Digital Plasticity and Transformations in Ageing

Return to User Requirements

Client-Centred Technology for Healthy Ageing: A one-day workshop organised by the University of York on behalf of the N8 Research Centre in Ageing and Health by the Centre for Usable Home Technology (CUHTec).

Date: 20/04/2009
Venue: Theatre Royal, York, UK

Digital Technologies should reflect an aging process which involves a series of overlapping transformations rather than a sequence of traumatic events. The plasticity of digital information means that it can react to user behaviour, be integrated into robots, take new forms in engineering re-integration and result in training free systems. This last development should reduce public sector expenditure and reduce the cost of services and the time of task completion for elderly users.

1. Introduction

There has been no time in history when older people have had so much to put up with as they do today. Of course this burden is the result of benign development, particularly in the areas of health, medicine, pensions, nutrition, transport and communication technologies. The best way to see the difference between elderly people now and 100 years ago is to visit an impoverished village in a developing country where infant mortality is high, life is precarious, longevity is low and life choices are almost non existent. That will knock the nostalgia clean out of you! In a literal sense, old people in these places don't have much to put up with because there aren't all that many of them and they don't live all that long.

But for today's elderly there is a burden, nonetheless, which we should not trivialise. Longevity brings with it the necessity to adjust to new circumstances in a world whose change is accelerating and shows no sign of decelerating. The critical point in a life trajectory is reached when the speed of change is quicker than the ability of the individual to adapt. This kind of change is, of course, asymmetrical: the adjustment required, for example, to move from using a 125 electric train to a TGV is minimal; but the switch from collecting your pension at the Post Office to receiving it in your mobile phone SIM card is considerable, even though the latter change is ostensibly more beneficial than the former. It would be invidious to generalise, but I think it is fairly safe to propose a rule of thumb that:

The older we are, the more difficult we find it to use novel products and processes, particularly those which:

Are the result of paradigm shifts;
Require a new skills set;
Are radically complex.

Respective examples of these three phenomena might be:

Triage replacing a call centre operator;
Learning web taxonomies;
Mastering the Video Cassette Recorder.

Before I go to the heart of my presentation, I want to make four general points on ageing:

Irrational extrapolation replaces research;
There is a conflation of inability with voluntary opting out;
There is a misleading aggregation of all pensioners;
That aggregation includes economic data.
Extrapolation. The area of access to technology by older people is particularly fraught with the postmodernist error of extrapolating personal experience into theory, e.g. "My granny is an internet wizard" or "My granny just won't go anywhere near a computer". It is remarkable how little we know about the way in which older people use consumer electronics and related technologies.
Conflation. The statistics for consumption by older people tend to confuse the public policy obsession with non performance and the private decision not to participate. There is a public sector assumed virtuousness in undertaking online transactions which is not supported by any ethical or practical justification. Almost all internet task completion, for example, is slower than using a telephone.
Aggregation. If we are to understand the situation of older people and technology, a demographic split by decile rather than lumping all over 60s together is vital.
Economics. There is no evidence, given the expenditure on subscription television by those with the lowest income, that cost is a major inhibitor of ICT use.

2. The Central Thesis

My central thesis is that:

The plasticity of digital technology should be harnessed to reflect overlapping life transformations.

Here is a summary of the difference between transformations and traumas:

Transformation	Trauma
Accumulated experience	No experience
Gradual adjustment	Radical adjustment
Ability to extrapolate/plan	Inability to extrapolate/plan

To take an example of my own specialist field, people frequently think of living with blindness as if it only occurs - against what they know from personal and statistical evidence - as the result of a traumatic event; they say such things as: "I don't know what I would do if I became blind tomorrow", to which the answer is: "But you almost certainly won't, unless you are the unfortunate victim of a major industrial or automobile accident; most people go blind very slowly." One reason for this misapprehension - indirect, admittedly, but still very powerful - is the tendency to think of disability as a paediatric phenomenon whereas it is largely adventitious. There are very good fund raising reasons why severe, paediatric disability should be advertised but it tends to point us to a false paradigm.

