruptive or invasive of service users’ physical space65Feeling stigmatised, loss of dignity33, 66Monitoring services and wearable devices (e.g. pendant alarm)Visibly, implies frailty, disability and dependency67, 54, 68, 19, 18, 69, 65Stigmatises need for assistance22, 14Makes home sanctuary “into a hospital”14, 18, 70“Most people who are given an alarm system leave it on the dressing table and never use it. The stigma of having an alarm is huge. A lot of people say: “I won’t be seen like that. It makes me look old.”” Executive of social enterprise Obtrusiveness

44. Physical capability: Mainstream ICTLiterature and interviews: few associations between ICT-use and physical capabilityOnline information little or no help for diet and exercise26No impact on participation in active sports5Tentative suggestion too much ICT ↓ exerciseCross-cultural observations:Spain: internet users better self-rated health than non users71New Zealand: “+ve” rela’ship internet and email and self-rated health8US: computer users healthier than non-users57UK: Internet non-users sig more likely to have health problems than users (2011 OxIS data) How ICT affects users’ physical capabilities to carry out ADLHealth-related behaviour, knowledge and awareness that affects physical capabilities

45. Physical capability: ICT-based careICT-based home care and internet interventions trends (ø sig.) improvement inMedication compliance, Weight control, Disease management72. 73, 64TelecareImproved knowledge and more control over health, Distracted from pain63No improvement of self-rated health17, 62TelehealthNo improvement of self-rated health61, 64MonAMI telecare servicesMore UNHELPFUL in feeling energetic, managing medication and memory16***Limited evidence***

46. Final Thoughts IMany benefits not unquestionably beneficialSome domains: mixed resultsPersonal safety and securitySocial involvementPsychological wellbeingQuestion of causalityHealthier people use ICT, benefit QOL Ø technical solution to every social problemMany older people ‘digital immigrants”, use ICT peripherally

47. Final Thoughts IIUnder developed methodologyMeasuring complex social outcomes of ICT interventionsDevelop specific QOL toolsChallenges with quantitative measures of subjective QOLComplement with qualitative methods to explore context in more depthTrade-offsBenefits of one domain weighed against disadvantages of anotherE.g. privacy/security vs living independently in own homeNon-ICT users? Fast moving topic, findings rapidly obsolete!

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