Proven Practice: assistive technology

Assistive technology for older people

Key messages

● The term ‘assistive technology’ incorporates a wide variety of devices.

● Assistive technology can be supportive, preventive or responsive.

● The increasing proportion of older people in the population makes the use of assistive technology an attractive option in social services.

● Perceptions vary as to whether or not assistive technology has sufficient benefits.

● Existing research supports the greater use of assistive technology but further evaluation and ‘local learning’ is needed.

Assistive technology is “any product or service designed to enable independence for disabled and older people” (King’s Fund 2001). The technologies embraced by these definitions include devices that might form part of “telecare” and “telehealth” service packages (that is, assistance devices linked to response teams via telephone, such as community alarm services, detectors or fire and falls monitors).

The definitions may also include more general technologies such as access to the internet which might have a role in promoting the independence and well-being of older people.

The UK faces a significant growth in the number of its citizens aged over 65 years, with an anticipated 47% increase by 2026. Increased access to assistive technology is seen as a cost-effective means of maintaining the independence, health and well-being of this growing population. The promotion of independence using assistive technology, however, relies on an increasingly wide range of devices which cover an equally wide range of individual situations.

With a growing population of older people, the increasing cost of acute interventions has focused policy-makers on ways of reducing this need. In recent years there has been greater recognition of the need to maintain health and well-being as a means of preventing ill-health.

The government has committed a high level of funding to the provision of assistive technology. A total of £80m was allocated to local authorities and their partners between 2006 and 2008 using the Preventative Technology Grant and a further £80m is planned between 2008 and 2010 under the banner of Extracare Housing. In return, the government anticipates potential benefits for people who use services in addition to a redistribution of health and social care spending.

There is also an increasing awareness of the need for person-centred planning in health and social care which is supported by the moves toward personalisation in a number of policy areas.

The use of assistive technology could provide a level of flexibility which supports this agenda although there could be conflicts between client and practitioner views of the relevance and role of assistive technology in care packages.

When placed against wider research with older people, assistive technology devices do target issues that they have identified as being important. These issues include concerns about being unable to undertake household chores, not wanting to be a burden on family members, fear of being taken ill when alone, and fear of accidents such as falls. These issues are categorised in assistive technology provision as supportive, responsive or preventative.

The types of assistive technology available can be grouped according to their role:

● Supportive technologies for helping individuals perform tasks that they may find difficult (for example, video entry systems, and medication reminder units)

● Detection and reaction (responsive) technologies to help individuals manage risks and raise alarms (for example, unburned gas detectors and panic buttons/pendants).

● Prediction and intervention (preventive) technologies to help prevent dangerous situations and, again, to raise alarms (for example, falls predictors, monitors for assessing physiological symptoms, room occupancy monitors).

Developments have meant devices are now more sophisticated although there are concerns over cost and user accessibility.

Findings from research

Positive feedback about the benefits of assistive technology has been obtained from people using services who have indicated that assistive technology promoted independence, enabled them to remain in their own homes, helped them to perform daily tasks and made them feel more safe and secure.

It is important to note that these aspects are fundamental to users’ perceptions of assistive technology and are likely to influence their willingness to accept assistive technology interventions. The respondents in this study also highlighted specific issues that can affect the acceptability of assistive technology for people who use services. They indicated, for example, that assistive technology devices should be not only be easy and convenient to use but also reliable.

Research into the use of assistive technology by occupational therapists has also indicated professional challenges that may have to be addressed when offering care.

In one Swedish study, for example, 102 older people, living in their own homes and eligible for care supported by assistive technology were interviewed. One aspect of the study was a comparison of the attitudes of people who accepted and those who declined care supported by assistive technology. The study found that those who accepted this were more likely to have a positive attitude towards the benefits of assistive technology.

People with a positive attitude were also more willing to have their home environment modified whereas others preferred “retaining an undisturbed home and uninterrupted life”, opinions that may also be linked to feeling stigmatised by the presence of assistive technology. As a result there may be discrepancy between users and practitioners in terms of their perceptions of the benefits of assistive technology.

Such findings emphasise the importance of ensuring that the introduction of care packages involving assistive technology are shaped by the desires and goals of people who use services. For community equipment, the outputs of the Trusted Assessor Project developed a set of competencies that those undertaking client assessments should adhere to. Key competencies within the framework include listening to and being guided by clients’ wishes and ensuring that clients understand the role of equipment and its relevance to their needs.

