What Do the Elderly Need?
Objective: Discuss three of the most significant culturally constructed problems confronting elderly people and those around them. Give examples of variation in the types and extent of problems among nations, subcultures within nations, ethnicities, social classes, and genders. What three social redesigns would you recommend be considered to ameliorate the problems and how could the social design component complement improved technical design? How will "outside-in" methodology influence your design?
Paper summary: Technology is becoming more and more sophisticated with each coming year, so Americans are slowly extending their life span. The slow but steady increase in life expectancy, coupled with the increasing birth rate, leads to an exponential growth in population. The increase of elderly in society leads to a plethora of culturally constructed problems. The ones I chose to focus on are long term care for the elderly, the concept of isolation, and isolation and the lack of emotional support.
Title: What Do the Elderly Need: An "Outside-In" Design Methodology
Due Date: October 22, 2007
Word Count: 2,853
With new advances in technology and medicine, humans are slowly increasing their life expectancy. In the United States, the average American currently has a life span of almost 78 years, as opposed to only 70 years in 1950 (NCHS, 2007). The slow but steady increase in life expectancy, coupled with the birth rate of about 14.16 births per 1,000 population leads to an exponential increase in population growth, and an unbalanced ratio between the older and younger generations (CIA, 2007). With so many aged people in society, culturally constructed issues arise. As people grow older, many become disabled as they start to lose some of their abilities, which leads to problems with daily activities and simple tasks that they would have been able to perform on their own in the past. When this occurs, the elderly must become dependent on others, ranging from family and friends to care-givers at home and at nursing homes. However, as the population slowly rises, the number of older people increases as the pool of workers and care-givers shrinks. In this sense, long term care for the elderly is becoming a significant cultural and social policy issue. Another cultural issue that arises is the concept of isolation. As a whole, society supports independence and looks down upon people that need help. This, along with loneliness and lack of emotional support and companionship, begins to isolate the elderly, which may lead to psychological problems and adverse health outcomes. A solution to the problem of isolation would be to increase the amount of social activities for the elderly to integrate them into society. The second solution is for society in itself to be more open to new ideas by redesigning the teaching of cultural values and respect from the younger generation up. A solution to resolve the issues related to long term care is to create new assistive technology, which puts the elderly on the road to regained independence.
In 1985, 5.5 million functionally disabled elderly were living in the community while 1.3 million were living in nursing homes. These figures are predicted to rise to 10.1 million and 2.5 million respectively by 2020 (Elliot, 1991.) As shown by these alarming statistics, long term care is becoming an important factor. Long term care involves a large range of social, medical, and services to helping the impaired older generation with daily actions and simple activities such as bathing and using the bathroom to preparing and eating meals. Ways of implementing care can range from long-term nursing through home-health care to community nursing homes. Long term care is a factor that "acts to modify the disablement process, reducing the severity of disability" (Hoenig, 2003). and is often is the factor that makes the difference for whether an elderly person will have the option to live in the community with help, or instead live in a nursing home. While long-term nursing is generally beneficial to the elderly, the number of workers is becoming too scarce to compensate for the quickly increasing number of aged people who desire independence in the community. Because of this, long term care for the elderly quickly becomes a significant issue.
In America, care was traditionally provided through the extended family. However, as life expectancy increase and family size decreases over the generations, the burden of elderly care is slowly being shifted over to the state or other institutions. The most evident elements the state and institutions help to provide are full-time nurses to help the elderly at home, fund nursing homes to house and care for a large number of people at the same time, and hospital care.
Nursing homes are often the last resort for the older generation, as there are so many to treat that physicians are less attentive and often careless. Every month, one out of ten nursing home residents suffers a medication-related injury, and 73% of the most severe injuries could have been easily prevented. This means that out of the nation's 1.6 million nursing home residents, there at 1.9 million drug-related problems per year, with 86,000 of them being fatal or life-threatening (Dembner, 2005.) For example, in 2004, 48 out of about 480 homes in Massachusetts were reported for errors in medicine distribution. One case involved a patient who had water build-up because he missed 22 doses of diuretic over 11 days, which put the patient in respiratory distress. This happened because the doctor's orders to increase the dosage was carelessly forgotten to be entered into the patient's medical record (Dembner, 2005.) Another incident occurred in 2005, when a 76-year-old woman because a worker administered a diabetic's medicine to her because he "forgot to check her armband." The California Department of Health Services (CDHS) blamed the nursing home as well, and reported that "the facility failed to properly assess the dangers of a medication error and failed to notify the resident's physician promptly of the error, which was life-threatening" (Brayton Purcell LLP, 2007). The situation is worse in Scotland, as one out of seven nursing homes there give their patients medication without consent. When surveyed, 14 out of 101 care homes admitted to "covertly" administering drugs. Another way to look at these statistics is that out of the 1,500 nursing homes, more than 200 have the potential to be giving the drugs without consent (Gray, 2006.) Also, a study in the United Kingdom in 2003 discovered that 22,000 elderly people where being given "powerful anti-psychotics" for no medical reason (Gray, 2006.) This is unacceptable, and something must be done to stop this, as peoples' lives are at stake.
