Gerotechnology: Providing Service Access to the Elderly
Barbara J. HOLT <firstname.lastname@example.org>
This paper describes the growing use of the internet by older adults, both as a source of entertainment and information. In particular, offering information on health care, social services, housing choices and caregiving can facilitate self-care and assistance from informal and formal providers. The Community Service and Outreach Unit of the Center on Aging at West Virginia University has developed a number of internet-related projects to increase service access to older West Virginians as well as elderly and caregivers worldwide. These services are described with links.
In our society, this story produces surprise and maybe a smile. While there is no longer the opinion that only those under the age of sixteen are capable of computer literacy, there is still not acceptance of the elderly as being comfortable with technology. Much of this attitude is the result of stereotypes which the general population holds on the characteristics of the older adult. The elderly are seen as being afraid of change, inflexible, and noncreative. Stereotyping the elderly as mentally slower, inflexible, and sensory-impaired has created the impression that they cannot compete, much less excel, in a technology environment. These perceptions will be addressed individually.
There is a misconception that the elderly are unable to learn new skills -- the "you can't teach an old dog new tricks" theory. A study of aging and cognitive abilities concluded that decreases in intelligence are modest until persons reach their eighties, and even at the age of 80, fewer than one half of the individuals showed measurable decreases. As compared with age 25, there is virtually no decline in verbal ability at age 88; however, inductive reasoning and verbal memory do decline, as do spatial orientation and numeric ability. While this decline can be attributed to the slowing of processing ability and response speed, it was argued that key variables increase the likelihood that mental abilities will be maintained in old age. These variables are
Therefore, it can be argued that use of intelligence to perform technical tasks perpetuates its own existence.
In addition to mental activity sustaining intelligence, it is also argued that intellectual decline can be reversed by mental activity. Perhaps the result of limited mental stimulation in their everyday lives, lower cognitive performance of older adults, even into their late seventies, can be reversed by involvement in tasks which require technical thinking (Whitborne, 1996).
Another area of contention is the belief that the elderly are set in their ways, that they are not open to change or capable of creativity. Research has refuted such claims, attributing creativity to personality traits existent throughout the lifespan and not dependent on age. It may be theorized that a reduction in creative activity may be explained by the lack of stimulating opportunities for the elderly or by a mental vacation at retirement. This is supported by studies which show creative productivity can undergo a substantial renaissance in the later years of life; some time after the late sixties, there is often a resurgence in output.
There is also the idea that older persons hate gadgets, that they prefer doing things by hand or with technology that existed in their youth. There are persons of all ages uncomfortable with electronics but it certainly is not relative to age. The use of microwaves, cordless phones, and emergency response systems by the elderly and disabled has made their lives safer and more convenient. Those who have not used computers and are suddenly placed in front of a Pentium will be expected to experience a learning curve, but many older persons are eager to become proficient and they have the time to learn.
Classifying all persons over the age of 60 as similar in physical impairments is generalizing over a 40+ year span; obviously such stereotyping is ridiculous. Studies have shown wide variation in functional status, emotional well-being, health perceptions, and satisfaction within the elderly population (McHorney, 1996). Disabilities occur at all ages, and the availability of computer technology to the impaired has facilitated their existence in the mainstream.
America is experiencing a major demographic revolution. Due to increases in life expectancy and the progression of the baby boomers through middle age, America is emerging as an "aging society." The over-50 age group is the fastest growing segment of the population, currently representing 26.1% of the population; those over 65 comprise 12.8% of Americans. This number is expected to rise as much as 106% in the next thirty years (Seigel, 1996). The increase in life expectancy is a result of medical advances which delay or prevent acute and chronic diseases in later life; therefore, the population is not only older, it is healthier in its old age. The quality of life has also been improved with the advent of Social Security, Medicaid, Medicare, the Older Americans Act, and anti-discrimination legislation. The poverty rate has been reduced by 600% for the elderly (Jackson et al., 1996), offering improved economic, social, and psychological health. Such significant population changes have profound implications for the use of computer technology across the lifespan.
What attracts the older adult to the World Wide Web? First, there is no travel involved. Sometimes because of growing physical limitations, sometimes because of a desire to stay at home, many of the elderly become more stationary. They may have moved from their primary family area to a retirement community, their children may have moved away, or their friends may have headed to retirement areas or been lost to illness. This tendency toward settling in can cause isolation; while there may be a desire to socialize, there are fewer motivations and more obstacles. However, bad weather, lack of transportation, and odd hours do not prevent a modem connection with the outside world.
