Introduction

We live in a world where technology is increasingly intelligent, pervasive, and connected. These extend to virtually every aspect of health and health care, such as enabling earlier and more accurate diagnosis, enhancing treatment and evaluation, enabling function and activity participation, and supporting general health and wellness. As populations age, the health changes associated with aging become more common. Technology promises to play a central role in enabling older adults to enhance or maintain their preferred lifestyles or adapt to age-related changes, and, more broadly, to manage the increasing demand on care providers and the health care system.

As the name suggests, gerontechnology is the intersection of the fields of gerontology and technology. Gerontechnology is a multidisciplinary field that aims to produce technology to support the needs of aging adults.¹ Technologies do not have to be specifically designed for older adults to be considered gerontechnology; a technology can be so considered if it is useful to older adults. As such, gerontechnology encompasses a broad range of applications, ranging from relatively simple devices, such as grab bars and walking aids, to complex systems, such as home-based semi-autonomous monitoring of vital signs. Other applications include devices and systems that foster social connectivity and participation in society, such as tablet computers and smartphones. Care providers are encouraged to think beyond what is typically considered to be a gerontechnology to encompass any technology that can support older adults, that is, to recommend a technological solution because it is a good match for the individual and the problem rather than choosing a technology that is classified as being “for older adults.” Finally, gerontechnology also includes environmental design and “built environments” that support independence, healthy living, and inclusion (see chapter 132).

Developers are putting increasing efforts into creating technologies that are usable by, and useful to, older adults and their social and care networks.² Their needs and use of technology vary, reflecting variability in health status from active individuals living in their own homes to very frail individuals with health challenges that necessitate ongoing caregiver assistance in an institutional setting. Furthermore, older adults cannot be viewed as a single cohort with respect to their knowledge, use, or perceptions regarding technology. In a recent study of technology use (e.g., Internet and broadband) among Americans 65 years old and older, it was concluded that in general, younger older adults (i.e., less than 80 years of age) had experience and enthusiasm toward technology.³ This trend toward technically literate older adults is likely to continue as technology becomes increasingly pervasive. Moreover, as the large baby boomer cohort ages, it is likely that more technologies will be developed that reflect their needs, desires, and abilities.

Whereas not all gerontechnology is geared toward care provision, much of it specifically focuses on the prevention, detection, monitoring, and support of individuals with acute and chronic health conditions. These types of technologies may have one or more users, which can include the older adults themselves and, if required, their family, friends, and caregivers. Family and friends may interact with a technology as a peer (i.e., working and sharing the experience together with the older adult) or may be an informal (unpaid) caregiver, who is using the technology to provide support to the older adult. Formal caregivers, such as health care professionals and paid support workers, may also be users. Both formal and informal caregivers may be responsible for initializing and maintaining the technology but also may find the technology supports their role in enabling older adults in their care to live where they choose and can mitigate informal caregivers’ emotional stress or physical injury.⁴ Informal caregivers of older adults are often older themselves, and technology is often useful to address some of their own care concerns. As such, gerontechnologies represent part of a solution to address the current trend of decreasing caregiver numbers for older adults with chronic health conditions associated with the global population aging.

This chapter begins with a discussion of the role of health care professionals in gerontechnology, followed by considerations regarding the provision of gerontechnology. Examples of gerontechnologies are then given before the chapter concludes with thoughts regarding future trends in the field.

Roles of Health Care Professionals

While many consumer technologies and some assistive technologies are privately and independently procured, health care professionals usually play a central role in the provision of appropriate technologies to support the often complex health and care needs of older adults. Ideally, health care professionals will work closely with older adults and others in their care network to determine treatment plans that may include technology recommendations. Provision typically entails (1) identification of need; (2) general and/or specialist assessment; (3) prescription, acquisition, training and/or education; and (4) follow-up and/or ongoing monitoring. It is the role of health care professionals, within the scope of their practice, to collaborate with older adults and, if necessary, their caregivers (who may be responsible for seeking out, procuring, using, maintaining, or otherwise managing the technologies) to make informed decisions in the selection and use of suitable technologies. Active involvement of older adults and their care network in the provision process helps to increase the likelihood that the person-technology fit is a good one and offers people who will be using the technology a chance to participate in the process. This can result in improved outcomes and can increase the likelihood that users will adopt recommended technologies.⁵ Several disciplines are involved in the provision of gerontechnology, and the extent, duration, and stage of their involvement depends on the specific activities that an older adult or caregiver needs to carry out, the technology options, the training of specific professionals, the jurisdiction, and the individual’s health care coverage.

