Measuring blood pressure

Home help

Technologists have come up with a kitchen that keeps an eye on Alzheimer's sufferers, and bracelets that monitor blood pressure. But will people wear them or reject them? E&T asks the question.

No one likes to think too deeply about ageing, or about the disabilities we might have in the future. But whether we like it or not, by the time most of us reach old age we will be having difficulties carrying out tasks we used to take for granted, and technology might provide the only solution to some of the care we need.

"As a society we are getting older. Over the next 30 years the number of people over the age of 65 is going to increase dramatically compared with the number between 18 and 65," says Helen Petrie, professor of human-computer interaction at the University of York. Originally a psychologist, Petrie now evaluates technology for people with disabilities and the elderly.

"It's not that it would be nice or interesting research-wise to use technology to help support people; we are going to have to, because there just won't be enough younger people around to care for the elderly," she says.

Although we are all likely to need some help in old age, anyone suffering with dementia will need more specialist assistance. There are currently 700,000 people in the UK living with the condition, with one in 20 people above 65, one in five of the over 80s, and one in three of the 90-plus age group affected.

A variety of electronic devices have already been developed to help. These include sensors that can detect whether a chair or bed is occupied, valves that automatically cut off the gas supply in the event of a leak, and a system that switches the bathroom light on when a person gets out of bed at night. All aim to make the home a safer environment for vulnerable people. "But take-up has been less than we initially thought it would be," says Professor Dawn Brooker, director of the University of Worcester Association for Dementia Studies.

"For diabetes, or heart-care, people are used to relying on little gadgets or things to deliver medicines, whereas in dementia care there is no history of that. So getting care staff and family members to think about technology as helpful is a bigger leap for people to make," she explains. "Then there are the ethical issues. In many cases you are working with people with limited capacity to make informed choices. So if you want to introduce a gadget that, say, helps track where people with dementia are or does things for them, I think that makes people uneasy and back away from using technology where it could be helpful."

An electronic blood pressure monitor that transmits readings wirelessly is just one example of a new technology that could be seen as quite invasive. But Brooker thinks the accurate picture of symptoms they give is useful. "Typically if you interview a person with dementia about their health they will say they are absolutely fine, although they may be having quite big problems. They're just not remembering that they have," she explains.

Electronic tagging for dementia

More controversially, there are also electronic tagging systems beginning to appear in the UK that can track the whereabouts of users. The United States and Sweden have already rejected some tracking devices because they feel it infringes on a person's rights.

"The whole issue of privacy and monitoring is a very personal one," thinks Brooker. "If you look at how people feel about identity cards there is a huge divide. Some people will go on protests about them, while other people think 'It's okay, I've got nothing to hide'. You are likely to see that same span of opinion in people who've got dementia."

Many of the electronic assistive systems undergoing development involve transmitting data from sensors wirelessly to a computer, and so effectively allow the user to be remotely monitored. "Elderly people don't like the idea of being watched by some sort of Big Brother, but as younger people that are used to electronics get older they will probably find this sort of technology more acceptable," says sheltered housing officer Joe Edmondson.

But what happens if we reach a state where we are no longer capable of expressing our opinions? Brooker says early diagnosis of dementia is key so people can decide on the level of monitoring they find acceptable while they still have the capacity to make a choice. Petrie echoes this view. "People need to make informed choices while they still can, and set limits. I think the problem with British society is we are a bit nervous about facing these things full on, as we've seen with euthanasia," she adds. "We have to stop being squeamish."

Hospice nurse Emma Dennis says their standard practice of recording what care people would like as their health deteriorates "definitely eases the burden on the family, and is something we find very valuable too." She can see the benefits of a similar procedure for assistive technology, but warns, "people sometimes change their minds along the way, so they might need to review their decisions."

In some cultures, the whole idea of elderly people living apart from their families and relying on assistive technology is totally unacceptable. But even among older folk who are used to living alone, some technologies have met with a negative response. "Older people with dementia can wander out of the house, and there was an attempt to record messages from an adult child saying things like 'Mum, please go back to bed, it's the middle of the night.' People were completely freaked out by this," explains Petrie.

According to Brooker, in the early stages of dementia, when memory loss is common, people are generally willing to try technological aids, "however there is a lot of stigma that surrounds dementia and stops people seeking help". Petrie feels we have good reason to form such attitudes. "We know deep down that our society is not very tolerant to people who are different in any way, so we don't want to draw attention to ourselves as being disabled," she explains.