Likewise, our whole account of ourselves tends to use hindsight to identify dramatic transformational events; we are much more interesting to ourselves if we are creatures of incident, and even accident, rather than being creatures of deliberative routine. We might occasionally slip into victimhood, blaming the Government or some other external force for our ill fortune, but we largely believe as a culture in self determination; and the word "believe" is important here because we believe this regardless of circumstance. Our culture of autonomy survived a 20th century during which governments took on huge powers to prosecute two world wars.

We can therefore see the perverse attraction of the traumatic but our experience, rigorously analysed, will show us that we live lives of overlapping transitions such as:

Childhood/youth/adulthood/ageing;
Learning/working/retiring;
Experimenting/deciding/synthesising;
Initiative/collaboration/wisdom.

Some of our transformational phases are purely biological but many are social and they all follow well understood patterns; which is where digital technology comes in. Contrary to popular experience which sees digital technology primarily concerned with communication (it is frequently collectively called "Information and Communications Technology"), its greatest strength is pattern recognition. Put simply, then, the great strength of digital technology is that it is well aligned with the way in which most of us experience our lives.

3. Technology & Ageing

In this Section I want to look at four key areas:

Data Processing/pattern recognition;
Robotics;
Engineering re-integration;
Training-free devices.

3.1 Data Processing & Pattern Recognition

It is possible to design systems that take us from pattern recognition to default via an extrapolation process.

Pattern Recognition;
Extrapolation;
Default.

On the surface this looks very simple. If you have eaten porridge every morning of your adult life from October to April and fruit salad in the other half of the year; and if the same goes respectively for soup or salad for lunch, it doesn't take a very powerful analytical tool to put together the breakfast and lunch segments of your shopping list. The same kind of systematic approach might be adopted for your use of television or the car journeys you take. Patterns can be extrapolated into defaults; but this need not simply be the presentation of a set of static options. It is July, so the system already knows we want fruit salad for breakfast and salad for lunch; but it doesn't actually take very much pattern recognition to know whether we want more or less the same ingredients every day in our respective salads or whether we like a wide variety of fruits and vegetables. It will soon be clear what we don't like and what are our favourite ingredients. This kind of analysis can, in turn, be written across to automated shopping lists. If we can't stand beetroot we are not likely, as a default, to want it in our special offers digital in-basket. The key point about this kind of set-up is that it can be reactive; and we can set the system's sensitivity to behaviour so that it picks up trends over a given period. If we, to take another example, routinely answer all our emails from our children the same day, pushing their emails to the top of our default ranking, a temporary crisis with our solicitor, which means we don't answer their emails on a particular day, should not change the default ranking.

This kind of pattern recognition and ranking to produce a default position is important because it both meets our known current requirement and can adjust in line with our transformational behaviour. Although some activities will change radically, most of what we do is to product switch inside systems: our basket of goods may change but we still shop; our television viewing may change but we still watch television; our daily aches and pains may vary but our underlying medical diagnosis will evolve rather than being traumatic; our social time may be spent in different places with different people. Of course, in all four examples, conditions may change radically: we might abandon television or going out; we might be forced to reduce our expenditure on shopping and our health may suffer a serious, as opposed to a gradual, decline; pattern recognition, with the exception of some kinds of medical diagnostics, cannot forecast trauma; but our normative existence, as I have said, is not traumatic.

More exciting, in the medium-term, is the prospect of using pattern recognition to analyse our behaviour so that we can stay home longer, avoiding lengthy hospital stays and premature admittance to a care home. I should say, by way of a short introduction, that the characterisation of such systems as an invasion of privacy is irrational; a person opting for voluntary home monitoring has much more privacy than the same person in a hospital or care home. Indeed, we need a much more sophisticated debate about the fundamentals of privacy than has so far taken place. Most of what people want to preserve as private, such as their financial situation and health condition, are actually public. Just stop for a minute and think about the number of people in your community who know how much you earn, what you spend it on and what ailments you suffer from.

Here are four major subjects of pattern recognition:-

Location;
Diet;
Medication;
Posture.

Most of the behaviour being monitored in this situation is diagnostic in some way, although medication can introduce a more prescriptive regime. Given the history of these technologies, the extension of liberty and the cost-saving, it is important to know why their adoption has been so sluggish.

Finally, there is another form of pattern recognition which is not strictly digital, and that is the adjustment of design to behaviour. I am not calling for the production of specially large mobile phones to accommodate the geriatric hand; but I do think that devices such as a programmable television and media remote controller would be a good, commercially viable, idea.

