FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLGY, TUE, EINDHOVEN, NL May 22-23, 2006 IMPACT OF TECHN0LOGY ON HEALTH AND SELF-ESTEEM James L. Fozard, Ph.D. School of Aging Studies University of South Florida Tampa, Florida For electronic copy of slides, send request to

Tribute to Powell Lawton: Person/environment relations in aging The late Dr. Powell Lawton is one of the best known US psychologists in psychology of aging, sometimes called geropsychology –His theoretical ideas about ‘person-environment fit’ are drawn from field theory of Kurt Lewin and other transactional theories linking man to environment –Lawton’s research made enormous contributions to theories of aging and practical research about the relationship between independence in old age and environmental stresses and opportunities –This lecture draws on and recognizes his life-work –Lawton MP. Future society and technology. In J Graafmans, V Taipale, N Charness (Eds) Gerontechnology: A sustainable investment in the future. Amsterdam: IOS Press, 1998, pp.12-21

Two topics of presentation 1.How does human aging relate to changes in the environment? 2.How the gerontechnology model improves other ecological models of health

How does human aging relate to changes in the environment? The environment changes over time –Continuous changes occur in the natural, built and social environment—called secular changes –Overlapping generations of aging people—called age cohorts-- who create and use environment are affected differently by environmental change –Aging 10 years between starting at age 60 is a different experience than starting at age 10 GERONTECHNOLOGY ADDRESSES THE DYNAMICS OF THE PERSON-ENVIRONMENT INTERACTION

Environment Person Social Built Natural Receptors Internal Effectors Structures Interface System Output Measure At any point in time, the Person-Environment Interaction may be Analyzed using the well-known human factors approach. System output can be altered by changing the environment, the person, or both.

Environment Person Interface System Output Measure Person and environment are considered as a system. Changes in either alters the system (system output), e.g., units produced, accidents. Interaction between person and environment is called user interface

Environment Person Social Built Natural Interface System Output Measure Environment has three components— Social, built or manmade, natural Fozard, Figure 1

Environment Person Receptors Internal Effectors Structures Interface System Output Measure Person gets information from environment (receptors), processes it (structures), and responds to it (effectors). 1

What happens when changes over time are added to the model? Adding time to the model, e.g., 10 years, allows us to consider three additional factors: –changes within a person as (s)he ages –Cohort or generational differences between successive age cohorts as they age Variability among members within any cohort increases because of differences in experience of the environment –Secular changes in the environment over time Gerontechnology deals with how changes in the environment affects different age cohorts

Environment Person Social Built Natural Receptors Internal Effectors Structures Interface Future Past Time System Output Measure The arrows represent changes over time, from Past to future

Environment Person Social Built Natural Receptors Internal Effectors Structures Interface Future Past Time Human aging System Output Measure Over the same period of time, people of different birth cohorts age (Human aging)

Environment Person Social Built Natural Receptors Internal Effectors Structures Interface Future Past Time Human aging Secular change System Output Measure Over the same period of time, changes occur in the social, built and natural environment (Secular changes)

Environment Person Social Built Natural Receptors Internal Effectors Structures Interface Future Past Time Human aging Secular change System Output Measure LESSON: BOTH age-related and secular changes affect system output dynamics

Lessons from the diagrams:1 Environmental change and aging Secular changes in the social component of the environment create the context for changing user interfaces Secular changes in natural and manmade components of the environment affect its sustainability Energy use –Renewable resource consumption –Viability—air and water quality, contaminants –Livability—housing density –Transportation Frankish J. Health promoting environments. Fifth International Conference on Communication, Ageing and Health, Vancouver, kBC, kCanada, July, 2001

Lessons from the diagrams:2 Environmental change and aging Secular changes in technology are creating dramatic changes in user interfaces –Wireless phones used for watching downloaded TV shows as well as communication –Adaptive robotic technology blurs distinctions between person to person and person to machine communication and interaction Adaptation process to secular change varies across age cohorts partly because of variety and amount of earlier experiences

Lessons from the diagrams:3 Environmental change and aging Within an age cohort, aging results in an increased interdependence between person and various components of the environment. This partly explains the well documented finding that older persons desire to “age in place”

Lessons from the diagrams 4 Experience with one user-technology interface can have negative or positive effects on the ability or willingness of a person to use a new one –Person with experience in electro-mechanical user interface may have difficulty using menu-driven interface for same function –Person with no prior experience with a particular user interface may be unwilling to learn that interface Docampo Roma M, de Ridder, H. Bouma, H. Technology generation and age in using layered user interfaces. Gerontechnology, 2001, 1, 25-40

