Information and communication technology (ICT) keeps advancing at a skyrocketing speed and complexity. Meanwhile, many developed societies are seeing an ageing population as a result of advancement in modern medicine as well as improvement in nutrition and public health. Indeed, in the case of Hong Kong, the number of persons aged 65 and above is projected to account for over 25% of the population in 2030, up from just over 16% in 2017. Adoption of the technology, however, has not been widespread in the elderly population. Many elderlies often have mixed views about the use of technology. Some consider new technology as being complicated and not user-friendly. Costs and privacy are also common concerns. To promote technology adoption among the elderly, family members’ support is often the key. Manufacturers can also assist by improving the products through creating simple and user-friendly devices. Governments may facilitate the adoption by encouraging or even working with non-government organisations (NGOs) to organise promotional activities, coaching sessions and providing continuous support. Technology can enhance the quality of life of the elderly, whether in sickness or in health. Potential benefits are countless.
Healthy Ageing
According to the World Health Organisation (WHO, 2020), healthy ageing "is about creating the environment and opportunities that enable people to be and do what they value throughout their lives". It is a process of maintaining and developing their functional abilities, which could meet their basic needs, keep their mobility, ensure they can build and keep relationships, continue to learn and make decisions as well as contributions to the society. There is an intrinsic correlation between individuals and the environment, which can be the home, community with relationships among people, as well as social policies and system. Individuals’ capacities are also related to physical and mental abilities like memory, hearing and vision, that can be affected by age.
Healthy ageing encompasses active ageing, which requires actions from different bodies and parties to provide resources to the family as well as community. In the local context, to promote healthy ageing, many government departments and public organisations are responsible for elderly services such as the Elderly Health Service under the Department of Health (2018) and The Chinese University of Hong Kong Jockey Club Institute of Ageing, which provide education to elderly on how to age healthily in the aspect of eating habit, mental health, relationship, technology, etc. Among all, technology is becoming the key element in promoting healthy ageing.
Technology Adoption among the Elderly
ICT keeps on developing and affects our daily life. Smartphones and other screen devices have advanced features, including video and music player, Global Positioning System (GPS) navigation and mobile applications for information, social connectivity and entertainment (Census and Statistics Department, 2019). Multiple media can also be accessed through mobile applications. Therefore, smart devices, in particular smartphones, have become a popular and necessary item as they allow information and social interactions at the touch of a finger.
The use of smartphones in turn improves people’s well-being, quality of life and psychological functioning (Mellor et al., 2008; Stevic et al., 2019). Such digital technology has the potential to support the elderly to live independently at home, in the way they have been used to in their whole life, and enjoy the familial environment. The elderly may consider how the capabilities of their daily life are enhanced by applying digital healthcare technologies (Nikon et al., 2020). More elderly who are aged 65-years-old or above are now using mobile devices. The ratio of them using smartphone was 2:5 in 2016 in Hong Kong and it was increased to 3:5 in 2018 (Census and Statistics Department, 2019). However, 90% of other age groups own a smartphone, whereas the coverage is only 57.2% among elderly aged 65 or above, mainly because of resistance or rejection of adopting new technology, and the perception on the complexity in managing electronic devices (Abdulrazak et al., 2013).
Model of Adoption of Technology by Older Adults (MATOA)
To explain the utilisation of technology by elderly, Wang et al. (2017) proposed a model of adoption of technology by older adults (MATOA) (Figure 1). It is converted and developed from the Unified Theory of Acceptance and Use of Technology (UTAUT) developed by Venkatesh et al. (2003). The effort expectancy, social influence, performance expectancy and facilitating conditions are built up by the following elements:
Figure 1. Model of Adoption of Technology by Older Adults (MATOA) (Source: Wang et al., 2017)
Before the actual use of technology, behavioural intention to use is about the end-user satisfaction and acceptance. It is affected by the perceived usefulness and attitude towards adoption. It is, however, difficult to measure end-user satisfaction (Holder & Karsh, 2010). Once people have a behavioural intention to use a new technology, they will take action to use the new system. In addition, influences of experience, voluntariness, gender, and age are significant moderators (Venkatesh et al., 2003; Tsertsidis et al., 2019). For example, the effect of social influence is stronger for women than men while performance expectancy effect is stronger in men than women. Benefits and impacts of technology adoption for the elderly may include enhancement of social connectivity with personal entertainment, lifelong education, health literacy, and improvement of mental wellness. Moreover, use of smartphones may foster the individual’s sense of psychosocial worthiness.