3.2 Robotics

It is with great sadness that I report the death of Aibo, Sony's robotic dog, not least because one of his number has been in residence at CUHTec for some years. In 2000 I forecast that by 2010 robots would replace Guide Dogs; I was wrong. No matter how good robots become at helping blind people to maintain independent mobility, the public will want to buy Guide Dogs. This is not to say that many people will not continue to want dogs as companions but such a requirement does not involve the huge expense in producing a professional Guide Dog in a working partnership with an owner. The technologies now exist to produce a powerful device:

Salient and Recessed Hazard Recognition;
LBS/GPS/Satellite Navigation;
Speed/road crossing calculation.

Again, there may be a number of very good reasons why people don't want to use a Guide Dog, including its role as the signifier of a disability, but this cannot account for the huge social isolation of more than 50% of all blind people. The use of a robotic mobility device would:

Cut the cost and complexity of training;
Cut the cost of acquisition and maintenance;
Allow detailed programming;
Provide feedback;
Adjust to user behaviour;
Handle strange environments.

Most of these points are very simple; but I want to draw the penultimate point to your attention; Guide Dog users have to calculate the safety of road crossing; a robot, knowing the speed of an on-coming car and the walking speed of its owner, could make a much more rational decision. This kind of technology links into two other aspects of the presentation, the need for better engineering re-integration and training-free devices.

The example of road crossing again emphasises the transitional nature of our mobility. The failure to calculate accurately may force us into a traumatic situation caused by a loss of self confidence, but the ability to respond to an accurate calculation will simply mean that we will take longer to embark on a road crossing. We may rationally decide, on that basis, whether the increased journey time means that we are not willing to walk to nearby shops when it is raining; but that is a much less drastic decision than deciding never to visit the shops again.

At a much simpler level, in the domestic environment the hiatus in progress since domestic consumer electronics, has been most disappointing. Vacuum cleaners still need directing and dish washers need stacking and un-stacking; at least my microwave oven will calculate a cooking time from a weight and a food taxonomy. There's no reason in principle why a kitchen floor and working surface cleaner cannot be developed to go round large objects and move small ones; i.e. a cleaner circumvents a table leg while floor cleaning rather than trying to pick up the table but, equally, it moves a salt cellar while table wiping. Sadly, too, the long-handled lawn-mower is the exception that proves the rule.

Overall, it is easier to re-programme devices than to make them physically adaptable to our changing condition and digital plasticity therefore has much to offer in the area of robotics because it converts what could be a set of traumatic decisions into transformations.

3.3 Engineering Re-integration

One of the customary explanations for why it is not possible to do certain things is that there isn't enough money. Fortunately, the engineering of the re-integration of technologies is not expensive. We have all the elements but just need to put them together in slightly different ways. Rather than trying to abstract the topic into principles, it would be helpful here to give examples:

Independent Mobility;
Simulation;
Multimodal output.
Independent Mobility. Currently, older people, particularly those with mild to severe disabilities, reach a traumatic point when they can no longer drive, or even visit the shops. From being relatively active and independent they can, over a span of only a few months, become house bound and isolated.

In the analogue era this traumatic situation was brought about because any assistance had to be physically alongside the person in need: thus, an older person needed a friend or relative to act as substitute driver or to accompany the person on foot.

Today, in the digital age, broad band multi-contact user groups and community transport suppliers can organise transport more rationally; the fact that potential users and suppliers do not use these sorts of systems presents us with a research issue very similar to that with respect to the very slow uptake of voluntary domestic monitoring. Clearly, multi-contact systems are more efficient than making a long sequence of calls on a land line telephone, not least because they enable both suppliers and users to operate outside rather rigid, quasi monopoly situations, where the user relies on one or two suppliers and the supplier meets the needs of a fixed group of users.

In the area of independent mobility, the prospects are even more intriguing. It is possible to combine GPS/LBS systems with lightweight cameras so that a person can travel independently, knowing that if she gets stuck or lost, either a monitoring centre or person, to whom she has signed up, will pick up the problem, or she can use a device to alert a monitor and then use the camera, with the GPS system, to become correctly oriented.