Lessons from the diagrams 5 Usual market forces in development and distribution of technology are necessary but not sufficient in gerontechnology. Problems in use of technical products and environments come from poor user interfaces (e.g., technology generations) and from distrust of advertising and marketing

Putting the 4 gerontechnology interventions to work Fozard, JL Impacts of technology interventions on health and self- esteem. Gerontechnology, 2005, 4, The diagrams relating the interactions between people and their environments are just the first step in planning environmental interventions The next steps include identifying the –Desired impact, e.g. prevention vs. compensation –Target of intervention –Site and placement of technology –Timing of intervention

Fozard, Fig.2 IMPACT? Prevention Compensation Care/organization Enhance FUNCTION? Physical Cognitive Emotional/Social System Output Environ- ment Person IMPACT? Enhance Prevent Compensate Care/organization TARGET? Physical Mental Emotional/social INTERVENE: TYPE, SITE? Person: Train, motivate Select Personality Demographics Environment: Built, social, natural Device on person Device: located near or remotely Time Planning Practical Application of Gerontechnology Concepts

Health and self-esteem—technology supporting physical, cognitive and emotional functioning as well as the treatment and prevention of disease. ‘Self-esteem’ refers to the use of technology to help maintain individual independence and dignity by reducing the direct dependence by an individual on other persons. Health and self esteem

Prevention and engagement-1 Prevention and engagement--technology to delay or prevent age-associated physiological and behavioral changes that restrict human functioning. It concerns accidents in and around the home and environmental factors contributing to allergies, depression and other modifiable conditions.

Prevention and engagement-2 Prevention thus represents a public health use of technology that is most relevant to life style factors that affect physical strength, mobility and cognitive and perceptual functioning Most applications of technology for prevention would be classified as primary prevention in the public health literature.

Compensation and assistance-1 Compensation and assistance-- technology that compensates for age- associated losses in strength and perceptual-motor functioning. Applications range from simple, ‘one size fits all’ mobility aids or large print-high contrast books to robotic and programmable equipment and products that adapt to the needs of individual users.

Compensation and assistance-2 Most applications of technology for compensation would be classified as secondary prevention in the public health literature. Compensatory devices related to gait, stumbles and falls--rolling walkers, grab bars, hip protectors, motorized and manual wheelchairs and related devices--are continually being improved. An increasing amount of sophisticated applied research is identifying the importance of vision and sense of balance for the compensation of age associated problems in gait,

Care support and organization-1 Care support and organization--use of technology for self-care by elderly persons with physical limitations or by caregivers—often elderly themselves— of elderly persons with disabilities. Care support and organization is considered tertiary prevention in public health literature

Care support and organization-2 Mann and colleagues demonstrated the cost effectiveness of multiple technological devices in prolonging life and improving it in very impaired elderly patients. In comparison to a usual treatment group, the availability of the technologies was reduced the amount of nursing and institutional care. Mann, W.C. et al. Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: A randomized trial. Arch. Family Med. 1999, 8,

Enhancement and satisfaction-1 Enhancement and satisfaction--the innovative uses of technology; e.g., virtual reality, interactive communication devices and self adapting equipment that expands the range and depth of human activities with respect to comfort, vitality and productivity.

Enhancement and satisfaction-2 Aging brings new opportunities for: –Adventurous and challenging activities –New social opportunities and friendships –Artistic expression –Learning –Work Technical support for all these activities is possible in home settings

Topic 2 in presentation 2.How gerontechnology paradigm improves other ecological models of health

The Gerontechnology paradigm improves other ecological models The gerontechnology paradigm related to health and self esteem shows how health and function is affected by changes in people over time as they age and the environment as it changes Two examples are described –The U.S. Surgeon General’s Healthy People 2000 –Marshall’s Models of health promotion: towards an integrated vision, 2001

Healthy People, 2000 The model to be described was developed to describe how well selected public health interventions decrease morbidity, mortality and increase the health of American children and adults over a ten year period Ten-year public health goals are set by the Surgeon General of the US Public Health Service. Progress toward the goals are measured by indices such as decreases in the number of teenage smokers, heart attacks, etc.