Social Connectivity and Entertainment
Many older adults experience decline in interpersonal interaction and hence increased isolation from their friends and family, resulting in social and emotional loneliness (Haris et al., 2014; Delello & McWhorter, 2017). The use of mobile technology facilitates closer relationship between the elderly and the community through the exchange of information in the virtual world. Such activities elicit closer family ties as well and further enhance the connectivity of their pre-existing social connections (Delello & McWhorter, 2017). The elderly can maintain social ties through text, voice calls and images in social media platforms via smartphones. Facebook and Instagram are popular social networking sites, providing convenient features such as the "Like" button, sharing photos and videos, commenting on others’ photos, and viewing videos and graphics, to facilitate social bonding and bridging (Jung & Sundar, 2016). They can search information and photographs of family events as well as the daily life of family members. They can also make video calls through communication apps like WhatsApp and Skype so that they can have live chats anytime and anywhere. This provides the opportunity for online intergenerational interactions as the elderly can communicate with their children and grandchildren via multimedia channels.
In the community, the elderly can communicate with people who share similar interests, and this enhances social contact. Older adults may participate in activities which can promote better health by using social media (Madden, 2010). They can also join some online social groups and browse news related to the community they live in. These actions can prevent isolation and feeling alone among the elderly (Leist, 2013; Chopik, 2016). At the same time, through electronic social media, they can entertain themselves. There are many platforms with easy access for all sorts of infotainment. For book lovers, there are free to download applications like Amazon Kindle for e-books online. There are also apps for online movies and television programmes. In addition, many mobile games are available on the Internet.
Lifelong Education
Informal education means ‘any voluntary, self-paced learning occurring in various everyday situations’. Mobile devices provide easily accessible tools that assist elderly in such learning (Jin et al., 2019). Instead of having a formal learning curriculum, self-paced learning through the use of mobile devices allows the elderly to choose their learning medium and access different learning material anytime and anywhere, depending on their own preferences (Leen & Lang, 2013; Ng, 2013). Such easy access can satisfy the elderly’s desire for knowledge seeking in terms of their interests such as cooking, language and health-related topics like nutrition and physical exercise (Lee et al., 2017). Elderly learners can then actively engage in online discussion forums to broaden their knowledge. Moreover, older adults gain collaborative learning experiences as they exchange their acquired knowledge through sharing and commenting on other users’ postings (Jin et al., 2019). Therefore, mobile devices provide a very convenient platform for sustainable informal and lifelong learning for the elderly (Ng, 2013).
In order to promote the use of ICT among the elderly in Hong Kong, ICT Outreach Programme and Enriched ICT Training Programme have been launched by the Office of the Government Chief Information Officer (OGCIO) since 2012 and many positive feedbacks have been received (Office of the Government Chief Information Officer, 2018). Both programmes had been extended into a two-year programme to give more opportunities to elderlies with dementia to enhance their ability through advanced training in using ICT. OGCIO subsidises non-government organisations to teach elderly to use mobile devices, including the tablet. It also provides medical treatments and physical exercise as well as communication opportunities with others by using smart technology like virtual reality (VR) and online meeting platforms. These programmes cooperate with the Elderly Academy to provide different aspects of information technology courses and the elderly can apply according to their own interests. They should be able to have better connection with the community and increase their self-confidence after having completed the programme.
Health Management and Literacy
Technology can help the management of health conditions for older adults. They can communicate with healthcare providers digitally and reduce the need for in-person appointments. ICT could also assist those with physical limitations to review or replay instructions and increase their understanding and compliance (Greenwood, 2020). Mobile health devices have functions for recording personal health status such as heart rate and temperature, monitoring treatment process, and providing medical appointments reminders (Deng et al., 2014). Telemedicine is a popular online healthcare platform in recent years and is used in video conferencing and telecommunication to enable medical services such as consultations, diagnostics, and education at a distance (Weinstein et al., 2014; Bujnowska-Fedak & Grata-Borkowska, 2015). The adoption of such mobile health technology benefits the elderly in maintaining their health conditions, overcoming mobility issues and promoting independent living.
Mobile health applications are equipped with automatic link to Internet resources and enable people to upload health data such as diabetes self-test results to a cloud platform, allowing doctors to access real time data (Weinstein et al., 2014). Some mobile applications are equipped with functions of navigation and GPS to deal with emergency and safety, to allow family members and caregivers to track the elderly’s location to ensure safety, and to provide immediate support. In Hong Kong, a similar technology had been developed to connect mobile devices with Personal Emergency Link Service to provide support to the elderly. This service operates 24 hours every day and has a centralised call centre to answer calls from the elderly. The centre also monitors the elderly’s location and contacts responsible organisations like the police and ambulance service when necessary. Family members and relatives can also use the mobile application called "e-See Find Service" to check the location of the elderly (Senior Citizen Home Safety Association, 2019).
