Using Telecommunications to Meet the Needs of Older People

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Using Telecommunications to Meet the Needs of
Older People

• Kirsty Williamson, PhD
• Monash University, Melbourne
• and
• Charles Sturt University, Wagga Wagga
• Australia

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Global Issues of Ageing

• We are all constituents of an ageing society,
  rural and city dwellers, public and private
  sector identities, families and individuals, old
  and young alike. It is crucial that societies
  adjust to this human paradigm as record numbers
  of people live into very old age, if we are to
  move towards a society for all ages.United
  Nations Division for Social Policy and
  Development June 2000

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Demography Australia - a Highly Urbanised Country

• 1 of the continent contains 84 of the
  population
• 83 live within 50 kilometres of the coast
• In 1911 43 lived in rural areas
• By 1996 only 14 of the population lived in
• rural areas
• Major cause of population decline is net
  migration loss
• Population decline is strongest in the
  Sheep-Wheat Belt.
• ABS 2001, Haberkorn et al . 1999

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Haberkorn Population Map
20 or greater below non-metro average 10-20
below non-metro average 0-10 below non-metro
average 0-10 above non-metro
average10-20 above non-metro average20 or
greater above non-metro average metropolitan
areas
Percent in relation to non-metropolitan average
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Placing Older People at the Centre of Service
Planning
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Matching Aged Services to Needs

• Planning for services needs to be dynamic
  because
• Over long term communities are dynamic (not
  static).
• The capacities, experiences and expectations of
  older people differ within, as well as across
  generations.
• There are variations in mobility patterns within
  and between communities, and over time.

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Virtual Communities

• Enable people to remain active in their networks
  even when physically frail.
• Some evidence they can significantly improve
  wellbeing of people who are housebound or
  isolated and people in residential care.
• A challenge to aged service providers.

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Australia

• How is technology helping older people in
  Australia?

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Attitudes of Older People to Technology in the
Early 1990s

• Williamsons PhD study found that, on the whole,
  older people had a negative attitude to
  technology
• Many participants were adamant that there was no
  role for computers in their lives.
• Barriers included both cost and the fear of
  something which was seen as complicated and
  difficult to master.

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1996 Computer and Internet Study Public Library
Setting

• Sample 120 respondents aged 50 and over
• 22 aged 50-59
• 34 were 60-69
• 35 were 70-79
• 9 were 80
• 28 had used a computer
• 9 had used the Internet

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Role of Computers

• 67 of respondents had negative attitudes
• 42 thought they would never need to use
  computers as they were not relevant to their
  lives.
• 25 said that they would use a computer if they
  really had to.

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Role of Computers (Cont.)

• Reasonably positive attitudes expressed by 24
  who found computers useful but not essential.
• A small number of people indicated a highly
  positive role for computers in their lives
• 4 felt that computers were a very important part
  of their lives.
• 4 said they would be lost without their computer
  now.
• These participants were usually younger, better
  educated and on higher incomes.

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What is the change since 1996?

• The largest increases in the number of
  Australians accessing the Internet in the period
  November 1998 to November 2000 are found in older
  age groups
• 188 increase in the 55 and over age group (now
  20), but 65 age group only 9
• 77 increase in the 40-54 age group (from
  45-53).
• But 75 of 18-24 age group were Internet users in
  Nov. 2000.

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Reasons for Increase in Older Adult Users

• Australian Commonwealth Government Initiatives
• Networking the Nation (NtN) Program
  particularly aimed at providing telecommnications
  infrastructure in rural areas.
• AccessAbility Program for online services for
  people with disabilities.

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NtN Examples of Initiatives

• 65 Online Access Centres have been established in
  the small state of Tasmania. (State Alzheimers
  Assoc. to provide information for carers and
  interested others through these centres.)
• The Council of Cabonne Council, a rural,
  agricultural shire of NSW set up Internet cafes
  in 3 small towns with NtN funding. Now all 8
  towns and villages of the shire have public
  Internet access through cafes or the public
  library.

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Examples of AccessAbility Initiatives

• Online Services for People with Disabilities in
  Australian Public Libraries a project aimed at
  selecting suitable adaptive equipment, providing
  training and developing policies for improved
  access.
• Literacy Online through Arts, Sports and
  Recreation (for the Deaf and People with Physical
  and Intellectual Disabilities).

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Reasons for Increase in Older Adult Users (Cont.)

• Myriad initiatives from older people themselves
  e.g., Australian Seniors Computer Clubs Assoc.
  (ASCCA), a public benefit institution organised
  by seniors to link computer clubs for seniors
  Greypath, an Internet portal begun by a senior
  citizen.