There is also little expense after the primary investment in a system. With the plunging startup costs of personal computers, a multimedia system, complete with modem, is becoming more of an affordable item for persons on fixed incomes. There are also many older persons who inherit a computer from their children or grandchildren when it becomes inadequate for their use and they upgrade to a faster system. One can connect to the Internet with a 386 or 486; while slow or perhaps limited in graphic capabilities, it can be sufficient for the older surfer who has time to wait for a screen and is not overly impressed by flashy presentations. Once the system is obtained, with Internet access as low as $10 per month, the expense becomes very nominal, even for those of limited resources.
As previously stated, the elderly retain their verbal abilities more than any other cognitive skill. Despite the graphics, the medium of the Internet is still the written word. Files may be downloaded or read online at one's own pace; e-mail, news groups, and even the creation of one's own Web page are not time-restrained and are dependent on vocabulary, syntax, and imagination. Life experience is an added bonus.
Rather than restricting one's interaction to family and local friends, or in some cases, only the occasional healthcare worker, the Internet provides links to the outside world. Being able to connect with interesting people, whether through postings or in real time, is an attractive means of intellectual stimulation and socialization in the comfort of home. The anonymity of the medium can also afford the opportunity to disclose emotions and opinions which one might not express in person.
There is also the mental stimulation of learning to master the technology itself and in exposure to infinite information, opinions, and activities on the Internet. The interactive nature of the Web provides significantly higher mental activity than watching television, a higher degree of selectivity in subject matter, and much more detailed information on chosen subjects. The instantaneous posting of information has advantages over books, magazines, and newspapers and is much cheaper.
One of the biggest and continual problems of professionals in the field of community services, whether social or health-based, is knowing what the agency down the street is doing. As agencies secure and lose funding and change directors and workers, the focus, perhaps even the mission, of an organization can change. Certainly details such as eligibility requirements are in perpetual fluctuation. Trying to stay current with available resources becomes more and more difficult.
The recent ability of being able to search for resources as increasing numbers of agencies establish a Web presence, as well as listing one's own capabilities and requirements for public information, provides a much needed tool for professionals. When handling a difficult problem, one is no longer limited to the advice of those employed in-house. Consultation through the Internet, whether from central sites, user groups, or e-mail, is usually free and constant. Ideas for innovative programs, supporting research data, or problem solutions can be found on a moment's notice. For researchers, scanning of publications is not only fast, it is current -- far surpassing hours spent poring over card catalogues and hunting for misfiled journals.
The chances of becoming a caregiver to someone with a chronic condition are much higher today than ever before -- and the likelihood will increase over the coming decade. The demand for caregiving will increase as the elderly population increases, particularly among those 85 years and older, who are most likely to be disabled by chronic conditions. For many adult children, the role of caregiver is difficult, stressful, and confusing. The myriad of services which confuses professionals astounds the layman.
In addition to the growing number of home computers, most adult children have Web access at work. As the comfort level for Internet usage continues, this will be the first means of looking for information and assistance. There are numerous central sites with links to all sorts of service agencies, eligibility information, and advice for caregivers, providing a place to start. Furthermore, the availability of information 24 hours a day is appropriate for a population for whom crises do not conform to office hours.
Two major types of populations can be served: the healthy, active older adults and those who are experiencing health or social difficulties. Both of these categories are the focus of the gerotechnology projects of the Community Service & Outreach Unit of the West Virginia University Center on Aging (http://www.hsc.wvu.edu/som/ctr-on-aging/coa.htm).
The Center on Aging, located in the School of Medicine, initiates and disseminates programs that enhance quality of life, promote wellness in later life, provide "state-of-the art" diagnostic and treatment services for elderly patients and their families, and sustain independence and creative potential across the life-course. Special emphasis is placed on the unique challenges and opportunities associated with aging in rural Appalachia. In recognition of the Center's leadership and expertise, the United Nations has designated the WVU Center on Aging as its affiliated international resource institution in the area of rural aging. The Community Service and Outreach Unit facilitates the development of multidisciplinary projects responsive to the needs of older adults. The Unit is WVU's liaison with older West Virginians and local, state, and national providers of aging services which emphasize physical, psychological, economic, and social well-being.
WVU's Institute for Learning in Retirement, established in 1993, has over 250 members and nonmembers participating in year-round educational, recreational, and social activities and a mailing list of an additional 500 interested individuals. The Institute has three semesters of courses and activities per year. The most popular classes offered are the computer classes, both in PC and Mac -- there is often a six-month waiting list. The CoA Web site offers not only a current listing of courses but provides registration capabilities (http://www.hsc.wvu.edu/som/ctr-on-aging/all.htm).
Senior centers are another common participant on the Internet. CoA is currently working with the state association of senior centers not only to provide training but also to assist them in creating their own Web pages.