With the electronic devices, the elderly may obtain, process, and understand health information and services needed. Such health literacy skills allow them to take control of their own well-being by making smart healthcare choices, improving their communication with doctors and giving them information that they need to advocate for themselves in a medical setting.
Mental and Cognitive Health
Social ties and connections are facilitated by the adoption of technology among the elderly, resulting in the reduction of sense of loneliness and isolation, and the relief of depression symptoms, while leading to improvement of psychological well-being (Cotten et al., 2013; Heo et al., 2015; Chopik, 2016). Loneliness and social isolation are predictors of cognitive decline among older adults aged 65 and above, and social interaction could help to overcome age-related memory changes (Quinn, 2018). Thus, the frequency of interactions in social media platforms like Facebook, Instagram, Weibo, etc., protects individuals from developing dementia and cognitive impairment (Seeman et al., 2001).
Engaging in greater social technology will enhance cognitive functioning due to the shift between tasks and concepts during the use of technology (Quinn, 2018). It is noted that brain training, including the ability to change and adapt to new information reduces cognitive decline with age (Delello & McWhorter, 2017). Moreover, learning to use new technology and social media has demonstrated improvement in executive functions in dimensions of episodic memory and processing speed (Quinn, 2018; Chan et al., 2016). The elderly can also learn and practice some new skills and movement from mobile applications, helping to enhance their logical and critical thinking when they play some problem-solving games. Thus, gaming can decrease age-related cognitive decline such as memory loss, etc., resulting in the reduction of the risk of dementia in advancing age (Charness & Boot, 2016).
The Barriers
Many elderlies have no experience in using computers and the associated software and applications in their life. Some equipment might not have been developed when they were growing up and in their formative years. Therefore, there is a significant knowledge and experience gap in this group, creating a barrier to the adoption of the electronic devices. Some older adults lack the confidence in learning and manipulating the smartphone or similar electronic devices.
Moreover, the cost of a smartphone and the service fee do not encourage the elderly to adopt the ‘new’ technology even when they perceive it as beneficial. Such financial consideration may form another major barrier. It has been shown that income and age are strongly associated with smartphone ownership. The older age group normally has lower income and thus less likely to own smartphones (Charness & Boot, 2016). This is natural because most of the elderly have retired and do not have spare disposable financial resources for expensive items. Many of them may consider a simple mobile phone would be good enough as they mainly use the direct calling function rather than other sophisticated services. According to the study on Usage of Mobile Phones amongst Elderly People in Hong Kong, elderly generally has found many value-added services in the smartphone such as mobile data for Internet access, call forwarding and polyphonic ringtone, etc. superfluous. Thus they will minimise the charges by using a basic plan (Chen et al., 2013). The Consumer Council in Hong Kong (2018) conducted a study about creating an environment for ageing-friendly consumption of mobile devices. Some elderlies reported that they could not find low-cost technological products with high efficiency. The other finding was about the mode of payment. As the bill was generally issued online, some service providers might charge for paper statement. This would entail extra charge for the elderly and raise up another barrier and complexity.
Smartphone is an intelligent device with many functions and applications, but it could be too complex for the elderly to handle (Charness & Boot, 2016). Although there are useful functions, including log-in to social media, applications, making telephone calls, setting alarm and taking and sending photographs, the complicated menu may be hard to use and easily frustrating the elderly (Chen et al., 2013). Although the font of words and figure on the display monitor can be adjusted into bigger size nowadays, the buttons on the keyboard are still too crowded for most elderlies to handle (Chen et al., 2013). The elderly may unintentionally choose the wrong functions by calling someone accidentally or locking the keyboard because they cannot remember the designated functions from the keys. The layout and interface design of the smartphone are particularly not suitable for the elderly with physical limitations in vision or hearing, or arising from arthritis and some rheumatic conditions (Wildenbos et al., 2018). Cognitive ageing makes the learning process slower and thus new technology would be even less appealing to the older adults (Salthouse, 2010; Charness & Boot, 2016). These ‘complex’ functions affect the perceived ease of use, and hence, motivation in using smartphones.
