Digital Britain: We must do more to make technology accessible to older people

As digital technology changes the way we perform daily tasks like shopping and paying bills, how do those not raised with smartphones and computers embrace such changes? Jacqueline Damant explains the various reasons why engagement with technology varies among the over-65s, and argues that government and the commercial sector should do more to support older people, as their market-led approaches tend to focus exclusively on younger users

What are the likely changes in society and technology which will impact upon the ability of older adults to maintain social (extra-familial) networks of support now, in 2025 and in 2040?

This report reviews evidence on how changes in information and communication technology might affect the ability of older people to maintain social networks of support. It considers both traditional and new forms of social media, along with technological advances in support such as robotics and telecare

Older adults, e-inclusion and access to ICT-based care

Background: Information communication technology (ICT) such as the Internet, mobile phones, computers and tablets, has become a central part of daily life. However a large number of older people do not use ICT, putting them at risk of exclusion from the digital society. Aims: To investigate level to which older people or are “e-included” (or engage with ICT) across various contexts, the factors which influence their e-inclusion and their access to ICT-based care, and the effects of ICT-use on their quality of life. Methods: Using a mixed method approach, I collected both secondary and primary data from numerous different sources including national datasets, the MonAMI project, the relevant literature, and interviews with older adults and technical experts. Analysis: Quantitative and qualitative analyses were performed according to the dimensions of the 6C framework for e-inclusion. The effects of ICT use was assessed against the domains of the ASCOT and WHOQOL models of quality of life. Results: Older people’s e-inclusion and access to ICT-based care were affected by a number of person-centred and environmental factors. There were marked variances in level of e-inclusion with the older population, which was partly attributed to a cohort effect. The evidence showed that access to ICT-based care was affected by local eligibility policies and care practitioner endorsement. Analyses revealed that ICT use positively affected older people’s quality of life in terms of maintaining independence and social networks, and improving psychological wellbeing. However, ICT-use had negative effects on older people’s sense of privacy. Moreover, ICT-based care services proved to be obtrusive and stigmatising for many older people. Conclusion: The findings highlighted a paucity in targeted policies which consider older people’s specific digital interests. There is also a need for a better understanding of the effects of ICT-based care on older people’s quality of life

Effects of digital engagement on the quality of life of older people

It is often asserted that older people's quality of life (QOL) is improved when they adopt information and communication technology (ICT) such as the Internet, mobile phones and computers. Similar assumptions are made about older people's use of ICT-based care such as telecare and telehealth. To examine the evidence around these claims, we conducted a scoping review of the academic and grey literature, coving the period between January 2007 and August 2014. A framework analysis approach, based on six domains of QOL derived from the ASCOT and WHOQOL models, was adopted to deductively code and analyse relevant literature. The review revealed mixed results. Older people's use of ICT in both mainstream and care contexts has been shown to have both positive and negative impacts on several aspects of QOL. Studies which have rigorously assessed the impact of older people's use of ICT on their QOL mostly demonstrate little effect. A number of qualitative studies have reported on the positive effects for older people who use ICT such as email or Skype to keep in touch with family and friends. Overall, the review unearthed several inconsistencies around the effects of older people's ICT use on their QOL, suggesting that implicit agreement is needed on the best research methods and instrumentation to adequately describe older people's experiences in today's digital age. Moreover, the available evidence does not consider the large number of older people who do not use ICT and how non-use affects QOL

What kind of home is your care home? A typology of personalised care provided in residential and nursing homes

This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three ‘types’ of personalised care in care homes. These conceptualise the care home as an ‘institution’, a ‘family’ and a ‘hotel’. We have added a fourth type, the ‘co-operative’, to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the ‘family’ model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost

Independent assessment of improvements in dementia care and support since 2009

The Department of Health commissioned a team from the London School of Economics and Political Science and the London School of Hygiene and Tropical Medicine to consider progress in dementia care since 2009. We were asked to focus particularly on three areas: improvements in diagnosis and post-diagnostic support, changes in public attitudes, and developments in research. Two major policy documents provide the context: the National Dementia Strategy 2009, which is now finished, and the Prime Minister’s Challenge on Dementia 2012, which superseded it

Unpaid carers of people with dementia and information communication technology: use, impact and ideas for the future

