Co-designing technology for ageing in place: A systematic review

Abstract

KEYWORDSco-design, user centered design, ageing in place, elderly, older adults 2 Abstract Background: Co-design in healthcare has become mainstream. Co-design with end-users can improve patient satisfaction, outcomes and reduce the cost of care. As populations age, there is a growing interest to involve the elderly in the co-design of health technology to maintain their well-being and independence. However, it is less clear if co-designed technology improves health and well-being outcomes. The aim of this study is to evaluate co-designed technology that supports elders to age in place.Methods: We conducted a systematic review to: i) investigate the health and well-being outcomes of co-designed technology for elders (≥ 60 years); ii) to identify co-design approaches and contexts where they are applied and; iii) to identify barriers and facilitators of the co-design process with elders. Searches were conducted in MEDLINE, EMBASE, CINAHL, Science Citation Index (Web of Science), Scopus, OpenGrey and Business Source Premiere databases using MeSH terms and key words. Results: We identified 14,649 articles of which 34 studies were included. Studies were from Europe (n=28), Australia (n=4), America (n=1) and Canada (n=1). Twenty of the 32 studies targeted older adults (≥ 60 years old) and 14 targeted specific medical conditions or elder-related issues. Technological solutions included robots, online applications and software, smart televisions, computer games for exercise, global positioning solutions, smart home systems and design of care pathways.Five studies reported health and well-being outcomes and were extracted. The health and well-being impact of co-designed technology was inconsistent. Co-design processes varied greatly and in their intensity of elder involvement. Common facilitators of and barriers to the co-design process included the building of relationships between stakeholders, stakeholder knowledge of problems and solutions, as well as expertise in the co-design methodology.Conclusions: The co-design approach was applied in the design of a diverse set of technologies. The effect of co-designed technology on health and well-being was rarely studied and it was difficult to ascertain its impact. Future co-design efforts need to address barriers unique to the elderly population. More evaluation of the impact of co-designed technologies' is needed and standardisation

Technology Used to Recognize Activities of Daily Living in Community-Dwelling Older Adults

“…This may include an element of routine monitoring alongside specific ADL recognition, as deviations from the routine can highlight changes in cognitive function often missed by the traditional measures, and therefore could provide a greater insight into the individual’s functional decline [ 39 , 43 ]. The involvement of key stakeholders, such as older adults and healthcare workers, should be prevalent within any future work [ 75 , 76 , 77 ] to ensure that the systems are both functional and usable; there is little point in developing a system capable of highly detailed ADL recognition if those it is designed to help are unable or unwilling to use it. This will help to ensure that any future developments are accepted by those whom it is intended to help, and that advancements are being made because they are needed, not simply because they can be.…”

Moving Toward the Promise of Participatory Engagement of Older Adults in Gerotechnology

“…Without dedicated funding and other resources to support activities of this kind, older adults are restricted to participating in earlier phases of the research as unpaid volunteers, which reinforces their marginalization and consignment to a tokenistic role ( Cook, 2012 ). Lack of sufficient financial resources and time have consistently been identified as key barriers to building the research competencies and digital literacy of older adults that are crucial for their meaningful involvement in gerotechnology research ( Merkel & Kucharski, 2018 ; Sumner et al, 2020 ). Other significant structural barriers to participatory research with older adults include gaps in education and training of researchers and designers with respect to how to engage in collaborative knowledge production with experiential stakeholders ( Wada et al, 2020 ) as well as the widespread prevalence of ageism, which includes researchers’ and designers’ stereotypes about older adults’ limited capabilities and interest in getting involved in gerotechnology research ( Fischer et al, 2020 ; Vines et al, 2015 ).…”

“…Consequently, when older adults expressed that they did not want to develop programs for robots and perceived working with a computer as “difficult,” the researchers concluded that they “were not ready for hands-on work with robots” ( Šabanović et al, 2015 , p. 110), rather than exploring why older adults were reticent about doing this and/or finding ways to increase their comfort and skill in this area. This is despite that technological literacy is a known barrier to the involvement of older adults in gerotechnology research ( Sumner et al, 2020 ). In neglecting to address these barriers, PD studies can inadvertently reinforce the negative stereotype of older adults as being incapable or uninterested in technology and its development.…”

“…The authors note that a full level of involvement (i.e., from project inception to dissemination) is more desirable in terms of democratizing the design of technologies given that this is a “normative presumption of [PD],” and yet they suggest that it is not always possible due to barriers such as budget restrictions ( Merkel & Kucharski, 2018 , p. e23). Additional barriers have been identified by others, including, for example, older adults’ lack of skills in design methodologies, low levels of digital literacy, functional challenges, and the time and effort required to address these barriers ( Sumner et al, 2020 ). Understanding these material barriers is certainly important for developing strategies to enable fuller involvement of older adults in PD.…”

Codesign approaches involving older adults in the development of electronic healthcare tools: a systematic review

“…Codesign approaches aim to elicit ideas and foster a non-hierarchical environment for stakeholders, in which their concepts, tacit knowledge and lived experiences can be applied to develop tools that meet their needs, improve usability and impact outcomes from use of the system. 1 2 Codesign is also likened to participatory design, each defined as focusing on the engagement and creativity of stakeholders, or those untrained in design efforts, but through collaborative efforts bring mutual learning into the development process. 3 4 Despite the underlying similarity of these approaches, there is heterogeneity in the terminology of codesign approaches, which leads to variation in the evaluation measures employed, involvement processes, levels of participation and learning outcomes.…”