The inadequateness of nursing homes is one of the reasons most seniors prefer home care. Home care is more expensive, but also the most desired, as the elderly would like to stay in their homes for as long as possible. There, they can receive immediate care and help the patients with daily activities and often provide therapy and support (Anderson). Care for the aged involves services such as meals, socialization, personal care, light housekeeping in the home, transportation, emergency systems, and friendly visiting (Helpguide, 2007).
However, as at home care for the elderly is becoming scarcer and nursing homes are undesirable, a solution must be found to help the aged become more independent. The best solution for this is for the government to put more money into researching and developing new and improved assistive technology. As assisted technology (AT) is generally designed for the disabled, we should focus our efforts towards designing for the elderly first. Sometimes, AT can make the difference between independent living and long-term nursing and even home-health care. For many elderly, when AT is implemented correctly into their lives, it gives them the ability to perform simple tasks, such as eating and getting around the house.
So what is AT? Assisted technology is defined as "any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently" (Administration on Aging, 2003). The simplest forms of AT can include devices such as a walker to move around the house, a hearing aid to amplify sound, and modified utensils that are easier to grip to help with eating. One example is a form of AT that solves the issue of internet accessibility for the visually impaired. Fire Vox, a free "screen-reading extension" for Mozilla Firefox is designed to "accommodate different users with different needs" (Chen, 2006). The program involves a variety of functions such as keyboard activated commands that can be easily reconfigured to avoid confusion with other software aids, a convenient on-screen highlighting feature that keeps track of where it is reading from, and close integration with Firefox, always providing a live view of the webpage instead of a screenshot (Chen, 2006.) Another example is an 85-year-old woman named Ida P. While she is energetic and smart, she has severe arthritis and is unable to walk in and out of her apartment alone. She has the option of either choosing intensive home-care, where a worker would shop and do errands for her; living in a nursing home where the staff will prepare meals for her and help her move around; or a form of assistive technology such as a wheelchair or walker which would allow her to remain independent. Between these choices, Ida would most likely choose the assistive technology. (Elliot, 1991.) As society has a tendency to look down upon those that need assistance, while AT is a solution to combat the shrinking pool of long-term care workers, it can ultimately become a way for many elderly to decrease their dependence on the workers and shift their needs to AT, becoming more independent.
One of the main reasons that society views the elderly negatively is because of "the stereotyped view that deterioration is inevitable" (Elliot, 1991.) Sociologists claim that this bias comes from the fact that since many of the older people are no longer active in the workforce, society believes that since they are no longer contributing to the community, so investments to improve their functional abilities are not worth the cost. As discussed in class, since America generally favors a fast-paced, independent society, Americans have the tendency to judge people with disabilities. To solve this cultural problem, as a whole, society needs to change their outlook on the elderly and put more into developing AT, which in turn would make the elderly more independent, thus making them more productive members of society and allow them to gain more self respect and acceptance in the community.
There still exists a problem, however. The aged find it hard to get used to the new technologies. According to Laura N. Gitlin, Ph.D., interviews with members of the older generation showed that there are many reasons why the elderly accept or reject a certain piece of AT. These factors involve the extent of the disability, the nature of the environment, including physical and social characteristics, and the demands of a task, as well as the aesthetic quality, which contains problems such as ease of use, durability, and quality (Gitlin, 1995.) Also, social attributes play a large part in acceptance, as "cultural judgments concerning independence and dependence, having or not having a disability, seem to represent powerful influences on whether devices are accepted into a person's daily public and private routines" (Gitlin, 1995.) The elderly do not want to attract attention, which means that if the aesthetics of a product show that it is obviously a form of assistive technology, they would rather use it in the comfort of their own home, and would be unwilling to take it outside.
