Chapter 1 Introduction

Digital technologies shape our embodied lives and affect our knowledge of the self and the world. The introductory chapter of the book presents the state of the art in the research on digitalisation of health and social care work, with a focus on care for older people. In ageing societies, understanding what it takes to introduce and use digital technologies can pave the way to a successful, sustainable, and equally accessible system of social care and healthcare provision for older people. The chapter discusses some of the limitations in the present discussion and how the book at hand aims to address these gaps. The chapter proposes that living in an increasingly digitalised world requires digital agency, that is the individual’s ability to control and adapt to their surroundings, and to critically address technological determinism in the everyday life. The chapter ends with an overview of the book’s subsequent chapters that demonstrate different aspects to service users’ and care workers’ digital agency based on recent studies of digital technologies in care for older people

Chapter 1 Introduction

Digital technologies shape our embodied lives and affect our knowledge of the self and the world. The introductory chapter of the book presents the state of the art in the research on digitalisation of health and social care work, with a focus on care for older people. In ageing societies, understanding what it takes to introduce and use digital technologies can pave the way to a successful, sustainable, and equally accessible system of social care and healthcare provision for older people. The chapter discusses some of the limitations in the present discussion and how the book at hand aims to address these gaps. The chapter proposes that living in an increasingly digitalised world requires digital agency, that is the individual’s ability to control and adapt to their surroundings, and to critically address technological determinism in the everyday life. The chapter ends with an overview of the book’s subsequent chapters that demonstrate different aspects to service users’ and care workers’ digital agency based on recent studies of digital technologies in care for older people

An “ultimate partnership”:Older persons’ perspectives on age-stereotypes and intergenerational interaction in co-designing digital technologies

AimThere is often a gap between the ideal of involving older persons iteratively throughout the design process of digital technology, and actual practice. Until now, the lens of ageism has not been applied to address this gap. The goals of this study were: to voice the perspectives and experiences of older persons who participated in co-designing regarding the design process; their perceived role in co-designing and intergenerational interaction with the designers; and apparent manifestations of ageism that potentially influence the design of digital technology.MethodsTwenty-one older persons participated in three focus groups. Five themes were identified using thematic analysis which combined a critical ageism ‘lens’ deductive approach and an inductive approach.ResultsAgeism was experienced by participants in their daily lives and interactions with the designers during the design process. Negative images of ageing were pointed out as a potential influencing factor on design decisions. Nevertheless, positive experiences of inclusive design pointed out the importance of “partnership” in the design process. Participants defined the “ultimate partnership” in co-designing as processes in which they were involved from the beginning, iteratively, in a participatory approach. Such processes were perceived as leading to successful design outcomes, which they would like to use, and reduced intergenerational tension.ConclusionsThis study highlights the potential role of ageism as a detrimental factor in how digital technologies are designed. Viewing older persons as partners in co-designing and aspiring to more inclusive design processes may promote designing technologies that are needed, wanted and used

Wearables measuring electrodermal activity to assess perceived stress in care:A scoping review

Background:Chronic stress responses can lead to physical and behavioural health problems, often experienced and observed in the care of people with intellectual disabilities or people with dementia. Electrodermal activity (EDA) is a bio-signal for stress, which can be measured by wearables and thereby support stress management. However, the how, when and to what extent patients and healthcare providers can benefit is unclear. This study aims to create an overview of available wearables enabling the detection of perceived stress by using EDA.Methods:Following the PRISMA-SCR protocol for scoping reviews, four databases were included in the search of peer-reviewed studies published between 2012 and 2022, reporting detection of EDA in relation to self-reported stress or stress-related behaviours. Type of wearable, bodily location, research population, context, stressor type and the reported relationship between EDA and perceived stress were extracted.Results:Of the 74 included studies, the majority included healthy subjects in laboratory situations. Field studies and studies using machine learning (ML) to predict stress have increased in the last years. EDA is most often measured on the wrist, with offline data processing. Studies predicting perceived stress or stress-related behaviour using EDA features, reported accuracies between 42% and 100% with an average of 82.6%. Of these studies, the majority used ML.Conclusion:Wearable EDA sensors are promising in detecting perceived stress. Field studies with relevant populations in a health or care context are lacking. Future studies should focus on the application of EDA-measuring wearables in real-life situations to support stress management

Gebruik van de RAND-36 bij zelfstandig wonende ouderen kan leiden tot een onderschatting van de ervaren gezondheidstoestand

De algemene gezondheidstoestand van de bevolking wordt veelal gemeten met de RAND-36 item Health Survey. De afkorting RAND verwijst naar de Amerikaanse onderzoeksorganisatie voor ‘Research and Development’ die de vragenlijst ontwikkelde. In 2012 is door Fontys en partners een longitudinaal veldonderzoek gestart met als doelstelling het in kaart brengen van factoren die van invloed zijn op het gebruik van technologie ter bevordering van het zelfstandig wonen door ouderen. In totaal worden 50 deelnemers van 70 jaar of ouder, vier jaar lang elke acht maanden geïnterviewd. Tevens worden er enkele vragenlijsten afgenomen waaronder twee vragen uit de RAND- 36 waarvan een item luidt: ‘Ik ben net zo gezond als andere mensen die ik ken’. Tijdens dit onderzoek is gebleken dat sommige deelnemers die zichzelf gezonder vinden dan andere mensen die zij kennen, de stelling ontkennend beantwoorden maar daarmee onbedoeld een antwoordcategorie invullen die zich vertaalt in een lagere score voor de ervaren gezondheidstoestand. Het op deze manier invullen van dit item kan daardoor leiden tot een onderschatting van de algemene gezondheidstoestand van ouderen