Further, we are living in a highly monitored society but the equipment could be used to help people as well as to watch them. It should be possible for people to register to be monitored by public systems and to ask monitors for advice and even to summon physical help.

This kind of flexibility will prevent older people having to take a traumatic decision, to go out or stay home.

Simulation. The plasticity of digital systems allows all kinds of adjustments to be made to simplify or magnify our understanding of our environment. Admittedly, analogue electronic devices have the capacity to alter sound volume and picture contrast but digital systems provide a far greater capacity for adjustment. Much of the progress in this area has been in flight simulators and games consoles but there is no reason why these technologies should not be used to elucidate the environment (through simplification and magnification) for those suffering from various impairment symptoms and their carers and those who work with them.
Multimodal Output. For people losing the keenness of one or more of their senses, the analogue world was somewhat unforgiving; one could simultaneously listen to a book, follow the text and look at related pictures but this involved a major effort. Today, it is possible to access text simultaneously in print and audio and to summon up a host of illustrative material. In making documents available, the paradigm should be the way in which we make television programmes where nobody questions the simultaneous use of audio, pictures and text; it is just that many documents have a different bias, with more text and fewer images or more music and less text. This use of multimodality allows another kind of continuity which does not force people to make a decision about reading or stopping reading. Of course, there may be a cut off point where somebody can no longer read print or hear audio but that can be the end of a long transition in the way text is used rather than being a sudden, traumatic point of exclusion.

3.4 Training-Free Systems

Here are some propositions about training-free systems:

Training is a cost shift from suppliers to consumers;
Automation requires simplification;
User Requirements and Procurement should require training-free systems.

There has been a quite remarkable public policy aberration in respect of ICT. Instead of governments developing user requirements for training-free systems and procuring on the basis of these requirements being met, governments have not only spent billions on ICT training, they have boasted about it. In a world of digital plasticity this is absurd. The public sector (and private sector) adoption of expensive, over-engineered, client side ICT systems bears witness to remarkable jutspa on the part of Microsoft and remarkable gullibility on the part of its major, standard-setting customers.

With reference to over-engineering, I worked for some years in what was then the DfES on the Cybrarian/myguide project which presented users switching on their computers with a simple choice of email or looking for something. We taught all-comers, including many elderly people, in under an hour and their task completion times plummeted with repeat use. The same over-engineering has also retarded the use of server-side models because of the ratio of traffic to telephone capacity; but if, in 1993, you had stayed with a DOS-based word processor, a server side model would have been viable.

Where training is necessary it should be:

Peer normative and not comprehensive;
Task oriented and not theoretical;
Time-conscious and not timeless.

I should explain these three ideas briefly. Digital Technology does not perform simple functions like lawn mowing or dish washing, it can be used for almost anything and there is therefore a temptation to train people to do almost anything. What older people want is to do what their peers do, to do it in a practical way and to do it quickly.

Having said that, over engineering and client side services are now avoidable. We should expect our ICT services to be as simple to use and as reliable as broadcasting.

Simplification. There is a win/win situation in simplification; it

Cuts costs for suppliers;
Cuts cost and time for users.

In the public sector at least, complexity results from the refinement of fairness and justice considerations; but we would be better served by simpler systems which would cut costs and allow 'rounding up' so that fewer options would not increase injustice. One reason why so many public sector ICT projects have failed is because they have tried to automate byzantine systems instead of simplifying them prior to automation. This has led to gross double-cost systems where the expenditure on ICT has not resulted in equal or greater savings in human resources.

On the other side of the coin, we already know that the fewer classes information is divided into, the easier it is to find[1].

If Government wants to cut costs radically in the imminent public sector squeeze, then systems simplification is the key and equally, that very simplification will increase reach and, in turn, cut human resource costs.

4. Conclusion

Together, all these measures should lead to simpler, more reactive, training free systems, allowing us all to pass from one phase of our life to another with greater ease, comfort and acclimatisation. The problem is not so much finance as imagination.

[1] Ormerod, Prof Tom; University of Lancaster; Lost then found: Applying psychology to problems of digital image handling: PACCIT Event ‘Access All Areas' (Royal Society, London, 27th June 2006) http://www.psych.lancs.ac.uk/people/TomOrmerod.html