Between October 2013 – November 2017, I was enrolled as a PhD. candidate in the Erasmus Mundus Interactive and Cognitive Environments programme at the Eindhoven University of Technology, The Netherlands and University of Genova, Italy. As part of my doctoral research, I had the opportunity to travel to Canada, the United States, China, Japan, Spain, Portugal, and England to fulfil my research obligations. In retrospect, I was very fortunate to be situated in a diverse landscape fashioned by a melting pot of cultures, all struggling to cope with an increasing ageing population. Upon reflection, the trends of population ageing were quite visible in these countries. To my surprise, many naive ageist assumptions were confounded by a battalion of strong, healthy, active, and well functioning older adults. Nonetheless, some exceptions faced physical disabilities, cognitive, and cardiovascular diseases as well as vulnerabilities to social isolation and loneliness. Despite these challenges, many older adults were unrelenting in striving to maintain their autonomy and quality of life. Thus, providing a rich opportunity space for designing technologies to promote ‘healthy and active’ ageing. In this article (i.e., wholly based on chapter 10 of my PhD. dissertation), I present some of my research observations as I designed and evaluated the Social Hue – a bidirectional activity-based ambient system to improve social connectedness between the elderly and their caregivers.
Understanding the Users' Context
The doctrine of understanding the user’s context has been repeatedly asserted throughout my doctoral research. In fact, to analyze their context, I always kept a watchful eye on the methods of social cohesion, routine tasks, mobile and cognitive vulnerabilities, as well as the technical constraints they faced. Initially, I will recount my observations of older adults in the western hemisphere (Canada, Italy, and The Netherlands) and later briefly reminisce on my encounters with the elderly from the Asia-Pacific region (Japan and China).
Perceptions on Independence, Mobility Aids, and Technology Use
I was fortunate to live temporarily at an independent living facility in Canada. This was an extraordinary experience as I had the opportunity to consult with several naturalized Canadian senior citizens mostly between 70 and 93 years. Frailty was observed among only a few older adults residing at the facility. These adults received assistance from formal care workers at least two-three times weekly or relied on mobility aids (e.g., walkers and wheel chairs) to move around. However, I was greatly surprised by the vast number of 80+ older adults who were still able to independently execute their activities of daily living (ADLs). However, in an era where technology is accelerating, I observed a few barriers to technology access among some elderly residents. The dialogues revealed that most older adults in that facility were reliant on their house phones to maintain contact with their family and friends. Besides, those who were fortified with smartphones expressed difficulties in learning to use the phone features, and other social technologies such as WhatsApp or Skype. Also, some older adults mentioned that they were unacquainted with how the Internet worked. Moreover, the Internet was viewed as expensive or an unnecessary luxury by some elderly residents. Accordingly, this highlights the need to promote technical literacy along with the provision of stable, reliable, and affordable internet connectivity to facilitate networked smart objects in ambient assisted living environments.
In Italy, on my daily commute, it was interesting to note that the Genovese elderly thrived in executing their ADLs (shopping, walks, bill-payments, etc.) in the mornings. Moreover, like the frail older adults observed in Canada, the Genovese frail elders were strongly reliant on manual mobility aids (e.g., walkers and canes) to execute their ADLs. Sometimes, there were signs of vulnerability and discomfort, and my efforts to assist were often futile as I was confronted by a set of older adults resolute on maintaining their independence. In hindsight, from my perspective, I observed a minimum dependence on AAL solutions to support mobility in Genova.
In contrast, when I reflect on my experience in Eindhoven, The Netherlands, I noticed a higher reliance on electronic mobility aids (e.g., scooters and stair lifts) to support the execution of ADLs among the dependent elderly population in Eindhoven when compared to their senior counterparts in Canada and Italy. The scooter’s affordability was a factor mentioned by a care worker at the independent living facility in Canada. Nonetheless, like the Canadian and Genovese elderly, I perceived that the Dutch elderly maintained a strong sense of independence overall. Regarding technology use, I noticed that many of our elderly Dutch participants were well equipped with smart devices, e.g., (mobile, phones, and tablets) and were well adept at using technology. Yet, there was still a measure of uncertainty among some elderly Dutch participants regarding their acceptance of technical assistive devices.
Looking back at my experience in two Japanese cities (Kochi and Tokyo), I observed many working people in the post-retirement age. Notably, the Japanese older adults appeared to be strong and often worked as taxi-drivers, farmers, and traders in Kochi. I had the most remarkable encounter at the Kochi market, where I saw an incredibly elderly lady, as she bustled through the crowded venue appearing to carry all her produce on her back. Signs of her pigmented skin, deep wrinkles, and faded youth were some of the indicators of her frailty, yet she vigorously braced through the crowd on a quest to independently complete her grocery shopping. Her resilience was applauded by the crowd who treated her with much honour and respect. Notably during my short stay, I hardly ever noticed a mobility scooter in either of these Japanese cities.