Policies and and Interventions Behavior Physical Environment Person Social Environment Biology Access to quality health care Health Status

Core of Healthy People model A person’s health is influenced by the physical and social environment The person-environment interaction includes behavior and biology components The goal shown in the diagram is access to quality health care

The gerontechnology model can increase scope of “Healthy Aging” The Healthy People 2000 model differentiates between the social and physical environment. Gerontechnology model differentiates between the man-made and physical environment The gerontechnology paradigm takes changes with aging and secular changes in the environment into account—important for a ten- year horizon Gerontechnology model reveals complexity of the Healthy People model as shown in the next slide

Environment Person Social Built Natural Receptors Internal Effectors Structures Interface Future Past Time Human aging Secular change Health Status Indices Established Policies and Interventions; Access to Health Care Fozard, Figure 5

Gerontechnology paradigm and a better Healthy People 2000 model Policies and interventions are shown as specific environmental determiners of the person- environment interface. Impact of the Healthy People interventions as well as all the other components will be reflected in changes in the various health status indicators, e.g., number of persons in different age groups who are obese, have hypertension, or who are smokers Public health policies and interventions are portrayed as environmental determiners of person-environment interactions

Victor Marshall’s (2001) ecological model of healthy aging Goal of model is to relate an individual’s “well being” at any age to determinants ranging from distal to proximal: –Demographic determinants—gender, class religion, language, marital status, etc. – Personal history determinants—labor force history, family and household, etc. –Proximal history determinants—health, wealth, social integration The word, “environment,” is not mentioned in the model

Gender Age Class Education Region Race Ethnicity Language Marital Status Industrial Sector Labor Force History Family and Household Health Wealth Social integration Well-being

Gerontological paradigm expands the Marshall model Marshall’s antecedent determiners of well being are shown as historical personal and environmental factors in the gerontechnology version Gerontechnology’s areas of application— communication, housing, work, health are related to Marshall’s derterminants of social integration, family and household, labor force history and health, respectively Transportation and mobility cut across all of Marshall’s determinants

Environment Person Social Built Natural Receptors Internal Effectors Structures Interface Future Past Time Human aging Secular change Measure of Well- Being Health, wealth, social integration Labor force and family history Demographics—age, gender, race, etc.

Dishman health technology model Dishman E, Mattews J, Dunbar-JacobJ. Everyday health:Technology for adaptive aging. In R. Pew, S.van Hemel (Eds) Technology for adaptive aging, Washington: National Academies Press, 2004, pp Dishman uses the same three levels of prevention used in the Gerontechnology model: primary, secondary, tertiary Dishman names four behaviors similar to the Gerontechnology model’s “health and self- esteem’: health status, physical function, social integration, cognitive function Dishman includes dimension called site of operation: the person, environment, remote, a dimension I incorporated in my model.

ADAPTATION DOMAIN HEALTH STATUS PHYSICAL SOCIAL COGNI- TIVE PRIM- SECOND- TERTI- ARY ARY ARY LEVEL OF PREVENTION REMOTE ENVIRONMENTAL PERSONAL/ MOBILE SITE OF APPLICATION

Dishman, Matthews & Dunbar (2004) health technology model The site of operation dimension is a useful addition to the gerontechnology model described in this presentation The technology chosen for an intervention can interface with a person on the body, in the house, in a remote location, or in a robotic companion

Fozard, Fig.2 IMPACT? Prevention Compensation Care/organization Enhance FUNCTION? Physical Cognitive Emotional/Social System Output Environment Person IMPACT? Enhance Prevent Compensate Care/organization TARGET? Physical Mental Emotional/social INTERVENE: TYPE, SITE? Person: Train, motivate Select Personality Demographics Environment: Built, social, natural Device on person Device: near or remotely placed Time Steps used in Practical Application of Gerontechnology Concepts

Conclusions Gerontechnology is... A major tool for creating what UN Secretary General Kofi Annan calls “Enabling Environments” A discipline based on obtaining scientific and consumer input on what constitutes an “Enabling Environment”

Conclusions: Enabling environment? Gerontechnology’s take on Kofi Anan’s concept The “enabling” physical environment is more than neutral or potentially harmful to human activity. The enabling environment is actively manipulated to optimize the functioning of people as they age.

Conclusions: Uses and usefulness of the Gerontechnology model The Gerontechnology model provides a useful tool for planning technological interventions in health care at all levels—primary, secondary and tertiary It adds the concept of enhancement to the usual three public health interventions The usefulness of the gerontechnology model is increased when used in combination with the Dishman et al model because the latter is specific about the site of application—personal, environmental or remote