Several health care professionals can be involved in technology recommendation, procurement, and implementation and can include physicians (including various specialists such as geriatricians, physiatrists, and others), physical therapists, occupational therapists, speech and language pathologists, audiologists, nurses, and social workers. In some specialized clinics, rehabilitation engineers and technologists are involved as well. In many care settings, such as acute care, community/home care, rehabilitation, and residential care, interdisciplinary teams work together in different permutations in the provision process. As with a transdisciplinary approach, there may be significant overlap and interchangeability in roles depending on the complexity of the technology and setting.⁶ For example, when dealing with a reduced mobility case in community practice, a physician or nurse may be the first to identify the need for a walker or wheelchair and write a referral for a patient to rent or purchase standard equipment. In more complex cases, the referral may go to a specialist wheelchair clinic where an occupational therapist and a rehabilitation engineer may be involved in the acquisition of customized wheelchair seating equipment. In these situations, the occupational therapist and rehabilitation engineer involved will require substantial background information from medical professionals (including diagnoses, prognosis, contraindications, medications, and other therapies), social workers (including social history, living environment and supports, financial information and funding sources), and physical therapists (including physical functioning and current treatment programs). Equipment vendors can be important as well, particularly with highly specialized and customized technologies.

Health care professionals can also play an invaluable role in gerontechnology development. Gerontechnologies may address complex needs from a broad spectrum of users whose abilities, resources, and intended applications vary considerably. Creating a useful and usable technology requires a cross-discipline effort, where experts from relevant fields combine their knowledge to develop effective solutions. This approach involves expert knowledge regarding the problem that needs to be addressed, the probable way the technology will be used, and the features and functions that could be useful to a range of users. Health care professionals have a first-hand understanding of the physiologic changes, functional changes, and social issues of older adults as well as the ability to identify successful intervention outcomes and ways to achieve them; this knowledge is invaluable to guiding how to build appropriate technology. Contingent on the need to be addressed and the complexity of the technology, disciplines that may be involved in development include gerontologists, psychologists, engineers (e.g., biomedical, human factors, mechanical, electrical, or robotics engineers), computer scientists, health economists, and social scientists. Similar to the provision process of involving older adults and their care networks, involving end users in a user-centered design approach often results in technology that better meets needs.⁷ Many developers employ user-centered design practices that involve the active engagement of end users throughout the development process to ensure that requirements for features, functions, usability, and aesthetics are reflected in the final product.

Advocacy is another important way that health care professionals are involved in gerontechnology. Ongoing issues with respect to older adult care across many jurisdictions include the following: improving services or access to services for the provision of technology that improves health and well-being; improving access to, availability of, and funding for technologies that demonstrate effectiveness and potential effectiveness; ensuring standards are in place for manufacturing and testing of technologies to be available on the market; improving and supporting translation of innovative technologies in development to address unmet needs or improve health and economic outcomes. Furthermore, health care professionals can play critical roles in public education, improving awareness of the availability of gerontechnologies and their application; dispelling ageist attitudes and beliefs in the public and in policy that older adults do not like, cannot use, or do not benefit from new technologies; and supporting older adults, caregivers, and other health care providers in learning about gerontechnologies.

Matching Technology to Users

Considering the widespread marketing of technologies, health care professionals are important in helping consumers to navigate and investigate new technologies. For a technology to be useful and usable, it must match an individual’s context, including their needs, abilities, resources, environment, and perceptions. In other words, the technology must address a problem a person is having; be something he or she is able to procure, implement, and operate; and be perceived as beneficial. Technologies that do not fulfill these criteria are of little use because they are inaccessible or will be abandoned by intended users. Moreover, it is important to recognize that an individual’s context is dynamic; his or her needs, abilities, environment, resources, and perceptions are dependent on a myriad of factors and will change over time. Hence a technology that works well at one point may become unsuitable as the user’s context evolves, such as changes in his or her health, living arrangements, or personal support network.

A primary focus in providing and developing gerontechnology is to match the technology to the user, rather than to match a user to a technology. Appropriately matching a technology to the user tends to result in better outcomes, achieving the user’s goals, acceptance, and use. Several models or frameworks are relevant to the provision and development of gerontechnology, such as the Human Activity Assistive Technology (HAAT) model,⁶ Matching Person and Technology (MPT) model,⁸ Comprehensive Assistive Technology (CAT),^9,10 and the Canadian Model of Occupational Performance and Engagement.¹¹ These models typically involve the following domains: user, activity or goal, environment of use, and technology. In general, it is understood that users have a desired activity or goal, the environment may act as an enabler or disabler for users who may or may not have specific limitations for that activity or goal, and the matched technology can help to enable, modify, mediate, or otherwise allow users to carry out that activity or goal in that environment. Again, active involvement of the intended users in this process is critical.

Several considerations are necessary when examining the user domain. A technology not only will have a primary user but often may have one or more secondary user(s) as well. For example, a caregiver or health care provider (secondary users) may be involved in setting up and maintaining a fall detection system for an older adult (primary user). The multiple users’ physical and cognitive abilities, subjective needs and preferences, belief systems, resources (including social and financial supports), and goals need to be understood for a good technology match. It may also be important to understand the desired treatment approach, such as whether intervention objectives are remedial or compensatory in nature. For example, remedial goals may be to improve general physical tolerance or to improve attention span. Compensatory goals may involve performing an activity in a different way, such as using a wheelchair to enable ambulation when walking is no longer possible. Accounting for developmental aging and the conditions associated with aging, it is also important to consider the progressions in abilities, whether deterioration, maintenance, or improvements are anticipated.