Concerns about privacy and information security are also considered as negative facilitating conditions on technology adoption (Venkatesh et al., 2003). This is more common among elderly aged 65 years or above, compared to the younger age groups (Hoofnagle et al., 2010; Fox et al., 2000). Older adults have limited knowledge on maintaining Internet security. As such, they may worry about the hacking of their account or not able to store their information safely. Hence, they seldom post their personal information such as photos, date of birth, membership or contact number on the Internet. Similarly, they may not know how to block cookies and delete browsing history (Charness & Boot, 2016). For those elderlies who are more knowledgeable on the privacy and security, they would like to decide who can access their data and at what level. Thus, for example, if they do not want to be tracked and traced, they will try to switch off the system or cameras before they would feel at ease (Vassli & Farshchian, 2017).
Help for the Elderly to Go Digital
MotivationMotivation is essential in driving people to accept new technologies, the elderly are no exception. However, managing electronic functions and accessing supports are often cumbersome and frustrating, resulting in unwillingness to continue to use smartphones and social media among the elderly (Wildenbos et al., 2018). To promote positive perceptions and attitudes towards the use of technology, practical benefits of independent and healthy active ageing, as well as usability and reliability, should be promoted (Hawley-Hague et al., 2014). Modification of technologies can result in the ease of use and better experience to older adults, especially those who are disabled, house-bound or even bed-bound. Such measures modulate the views of users and uphold their motivation and wish to learn and experience more about electronic devices in enhancing their daily living. Furthermore, family members, carers, friends and community health practitioners should encourage the elderly and provide assistance to them in the adoption of smartphones, smart devices and social media usage. They are in the best position to advise and remind the elderly in the proper and safe adoption of technologies such as network security and Internet safety, and help them when they encounter difficulties. More importantly, family relationship can be enhanced as the elderly become confident and feel safe in learning to use smartphone / smart devices and handle social media.
Finanical SupportGovernment and NGOs can provide financial support and learning opportunities to elderly to acquire and learn how to use smartphones or other smart devices because most elderly are retired and are less ready to or seldom spend money on expensive goods. On the other hand, government can collaborate with NGOs to organise age-oriented ICT training for this group in the community. Service and network providers should consider special budget plan for the elderly to remove the financial barrier and consideration in technology adoption.
Smart DesignThe silver market is huge in the world-wide ageing population. Manufacturers of smartphones and creators of social media should capture the opportunity. They ought to be innovative in the design and presentations to attract and facilitate the utilisation of technologies and devices of elderly (Wildenbos et al., 2018). Designers can provide an easy-to-browse version of the mobile app, such as using extra-large font and pictures and make use of voice search function to aid the elderly. The functions must meet special functional needs of the elderly with easy to use and practical features, leading to increased motivation and positive perception towards new technology.
Assisted and Smart Technology for Elderly in the New Decades
Digital health technology, including virtual reality (VR) applications, helps healthy ageing and has the potential to enhance the physical, emotional and social well-being as well as quality of life among older adults. VR can be used to play scenarios of historical environment to allow the elderly to revisit their past, at work or at home. As VR paves the way to virtually visit remote locations, seniors with limited mobility are now able to combat isolation and boredom. VR is also a tool for rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition to reduce risks of falls. There are also phone apps that can help seniors to monitor their heart rates, or allow their family members to track where they are.
Telemedicine and telehealth are also becoming popular over the world, especially during the COVID-19 pandemic when social contacts are down to the bare minimum. Telemedicine is an advanced e-health service which changes the traditional delivery of health services with consultations being done remotely and records are kept electronically. It entails virtual healthcare support and transferring health information to authorised professionals. It also reduces the period of hospital admission and mortality rate. Telemedicine can provide an affordable and faster service to the public through the monitor and measurement from the system by using the wireless local area network (WLAN) (Majumder et al., 2017). On the other hand, telehealth is suitable for elderly who need to have rehabilitation from allied health services of physiotherapy and occupational therapy. Healthcare professionals can use video calls or online meeting platforms like Microsoft Teams and Zoom to assist and finish the treatments with patients. Caregivers can also join in remotely (Ministry of Health Singapore, 2019). Telehealth and telemedicine will be the upcoming trend for the healthcare service in the future with the continuing advancement and development of the virtual network, without the restriction of geographic or social distance.Artificial intelligence (AI), such as a robot, is another example of assistive technology. It can be used to better explain health information and provide entertainment to elderly, and even accompany them to therapies. This technology has already been used in Japan and is starting to develop elsewhere like Singapore. Researchers are considering adding a screen on the body of the robot in order to enhance the communication and learning experiences, particularly to people with visual impairment such as the elderly (Ministry of Health Singapore, 2019). Besides, AI is also applicable at home. In the United Kingdom, families and patients can use a digital platform to select a suitable robotic carer to assist the elderly in their daily routines. With the ageing population and diminishing workforce, it is necessary to develop AI and robots to supplement the human manpower, especially in the caring for patients with chronic diseases and disabilities. In addition, psychological supports and social interactions are provided to the elderly and allow them to reconnect to the society (Swain, 2020). The middle-aged, who will become older adults in the next two decades, must get well acquainted and familiar with digital health technologies to gain the maximum benefits of healthy ageing in a smart environment.