Similar competencies frameworks have been generated for practitioners caring for individuals who are suffering from long-term conditions and they are relevant for practitioners involved in the supply of assistive technology. The Care Services Improvement Partnership suggests that to ensure there is an ethical approach to shared decision-making, issues should be addressed by practitioners in their conversations with people using their services (see box below).

Further information

● Click here for Assistive Technology and Older People and Knowledge review 13: Outcomes-focused services for older people
● Care Services Improvement Partnership (CSIP)

Practitioners’ messages

● The term ‘assistive technology’ incorporates a wide variety of devices.

● Assistive technology can be supportive, preventive or responsive.

● The increasing proportion of older people in the population makes the use of assistive technology an attractive option in social services.

● Perceptions vary as to whether or not assistive technology has sufficient benefits.

● Existing research supports the greater use of assistive technology but further evaluation and ‘local learning’ is needed.

Author: LOADER Brian D. HARDEY Mike KEEBLE Leigh

Health informatics for older people: a review of ICT facilitated integrated care for older people

Reference: International Journal of Social Welfare, 17(1), January 2008, pp.46-53

Abstract Growing demands on welfare services, arising from expanding populations of older people in many countries, have led policy makers to consider the use of information and communications technologies (ICTs) as a means to transform the cost-effective delivery of health and social care. The evidence for these claims is examined by reporting the main findings of a review of worldwide published literature documenting the adoption of health informatics applications to improve health and social care for older people. It focuses on two dimensions of the UK government’s programme for modernising public services, which emphasise the use of ICTs to facilitate the sharing of health and social services information and their potential to foster person-centred approaches to independent living. Findings suggest that there is little evidence that these dimensions have been realised in practice and the perceived incompatibility between them is more likely to produce expensive and ineffective health informatics outcomes.

Author: TINKER Anthea et al

Remodelling to extra care housing: some implications for policy and practice

Reference: Quality in Ageing, 9(1), March 2008, pp.4-12

Abstract This research reports on recent attempts from 10 case-study areas in England to remodel sheltered housing and residential care homes to extra care housing. The results are mixed, with satisfaction reported by many new tenants, anger by some existing ones, and issues over the provision of assistive technology and care. Nearly all the schemes experienced unexpected problems during the course of construction. The research showed that remodelling is not a quick fix, but that it did have considerable advantages for many of the older people and support staff who were living and working the remodelled buildings. The research concluded that remodelling should only be undertaken when other options have been carefully examined. Drawing on the research findings, advice to policy-makers and practitioners who are considering this course of action is outlined in the discussion.

Author: GOODACRE Kate et al.

Enabling older people to stay at home: the costs of substituting and supplementing care with assistive technology

Reference: British Journal of Occupational Therapy, 71(4), April 2008, pp.130-140. ISSN paper 0308-0226

Abstract A multiprofessional research project explored issues relating to the introduction of assistive technology into the existing homes of older people in order to provide them with the opportunity to remain at home. The financial relationship between assistive technology and packages of formal care was also explored. The costs of residential care and those of several packages containing differing quantities of assistive technology, formal care and informal care were compared. The analyses provide a strong financial case for substituting and/or supplementing formal care with assistive technology, even for individuals with quite disabling conditions. Although needs and hence the cost of provision rise with an increasing level of disability, the savings in care costs accrue quickly.

Author: GOODACRE Kate et al.

Enabling older people to stay at home: how adaptable are existing properties?

Reference: British Journal of Occupational Therapy, 70(1), January 2007, pp.5-15.

Abstract: This multiprofessional research project examined in detail the factors that affect the adaptability of existing housing and explored issues relating to the introduction of assistive technology into the existing homes of older people in order to provide them with the opportunity to stay in their homes. The research reported here investigated the feasibility of adapting the existing stock of social housing and the resulting costs and outcomes of introducing assistive technology. This paper outlines that part of the project that examined in detail the adaptability of 82 properties representing a variety of property types to accommodate the needs of seven notional users, characterising the most common range of impairments of older people. The factors that affect a property’s adaptability include property type and specific design and construction features. The implications for housing providers, clients and occupational therapists are discussed. The research identified the unique expertise of occupational therapists, spanning the areas of housing, older people and assistive technology, and it introduced methods and tools that can help to determine best housing outcomes as well as cost implications. It is crucial that the profession is proactive in contributing to the development of housing policies that address the needs of an ageing population effectively.