There are also multiple considerations related to the activity domain. The nature of the targeted activity, whether it be related to taking care of oneself in daily activities, engaging in paid or unpaid work, or participating in recreational and social activities, may be highly variable and range from comparatively simple (e.g., pulling up one’s pants) to complex (e.g., managing finances). To be able to identify appropriate gerontechnology solutions, it is necessary to understand how the activity is typically carried out, how users prefer to carry out the activities, the necessary steps, the requirements to carry out the activity (e.g., cognitive load, time, and performance criteria), the contingencies, and the desired outcomes.

Within the environmental domain, it is useful to examine physical, social, cultural, and institutional factors.¹¹ Physical factors often entail structural features of the environment (e.g., stairs, width of doorways, textures of surfaces), lighting, noise, and smells. Characteristics in the physical environment may determine the need for technology and the types of technology that may be recommended. Social and cultural factors may include a group’s beliefs and values about a particular subgroup, situation, or technology and how members of groups behave in relation to these perceptions. Institutional factors include policies and laws. Social and cultural factors can be enablers or disablers for subgroups or individuals, and are often reflected in how the physical and institutional environments are constructed and what affordances are provided to those considered outside the group’s norms. For example, perceptions of older adults and individuals with disabilities can limit what services or technologies are offered and developed, can result in stigma perceived by older adults, and may influence the adoption or rejection of different interventions.

The assessment phase of provision described earlier informs the various stages that follow. Depending on the complexity of the technology, the next steps of provision may include selection, trials, education and training, acquisition, and/or follow-up or ongoing monitoring. The selection of an appropriate technology for the user depends on the assessment and several additional factors, such as the local availability and supports available for maintenance. Some technologies may also require an extensive trial, mock-up, and customization phase (e.g., power wheelchairs and environmental control units). Training and education in use are critical for ensuring users are actively involved in ongoing use of the technology by helping them to understand the rationale behind the recommendations and to ensure they are able to operate and use the technologies to achieve intended goals. Follow-up and ongoing monitoring phases evaluate the outcomes of the technology intervention to ensure that the specified goals of the users are achieved.

Some of the concerns with technology provision and development include issues of uptake, acceptance, use, and abandonment. Contrary to what may be believed, older adults are often accepting of using technology, if they believe that its use can be beneficial and it is easy to use.¹² Furthermore, age has not been found to be a good predictor of frequency of use of devices in the home.¹³ Assistive technology use or non-use may be the result of multiple factors that are personal, environmental, and technological. Personal factors may include need or perceptions of need, functional abilities and limitations, and beliefs, feelings, and experiences with respect to disability and technology.¹³ Often the goal of a technology may be to improve independence, but to its user it may also act as a reminder of their functional loss, which can discourage use. Environmental factors may include various characteristics of the environment or the activities within those environments that promote or deter use. Technology factors include features of the technology itself, such as its usability, aesthetics, and durability and overall match between the user and the environment.

Common reasons for using technology are that it makes activities easier, more comfortable, or more enjoyable to carry out; improves function and independence; and offers feelings of security and safety. When a user perceives that the benefits outweigh the costs for using the technology it is found to significantly increase continued technology use.⁵ A recent review explored the acceptance of electronic or digital technologies (e.g., sensors in home for activity monitoring, detection of wandering and falls, and e-health applications) for older adults living in the community and found factors at the preimplementation stage that seem to be related to acceptance.¹⁴ These factors included technology concerns, expected benefits, perceived need, alternatives to technology, social influence, and older adults’ characteristics. At a postimplementation stage, perceived need and social influences were still concerns, with many older adults indicating that they did not feel that they needed technology. Various reasons have been cited for not using or abandoning recommended assistive technology, including that the user’s functional abilities change, technology use depends on use of other technologies, education and training on how to use the technologies were insufficient, the technology is somehow changed (broken and not repaired/replaced or lost), the cost was high, the user prefers to be assisted by another person, or the person feels embarrassed.¹³

Abandonment of technology means that resources may not be used effectively or efficiently and user needs may not be adequately met. Ways of overcoming such challenges are to involve users in the development and provision of technologies. In the development of new technologies, the concerns for adoption and use need to be carefully considered and addressed in the design to minimize the potential for abandonment. Within the provision process, it has been found that satisfaction with the technology and sustained use were associated with whether or not the user was able to trial the technology before acquisition and if the users felt they were involved in the selection and decision-making process for technology acquisition.¹⁵ If a user has professional support (such as with education and training regarding use and maintenance), consideration for financial and funding concerns, and appropriate follow-up, they are more likely to continue using the technology.⁵ With regard to training in technology use with older adults, it is recommended that tasks be divided into smaller tasks to be learned in short sessions, skills are learned in the context in which they will be used, and ample time for practice and customization of devices is offered.⁵