Gerontechnology is a new discipline developed in the last few years. It entails the opportunities and aspirations for older adults to use technology, with the aims to improve their daily living and quality of life. It enables older adults to increase their self-reliance without any significant changes, forestall problems, provide the services they need, compensate for the loss of options and enhance productivity (Halicka, 2019). Lingnan University in Hong Kong (2018) conducted a survey about residents’ interests in gerontechnology in 2018. It found that over 80% of older adults who were above 60 years old were interested in the aspects of transportation, living, dining and healthcare. Since the ageing population increases rapidly in Hong Kong, different governmental departments have cooperated and developed gerontechnology in the districts or housing estates in order to reduce the potential strain to the society. For example, they have installed Wi-Fi network reader in public housing estates for older adults to have video calls with their relatives and receive public announcements. They can also convert words into recording by using the RFID reader in the smartphone to receive different messages. Other features such as the washroom flushing sensing system being tested in some housing estates to monitor the frequency of flushing. If the system detects that the toilet has not been flushed for a long time, it will inform relevant staffs to pay attention to the household (Logistics and Supply Chain MultiTech R&D Centre, 2020).
Conclusion
ICT keeps advancing and changing every day. People are using smartphone, smart devices and social media to collect the latest news from the society and exchange information with others, bringing many benefits such as maintaining social ties, providing continuous education opportunity, enhancing mental health and safety concern, etc. to older adults. With the ageing population in developed economies, there will not be sufficient carers or financial resources to maintain a high standard of care for the elderly in these economies. We have to explore and implement technological solutions if we were to meet the growing demand for elderly care services, from health care to assisted housing, etc. Technology, whether employing smart devices at home to monitor the elderly, or assistive devices to help with household chores, etc., can be one of the key solutions in an increasing ageing population like in Hong Kong. There are even greater potentials in the application of AI devices, robots and tailored-made digital health equipment in the local communities, where recruitment of carers is a major social concern, particularly in connection to the reluctance of youngsters in eyeing a career in elderly care. However, owing to the lack of life experience with new technology and cognition degradation amongst some elderlies, they think that technology adoption is complicated, unuser-friendly and expensive. They may not have the motivation or knowledge to use smartphones and smart devices. To enhance their perceived ease of use and usefulness, the government, NGOs, smartphone / smart device manufacturers, mobile app creators, social media service providers and family members should assist elderlies in the adoption of new technology. There should also be dedicated programmes to monitor and advance such development by all governments.
To take the matters further in a proactive perspective, innovative and appropriate planning of future homes for elderly should be gerontechnology-led to incorporate the state-of-art smart systems and to create age-friendly communities for the "new" generation of elderly who are now in their forties and fifties, and are more educated and familiar in using electronic devices, hence more receptive to new gadgets and technologies.
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Author: Cynthia S Y LAU Cynthia is currently working as Project Assistant in the Department of Applied Biology and Chemical Technology at The Hong Kong Polytechnic University (PolyU). She is a graduate from the BSc (Hons) of Applied Sciences (Health Studies) of the School of Professional Education and Executive Education (SPEED) under the College of Professional and Continuing Education (CPCE) of PolyU. She was a Student Research Assistant in the Centre for Ageing and Healthcare Management Research at PolyU SPEED and has contributed to writing and publishing papers on the topics of ageing and healthcare issues. Ben Y F FONG Dr Ben Y F Fong is a Family Doctor and a Specialist in Community Medicine, holding Honourary Clinical Associate Professorship at the two local medical schools in Hong Kong. He is currently the Professor of Practice (Health Studies) and Associate Division Head of the Division of Science, Engineering and Health Studies of PolyU CPCE, and Centre Director of the Centre for Ageing and Healthcare Management Research at PolyU SPEED. He has contributed to publications as lead editor of three books in English, including a recent title of "Primary Care Revisited - Interdisciplinary Perspectives for a New Era" published by Springer, over 30 health books in Chinese, and 40 journal papers.
March 2021