Sociodemographic Factors Influencing the Use of eHealth in People with Chronic Diseases

Alongside the growing number of older persons, the prevalence of chronic diseases is increasing, leading to higher pressure on health care services. eHealth is considered a solution for better and more efficient health care. However, not every patient is able to use eHealth, for several reasons. This study aims to provide an overview of: (1) sociodemographic factors that influence the use of eHealth; and (2) suggest directions for interventions that will improve the use of eHealth in patients with chronic disease. A structured literature review of PubMed, ScienceDirect, Association for Computing Machinery Digital Library (ACMDL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted using four sets of keywords: “chronic disease„, “eHealth„, “factors„, and “suggested interventions„. Qualitative, quantitative, and mixed-method studies were included. Four researchers each assessed quality and extracted data. Twenty-two out of 1639 articles were included. Higher age and lower income, lower education, living alone, and living in rural areas were found to be associated with lower eHealth use. Ethnicity revealed mixed outcomes. Suggested solutions were personalized support, social support, use of different types of Internet devices to deliver eHealth, and involvement of patients in the development of eHealth interventions. It is concluded that eHealth is least used by persons who need it most. Tailored delivery of eHealth is recommended

Coping with complexity: Designing homes and facilities for frail and dependent elderly in a changing society

Demographic changes, technological innovations, and plurality in values place architects and consulting engineers for large challenges. This chapter unravels the different types of complexity that play a role in designing homes for frail elderly and facilities for adults with dementia. Five types of complexity are identified as follows: aspectual complexity, contextual complexity, stakeholder-related complexity, value-based complexity, and technological complexity. It is shown that this model guides architects and consulting engineers in analyzing and designing complex homes and facilities

CeHRes Roadmap to Improve Dementia Care

Dementia and technology, how do they go together? Technology might be a solution to support health and well-being for patients. Although promising, a lot of technologies are not used due to higher cost than expected, ineffective implementation, and technologies that do not work or help people in a positive way. To improve the adoption and use of technologies for health and well-being, we created a roadmap to guide the process of development, evaluation, and implementation (van Gemert- Pijnen et al. 2011). The roadmap is based on reviews of existing frameworks for eHealth and prior research about development, design, and implementation and applied in several research and development projects (van Gemert-Pijnen et al. 2013). In this chapter we elaborate on the use of the CeHRes roadmap for dementia care. First, we will describe the CeHRes roadmap and its principles for development, then we present a case study to demonstrate how the roadmap was used in practice, and finally we will reflect upon the case study by means of lessons learne

Factors influencing acceptance of technology for aging in place: A systematic review

Purpose To provide an overview of factors influencing the acceptance of electronic technologies that support aging in place by community-dwelling older adults. Since technology acceptance factors fluctuate over time, a distinction was made between factors in the pre-implementation stage and factors in the post-implementation stage. Methods A systematic review of mixed studies. Seven major scientific databases (including MEDLINE, Scopus and CINAHL) were searched. Inclusion criteria were as follows: (1) original and peer-reviewed research, (2) qualitative, quantitative or mixed methods research, (3) research in which participants are community-dwelling older adults aged 60 years or older, and (4) research aimed at investigating factors that influence the intention to use or the actual use of electronic technology for aging in place. Three researchers each read the articles and extracted factors. Results Sixteen out of 2841 articles were included. Most articles investigated acceptance of technology that enhances safety or provides social interaction. The majority of data was based on qualitative research investigating factors in the pre-implementation stage. Acceptance in this stage is influenced by 27 factors, divided into six themes: concerns regarding technology (e.g., high cost, privacy implications and usability factors); expected benefits of technology (e.g., increased safety and perceived usefulness); need for technology (e.g., perceived need and subjective health status); alternatives to technology (e.g., help by family or spouse), social influence (e.g., influence of family, friends and professional caregivers); and characteristics of older adults (e.g., desire to age in place). When comparing these results to qualitative results on post-implementation acceptance, our analysis showed that some factors are persistent while new factors also emerge. Quantitative results showed that a small number of variables have a significant influence in the pre-implementation stage. Fourteen out of the sixteen included articles did not use an existing technology acceptance framework or model. Conclusions Acceptance of technology in the pre-implementation stage is influenced by multiple factors. However, post-implementation research on technology acceptance by community-dwelling older adults is scarce and most of the factors in this review have not been tested by using quantitative methods. Further research is needed to determine if and how the factors in this review are interrelated, and how they relate to existing models of technology acceptance

Smart Living in Dementia Care

In order to provide adequate care and housing to the growing number of people with dementia, new technologies are necessary to provide good care and reduce the costs for these care services. Numerous technologies are available, which decrease the need for care and increase the self-reliance of clients and support relatives or professional carers. This chapter discusses the use and implementation of e-health technologies and provides an overview of recommendations on how to start using technology for people with dementia in an efficient and effective way. E-health technologies may reduce the number of falls and improve one’s quality of life, both for people with dementia and their family carers. For family carers, the technology makes life easier and accounts for a reduction of time spent on caring, improved independence, and a diminished occurrence of depressive feelings. In the field of work satisfaction of professional carers, little research has been done. There are many design and implementation challenges concerning technology for people with dementia, which can lead to the success or failure of technology in dementia care