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ASCCA

• Provides a channel for like-minded people to
  share the potential of the computer age, for
  individual and community goals.
• Has become a catalyst to enthuse, encourage,
  empower and assist seniors.
• Advises and supports existing clubs and helps
  with the establishment of new clubs. (A
  development kit is available www.seniorcomputing.
  org)
• Provides a non-threatening envionment for seniors
  to learn.
• Some clubs provide assistance in the home for
  members with a disability.

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www.greypath.com

• A highly creative Internet portal, targetted at
  seniors.
• Has a 3D virtual community, with a unique,
  user-friendly environment and numerous specific
  venues,
• e.g., the village pub, St Isadores
  Church.
• The village library hosts regular book chats.
• A Lyceum provides free online educational
  programs,
• e.g., on art appreciation.

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www.greypath.com (Cont.)

• A Health Centre offers online consulting
  services.
• Online advisers are available for a range of
  topics, e.g., computers, legal issues, pets,
  gardening.
• There are innumerable links to sites likely to be
  of interest to seniors.

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Reasons for Increase in Older Adult Users (Cont.)

• Activities of peak bodies with aged care
  responsibilities are significant,
• e.g., Council on the Ageing (Australia),
  University of the Third Age (U3A) with its
  emphasis on lifelong learning online.

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Reasons for Increase in Older Adult Users (Cont.)

• Other important initiatives include
• The e-Launceston project, a collaborative project
  of the University of Tasmania and a major
  telecommunications company, Telstra.
• (Learning outcomes from Internet access
  issues affecting access and use.)
• Tesltra e-Launceston is a partner in CIRCLE
  (Computers into Residential Care Learning
  Experience), supplying pre-loved computers to
  nursing homes (involving VET Aged Care students,
  Senior Link eBuddies and computer literate
  volunteers).

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Reasons for Increase in Older Adult Users (Cont.)

• Accessible and Inexpensive Training
• The most important ingredient.
• Most of the above organisations are involved
  providing special classes for seniors.
• Easy-paced learning, friendly environment.
• Peer teaching is considered very beneficial.

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Reasons for Increase in Older Adult Users (Cont.)

• The NEAT Network (Education, Ageing and
  Technology Network)
• A very active and successful Australian listserv
  with some international participation, initiated
  by Centre for Rural Futures, University of New
  England.
•  
• A cross-disciplinary and inter-organisational
  initiative, open to anyone interested.
•  
• Encourages information sharing, discussion of
  issues and provides publicity for initiatives.

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The NEAT Network (Education, Aging and Technology
Network) (Cont.)

• Involves (amongst others)
• key older people (active in assisting their
  peers).
• government and agency personnel (local, state and
  national) with technology or aged care
  responsibilities.
• Peak organizations (e.g., Council on the Ageing,
  Adult Learning Aust., University of the Third
  Age, Aust. Seniors Computer Clubs Assoc.,
  Consumers Telecommunications Network).
• academics and researchers from a range of
  disciplines.
• library representatives.

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Online Benefits for Seniors

• Value for self-esteem
• I cant have a six-year-old saying Nana, you
  do it this way. (P-G study on computer use by
  older people.)
• Assists in promoting shared interests,
  particularly with the younger generation
• I also find its a great medium of
  communications between myself and the grand kids.
  (I have 5...) So we have a shared interest which
  is great.(P-G study)

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Online Benefits for Seniors (Cont.)

• Virtual access to the rest of the world can
  assist with isolation due to geographical or
  mobility reasons
• For others participants in the P-G study, it
  was a lifeline that restored their connection to
  the outside world, to family, friends, and
  significant others (Barnett 2001).
• One 61-year-old participant in the P-G study said
  that her hand-writing is very bad now, but the
  computer has solved the problem
• Our son is overseas and I write to him every
  fortnight using script typing, adding some clip
  art and generally jazzing it up.

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Online Benefits for Seniors (Cont.)

• The benefits for geographically isolated seniors
  is illustrated by this 74-year-old rural
  Queenslander
• Three years ago, we were computer illiterate.
  Now we pay a lot of our bills and do much of our
  banking on the Net. We correspond by email. We
  buy goods online. We source information online.
  The computer is as important to our quality of
  life as our car. (P-G study).
• Computer clubs provide opportunities for
  teachers and students. Seniors with computer
  skills can contribut to the community in ways
  that are within their physical capacities.

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Online Benefits for Seniors (Cont.)

• From a conference, held at the University of
• New England in 1999, came a participants
  comment
• I have a lovely man here over 90 who tells me
  that the Internet is the only reason he gets out
  of bed in the morning. The only real people he
  sees are the Home and Community Care workers.
  (Co-ordinator of a Seniors Service. Making the
  Connections 2000.)
• Two comments from nursing home and retirement
  village initiatives
• We have had some glowing reports back about
  patients who were previously loathe to get out of
  bed, who now wheel themselves down the hall to
  get on the computer. (P-G study)

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Online Benefits for Seniors (Cont.)