A major project of the Community Service and Outreach Unit is the Retiree Attraction Program. As part of a state task force, the Unit has formed alliances with the WV Office of Development, the WV Office of Aging, the WV Division of Tourism, the West Virginia Chamber of Commerce, and several local communities. As part of this program, the Unit has responded to inquiries from individuals in 35 states, 3 countries, and the District of Columbia. The CS&O Unit continues to work with interested local communities to establish Special Interest Committees and retiree attraction projects and supports state officials in the establishment of a formal program on the state level to address this issue. Working with the public officials, CS&O is creating a Web site of information on housing, recreation, education, and healthcare opportunities in West Virginia communities for those searching for a retirement location.
The first issue in looking for assistance is the determination of what type of service is needed. To this end, CS&O has created an online assessment -- a self-administered pre-screening which questions functional ability and then identifies the types of services which may address the disability. This site is not intended to be prescriptive or all-inclusive but to provide appropriate vocabulary and steer the searcher to the correct types of agencies (http://www.hsc.wvu.edu/som/ctr-on-aging/assess.htm).
The next step is to locate the service you need. This is the purpose of Link-Age West Virginia which established a statewide single point of information on the types and locations of services for the elderly and their families, as well as professionals. The Community Service and Outreach Unit currently operates a Web site at http://www.hsc.wvu.edu/linkage which contains a listing of services available within the state and national services applicable to the West Virginia population. In addition, Link-Age is connected to the National Eldercare Locator Service to assist persons out of state in finding West Virginia services for their relatives. The information on this page is useful not only to consumers with online access but also to professionals in aging-related occupations as a source of resources.
CS&O collects data quarterly and analyzes the calls received, the types of services requested, the locations of callers, and other data so that the prime areas of interest, gaps in service delivery, characteristics of callers, and response rates to requests can be of value in planning future service systems as well as strengthening existing ones. The outcome of the project will be available to all public and private professional groups as well as consumers; it is anticipated that hospital discharge planners, nursing home social workers, university researchers, case managers, public health nurses, and other professionals dealing with the aging population will find valuable assistance in the identification of resources. Indeed, the very rural nature of the state makes electronic accessing of such information of critical importance.
The Community Service and Outreach Unit has developed a statewide network of family caregiver support groups in underserved rural communities. Caregiver family support groups address the needs of family members and others who care for the elderly to reduce the likelihood that they will become overwhelmed and turn to residential placement. There are currently eighteen such support groups in West Virginia, and many more localities in West Virginia's 55 counties have expressed the desire to develop such a service.
The support groups focus on (1) direct emotional support; (2) problem-solving through peer guidance; (3) social networking and cooperation; (4) educational opportunities; and (5) short-term respite from the caregiver role. Once developed, support groups operate under the control of local volunteers; the Unit's role is mainly as a resource for projects, issue resolution, and referral to sources of assistance. During the two years of operation of this project, the staff has gained experience; accumulated information on the design, recruitment, marketing, training, and maintenance of groups; and developed activities and resources for group meetings.
The newest element of this project is the online services available to members of groups and to caregivers without support groups. A usenet group (email@example.com) has become an active site for those needing to discuss caregiving issues. This Web site allows people to share experiences, information, and resources and to support one another. The process of caregiving can be physically as well as emotionally demanding. It is often difficult for caregivers to receive the support they need in order to maintain their well-being. By providing this forum, it is our hope that all those who have a genuine interest in caregiving, or are caregivers themselves, will find a place of support. The process of sharing experiences, thoughts, and feelings with others who can, and do, understand is invaluable. The CSN now makes this opportunity available to everyone, including caregivers who may be isolated due to rural settings.
There have been inquiries from college students wanting information for academic assignments and researchers from companies producing goods related to homecare looking for subjects to test their products. But the primary function has been the peer interaction of those actually delivering care; the level of discussion has been amazing. The following is a recent message from one caregiver responding to a noncaregiving adult child, concerned about the actions of the sister who was providing care:
Such dialogue is not only moving, it is honest, experienced advice which is not available from a social worker or psychologist in an office.
The success of the listserv has resulted in the latest feature, a chat room for caregivers. While the CS&O does not have the personnel to monitor the chat room continuously, the clinical psychologist who manages the Caregiver Support Network holds weekly sessions; sometimes leaders of actual support groups volunteer to participate in the discussion. While it may never achieve the popularity of teen chat rooms, it is hoped that those who can benefit do participate and feel it is worthwhile (http://www.hsc.wvu.edu/som/ctr-on-aging/csn.htm).
As each Internet-related project is developed, we have come to identify others which can be applied to the medium. While the state and national recognition that these projects have received is gratifying and somewhat surprising, the main benefit has been the response of the users -- the professional agencies, the caregivers, and the older persons themselves. It is our intent to continue to provide online access in these and many other ways we have not yet imagined.