Objectives Several 100,000s of people living with dementia in the UK are cared for at home by a spouse or relative. Few studies have considered the ICT needs and experiences of unpaid carers. This study explores the types of ICT unpaid carers use, the ways they use ICT, the impact of ICT-use, and their ideas for how ICT could be more supportive of their role as a carer. Methods Six focus groups with 32 unpaid carers of people living with dementia discussed their experiences of – and barriers to – using ICT. Transcripts were analysed thematically according to three types of ICT (mainstream, accessible and formal) and five functions (supporting domestic tasks, care management, monitoring, communication and information and education). Results Participants predominantly used mainstream ICT devices such as laptops and smartphones and internet-enabled applications including videoconferencing and social media platforms to support their daily activities and assist them in their caring role. A few participants discussed using accessible devices such as memory clocks and formal telecare and care-phone services for care management and monitoring functions. Participants’ ideas for improvements centred on personalised communication applications that facilitate remote interactions and promote persons living with dementia’s independence. Others expressed concerns about the growing need to use ICT to access formal care services and the inadequacy of the ICT infrastructure in some care homes. Conclusions Unpaid carers mostly turn to readily available mainstream ICT to support their personal and care activities. Further research is required to understand the social impact of the increasing reliance of ICT across health, social and residential care service sectors. Improved cooperation between unpaid carers, technology developers and care services providers could align ICT development to the needs and experiences of families living with dementia and assist unpaid carers with identifying ICTs that optimally support their personal circumstances

Unpaid carers of people with dementia and ICT: use, impact and ideas for the future

Objectives: Several 100,000s of people living with dementia in the UK are cared for at home by a spouse or relative. Few studies have considered the ICT needs and experiences of unpaid carers. This study explores the types of ICT unpaid carers use, the ways they use ICT, the impact of ICT-use, and their ideas for how ICT could be more supportive of their role as a carer. Methods: Six focus groups with 32 unpaid carers of people living with dementia discussed their experiences of – and barriers to – using ICT. Transcripts were analysed thematically according to three types of ICT (mainstream, accessible and formal) and five functions (supporting domestic tasks, care management, monitoring, communication and information and education). Results: Participants predominantly used mainstream ICT devices such as laptops and smartphones and internet-enabled applications including videoconferencing and social media platforms to support their daily activities and assist them in their caring role. A few participants discussed using accessible devices such as memory clocks and formal telecare and care-phone services for care management and monitoring functions. Participants’ ideas for improvements centred on personalised communication applications that facilitate remote interactions and promote persons living with dementia’s independence. Others expressed concerns about the growing need to use ICT to access formal care services and the inadequacy of the ICT infrastructure in some care homes. Conclusions: Unpaid carers mostly turn to readily available mainstream ICT to support their personal and care activities. Further research is required to understand the social impact of the increasing reliance of ICT across health, social and residential care service sectors. Improved cooperation between unpaid carers, technology developers and care services providers could align ICT development to the needs and experiences of families living with dementia and assist unpaid carers with identifying ICTs that optimally support their personal circumstances

Facilitators of, and barriers to, personalisation in care homes in England: evidence from Care Quality Commission inspection reports

The personalisation of residential care services is based on three broad principles of valuing personal identity, empowering resident decision-making and fostering care relationships. We analysed 50 Care Quality Commission care home inspection reports to identify factors that the reports indicate facilitate or hinder the delivery of personalised residential care in England. Findings suggest that the provision of personalised services is affected by staff skills, attitudes and availability, as well as the quality of care home leadership. Future care policy should consider addressing external pressures facing the care home sector, including inadequate funding and too few staff, to mitigate barriers to delivering high-quality, personalised care

Explaining low uptake of direct payments in residential care: findings from the evaluation of the Direct Payments in Residential Care Trailblazers

In 2012, the Government invited local councils in England to participate in a pilot programme to test direct payments in residential care. While the programme was set up to allow for comprehensive summative evaluation, the uptake of direct payments in residential care was substantially lower than anticipated, with only 40 people in receipt of one at the end of the programme. Drawing on qualitative data collected for the evaluation, this paper aims to understand better the barriers to implementing direct payments in residential care. Evidence from the use of direct payments in domiciliary care identified gatekeeping by council frontline staff as a major barrier for service users to access direct payments. Our findings suggest that, whilst selectivity of both service users and providers was an integral part of the programme design, gatekeeping does not fully explain the poor take-up. Other factors played a part, such as lack of clarity about the benefits of direct payments for care home residents, the limited range and scope of choice of services for residents, and concerns from care providers about the financial impact of direct payments on their financial sustainability