• We are finding that the placing of computers in
  retirement
• complexes is having a number of exciting and
  not-thought-of
• consequences, e.g., learning to use email has
  brought a
• number of people into contact with family
  members and
• changed their outlook on life. The internet has
  given them a
• new dimension and encouraged their mental
  activity, which
• has a marked effect on their physical health.
  (E-Launceston
• Project)
• The benefits of lifelong learning are well
  established. The NSW Committee on Ageing, Never
  Too Late to Learn provides many interesting case
  studies.

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Online Benefits for Seniors (Cont.)

• Spender comments on Internet advantages
• There is no gender, age, or time barriers on
  the Net ageist stereotypes can disappear.
  (Spender 1998 cited in Scott 1999).
• There is evidence that an Internet connection
  is even better for their seniors health than a
  pet in terms of enhanced intellectual skills
  and emotional well-being. (Spender 1998, cited
  in Scott 1999).
• No-one knows you are a dog on the Internet,
  one 75-year-old told Spender.

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Disadvantages

• Cost is a problem for older people with lower
  incomes, especially in rural areas where
  telecommunications charges are high.
• Availability of online services gives service
  providers, such as banks, an excuse to curtail,
  or close down, face-to-face services which many
  older people prefer.
• Online access may be seen as a suitable
  substitute for face-to-face social contact, but
  may not be acceptable to many older people and
  exacerbate their isolation.
• Not everyone wants to, or is capable of, using a
  computer and the Internet.

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Other Telecommunications Options

• The POTS (plain old telephone service) provides a
  lot of the same benefits as the Internet for
  seniors.
• Williamsons (1995) PhD study found the telephone
  played a hugely important role for information
  and communication. For example, there was the
  role in the social rituals of life, where people
  could not be physically 'together'.

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Other Telecommunications Options (Cont.)

• One female respondent, who was 83 years old and
  virtually housebound, had daily 'drinks on the
  phone at 5 o'clock' with an elderly male friend,
  who was in a nursing home on the other side of
  Melbourne.
• In another case, a respondent recorded in her
  telephone diary that her cousin, George, rang
  from England
• 'At the end of the call George suggested that
  next time we talk on the phone that we all make a
  cup of tea and drink it together'.

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Information-Seeking Behaviour

• The PhD study found that there was a wide variety
  of ways in which older people seek and acquire
  information and that, to ensure that key
  information for everyday life is available to
  all, a range of formats and delivery modes is
  essential, e.g., print (newspapers, magazines,
  pamphlets), radio, television, the Internet.
• Particularly interpersonal sources (family,
  friends and acquaintances) are very important.

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Information-Seeking Behaviour (Cont.)

• People very often acquire information, rather
  than purposefully seek it (and this particularly
  happens with readily accessible information
  sources).
• Institutional sources, e.g., libraries and
  information centres are less often used as they
  require more effort and usually involve
  purposeful information seeking.

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E-health, Telehealth and Telemedicine

• Conceptual approach Australia
• E-health is the overarching technology and
  philosophy under which telehealth resides.
• The term telehealth describes the use of
  communication technologies to provide
  health-related activities at a distance. Current
  telehealth practice includes videoconferencing

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E-health, Telehealth and Telemedicine

• for clinical, educational and administrativ
• purposes as well as electronic transfer of
• medical images between facilities. (Australian
• and New Zealand Telehealth Committee 2000)
• Telemedicine is a subset of telehealth,
  incorporating medical subspecialities, e.g.,
• (tele)pathology, (tele)radiology.
• Nevertheless, the terms tend to be used
  interchangeably.

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Telemedicine in Australia

• Has flourished in Australia, particularly in
  Queensland, but also in NSW and South Australia.
  Even Tasmania is now developing telehealth
  systems.
• Reasons for Success
• Vast distances and isolated populations.
• A comprehensive business planning approach.

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Reasons for Success (Cont.)

• Early reviews to refocus systems if need be.
• Preparedness of state-run health services to
  invest in telemedicine activities.
• A quite benevolent medico-legal environment.
• The strong clinical research base which has been
  developed.

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Initiatives in Telemedicine

• A virtual rehabilitation service has lead to a
  large number of severely disabled patients
  receiving custom-designed physical aids, e.g.,
  wheel chairs or walking frames, without travel.
• A very successful ultrasound service.
• Hospital Without Walls, which provides electronic
  monitoring of elderly patients who are at risk of
  falls.
• (Yellowlees 2000 - Journal of Telemedicine)

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Conclusion

• The new architecture of ageing requires policies
  that remove obstacles and facilitate
  contributions. It also requires seminal thinking
  and images that reflect reality and the
  potential, not stereotypes and myths. So relative
  are the experiences of ageing in different parts
  of the world, and so complex and multiple their
  roles, that the world can no longer accept images
  of ageing as a panorama of near
  homogeneity.United Nations Division for Social
  Policy and Development 2000