Impressions of the Social Context
Sociality and a strong sense of family appeared to be ingrained in the Italian culture. If you have been to Italy, you will know that mealtime is a means of maintaining social connectivity in Italy. This observation is also supported by the work done by Ochs and Shohet (2006). Upon reflection, the Italian grandmothers (nonne) were often seen as the matriarchs of the family. Their cooking skills, recipes, and profound wisdom were sometimes used as a reference for initiating contact on the part of the younger adults. An additional factor supporting the profound sense of belonging in Italy was its strong group culture. As such, older adults were frequently observed to engage in family outings, dinner parties, Sunday brunches, attendance to the cinema or orchestra with their elderly peers, and early morning coffee breaks among others.
Also, a strong in group culture was observed in the Eastern Hemisphere. Specifically, square dancing was commonly seen among retirees in the parks of these Chinese cities (Hangzhou, Wuxi, and Shanghai). While to my surprise in Tokyo, a communal hot spring (i.e., an onsen) was mainly occupied by a group of elderly women. I was intrigued by the sense of social cohesion among these ladies and considering my interest in ageing societies; I proceeded to enquire more about their social practices. These older women highlighted that being naked in the onsen was a tradition since childhood and was a means to bring them closer, release their stress, and embrace their youthfulness despite the challenges of ageing. Further discussions with a home room teacher (Ms. Leng – for the purposes of anonymity), who has resided in Japan for over six years provided additional insight into Japan’s in group culture (uchi). Ms. Leng emphasized that uchi is entrenched in the entire Japanese society as they strive toward a spirit of harmony, where one is encouraged to think of the group over himself. Moreover, she highlighted that the in-group culture encourages conformity as suggested by the following Japanese proverb. “The nail that sticks out gets hammered down.” An individualistic mentality is perceived as negative within the Japanese culture, and there are many instances of self-sacrifice to ensure another person’s happiness. This proverb confirmed the impassioned sense of loyalty that I felt during my stay in Kochi, as some store owners even left their expensive jewelry shops unattended to guarantee my safety.
Although the Dutch elderly had their mechanisms for social cohesion (e.g., interdependence among neighbours, sports, knitting, and health groups, retired professional associations, volunteer societies, and Sunday family brunches). Seemingly, there is a tendency towards individualism in the Dutch culture as is evidenced by Hofstead’s model of national culture. In hindsight, from my interactions with our Dutch participants, a higher value is placed on their personal and immediate family needs when compared to the Italian and Japanese elderly. Moreover, personal freedom and the right to privacy were recurring traits of Dutch older adults. Nevertheless, I had the opportunity to get to know some of my elderly Dutch participants who are good natured and extremely helpful, encouraging, and friendly. To date, they remain as some of my most treasured friends.
Interestingly, the Canadian independent living facility was multicultural as most occupants were naturalized Canadian citizens, having roots in the Caribbean, Africa, Asia, and some European countries. Evidently, the sense of community was promoted at the facility, which boasted a game room and several support groups including (health and fitness clubs) to ensure their social integration. Older adults at the facility were usually seen in pairs and interdependence among neighbours was quite common among residents. For instance, one frail female resident (aged 80+) expressed that her children were too far away and her neighbour (aged 70+) was her only source of help and care. On a different note, the experience of loneliness and social isolation was quite uncommon among our elderly participants. One female resident (90+), never married and has limited contact with surviving friends and family expressed peace and content with her situation. In an interview, she mentioned that she enjoyed her own company and found a myriad of things to do to occupy her time (reading, prayer groups, television, church attendance, exercise, and chores, among others). This encounter was a pleasant reminder of the need to avoid clichés and stereotypes when working with older adults.
In sum, by describing my observations and experiences, I have provided a glimpse into the methods of social cohesion, use of technology, challenges, and cultural situation of a small fraction of seniors from eastern and western societies. From a design perspective, it is imperative to get closer to your elderly users and give them a voice throughout the stages of the design process. In fact, their knowledge, experience, and skills could be useful to design interactive assistive solutions to improve their overall quality of life.
For more information concerning my reflections and the work done in my PhD. research – you may retrieve my thesis at https://pure.tue.nl/ws/files/87285221/20171130_Davis.pdf.
Davis, K. A. (2017). Social hue: a bidirectional human activity-based system for improving social connectedness between the elderly and their caregivers. Eindhoven: Technische Universiteit Eindhoven.