"So much depends on the character of the person," adds Dennis. "Some people will accept any aid if they feel it is going to help them and their family, as I think many people have a fear of being a burden. But some people are totally against even considering something as basic as a walking stick. They see it as a constant reminder to them and the outside world that they are becoming more frail."

Edmondson also thinks people's acceptance of their disability will affect take-up of new technologies. "Specialist aids such as the flashing lights on doorbells that alert deaf people tend to be readily accepted by users because they can immediately see the benefits. I feel people familiar with these sorts of devices would be more likely to accept new electronic healthcare technologies than someone who has not used anything like this."

One rather surprising reaction is people becoming very attached to assistive technology. When a care home recently installed a wireless tracking system for example, the residents decided to personalise the modules they had to wear by decorating them.

Fear of technology

It is easy to believe that the elderly will, almost as a matter of course, reject technology. But that is becoming less likely. "People who are in their seventies and eighties now probably didn't use computers at work very much. But as we age we will expect to keep on using technologies, and will think more of technology as a solution to our problems," says Petrie, swiftly adding that the popular belief that the current older generation have an inherent fear of technology is nonsense.

The key, she says, is to relate new technologies to things pensioners are familiar with, like telephones, dictating and typewriters. When Petrie introduced groups of older people to voice input technology - a much more accessible option for people with arthritic hands than a keyboard and mouse. "They loved it," Petrie enthuses. "They said: 'We never knew this existed, what a wonderful idea. Why can't we use a computer this way?'"

Petrie is currently researching whether virtual personal assistants or companions would also be useful for older people living alone.

"Part of what a virtual assistant could do would be to encourage you to go out, or to Skype your children or friends, so it would help you keep in touch with real human beings," she explains. "You could have a purely software system with an avatar on a TV or PC screen. Or would people prefer it was a physical thing that sat on their kitchen table and talked to them?" One mainstream example of the latter that Petrie is studying is the Nabaztag electronic 'smart rabbit'. The plastic pet connects to the Internet and can carry out a range of tasks including reading website content and blogs, giving news or weather information on demand, and telling you when emails have arrived.

"I think this is the future," says Petrie.

The idea that any form of electronic assistant or monitoring could be misused to replace human interaction does, however, cause anxiety. "People need people primarily," says Brooker, "and I think the biggest danger is that we use technology to take the place of human contact and kindness, and that it is seen as a cheaper alternative to having staff visit people."

"It could mean staff sit in a control room looking at a monitor," Edmondson points out. "What the residents [of sheltered housing schemes] need is company, and people to see them on a daily basis. They don't want to be ruled by machines."

Petrie, who advises designers of new assistive products, as well as Web designers, firmly believes the issue of accessibility for all is a challenge rather than a problem. She does however acknowledge there are some issues to be addressed, particularly when it comes to specialist aids.

One of the biggest problems, says Petrie, is that designers go too far through the design process without consulting the likely users. Alternatively, they design something for just one disabled friend or elderly relative only to discover it does not provide a solution for anyone else. To help combat this, the Foundation for Assistive Technology, for which Petrie is a trustee, is currently setting up a user-panel of people of different ages and with different disabilities to act as testers for new products and take part in focus groups. It is vital for engineers and technologists to have access to "a broad range of information from an appropriate spectrum of people," says Petrie.

Looks are also important. "There has been an unfortunate tradition of thinking aids don't have to be attractive," continues Petrie. "Because we live in a very consumer-aware age you need to make assistive technology look really cool."

However it is equally important for things to look familiar. This was one of the main aims of a University of Newcastle project to design an 'Ambient Kitchen' for people with dementia.

Newcastle is one of three research hubs announced in April this year - the others being based at Aberdeen and Nottingham universities - to develop digital technologies to transform the lives of the elderly, disabled and isolated.

Although it looks exactly like an ordinary kitchen, the Ambient Kitchen is computer-controlled and has sensors in utensils, cupboards, appliances, work surfaces and the floor. Users see prompts projected onto the wall they are facing if they stray from a pre-set 'recipe' they are following.

"One of the things I say to health and social care providers is if you get a service right for somebody with dementia, you'll get it right for everybody else," concludes Brooker. "I've sometimes been in hotel bathrooms where I think 'Where's the basin? How do I get some soap?' But if you are designing a bathroom for somebody with dementia you have to make sure it looks like the sort of bathroom we all had as children. That will be a bathroom everybody can use without feeling stupid, and the same goes for technology."

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