To solve this issue, designers need to find a better and more universal design. Universal design, defined as "the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design" (RESNA 2007), involves seven important principles while designing for a society. These include equitable use, flexibility in use, simple and intuitive use, perceptible information, tolerance for error, low physical effort, and size and space for approach and use (RESNA, 2007). These principles must be taken into account to create a good product. Also, the new design must be efficient, reliable and durable: simple and easy to operate for people with disabilities. The directions must be simple enough for the elderly to figure out on their own, as the problem that AT is supposed to solve is to make the elderly more independent, so they don't want to have to ask someone else how to use it. For more complicated devices, a smooth system of coordination must be implemented to teach the aged how to use them. It is a large problem that people with disabilities and their friends and families lack knowledge of the use of AT and support necessary to be able to gain the benefits from them (Morrissey, 1989). The new system would be able to solve this problem. The product and technology must also be publicized with more information available to consumers, so more would trust them and be willing to use them.
The biggest thing to keep in mind when designing assistive technology for the older generation, however, is that a high level of interactivity with society is a plus. While AT is a great help to those with disabilities to help them become more independent, it can also be viewed as a way to become more reclusive, as human aid is not needed anymore. According to the "Confidential Summary Report" read in class, AT should "not replace, but ought to supplement, contact with people." AT must be used as an aid, not as a replacement to contact with people, as the elderly people's "needs for self belonging, self-perception, and socialization" must also be attended to.
Another culturally constructed issue in our society today is the issue of isolation among the elderly. In many other cultures, such as the Japanese and Chinese, "elderly people are revered and their advice is sought and respected" and age is associated with wisdom and knowledge (Day). In general, American society glorifies youth and fears old age, which can be seen in our media. For example, the stereotype of an old person is weak, bumbling and indecisive, and we "laugh at their misdeeds and forgive their mistakes knowing in the back of our minds that they are old and can't help themselves," (Day). This is because we view them as less capable as the younger generation, which is the primary reason for retirement – because employers and society as a whole believe that older workers are no longer useful or productive (Day). Even the elderly are falling victim to this perception of them and instead of becoming leaders in their families or community, many begin to stop taking responsibility for their decisions and rely on their children to take the responsibility for them. This problem, combined with increasing disability and loss of mobility can often cause worsening social networks and a loss of support from others, which ultimately causes isolation (Biocca, 2001).
One of the results of isolation is late-life depression. Late-life depression is apparent in about 6 million senior citizens in America, but only 10% receive treatment. Depression in the elderly is very likely to lead to suicide, as suicide rates in people between ages 80-84 is more than twice that of the general population (Healthyplace). Also, research has proved that "every unit increase in perceived emotional support and companionship was associated with a 97 percent and 91 percent decrease, respectively, in the odds of having a heart condition" (Ham, 2002.) When 180 elderly men and women aged 58 to 90 were asked to rate their loneliness level and availability of emotional support and companionship, the results showed a "significant correlation among loneliness, lack of emotional support and lack of companionship and heart disease," which basically means that depression was more prevalent among the elderly living alone, or in isolation. Also, the study showed that having just one other person around for emotional support considerably reduced the risk of heart disease (Ham, 2002.)
A solution is needed to combat the issue of isolation. We need to take steps to implement more productive and social activities for the elderly in our community. A point that came up in class was that many elderly workers do not retire because they have a strong passion for their jobs, and that in some cases, work can even be considered a social activity. Also, according to a study of social and productive activities of elderly Americans conducted in 1999, researchers concluded that "social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do" (Glass, 1999). Social activities can be implemented in senior centers, which would allow the elderly to socialize with people their own age instead of just their family. Studies have shown that socializing is a major motivation for most older people to maintain an active social life, and that senior centers let them find more friends and people with the same interests (Biocca, 2001).
Another, more general solution is for society as a whole to be more open to new ideas. The way society views elderly people should be reconstructed and redesigned to be more welcoming and respectful. Family values and respect should be taught from the youngest generation up, so these values can be slowly implemented into the system. Younger children are more open to new ideas, so if they grow up with these new values, slowly society will become more accepting.
These culturally constructed problems related to the elderly are an issue that needs to be addressed in our society. While they are a huge issue, these issues are not impossible to resolve. Society just needs to be pointed in the right direction and have the correct mindset to improve these situations through assistive technology, new social activities, and teaching new cultural values. However, none of this can be done without everyone, including the senior citizens, having a positive frame of mind and working together towards a tangible solution.
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© Copyright 2007
Tiffany Hu
Product Design and Innovation 2011
