Fulfilling the promises of gerotech requires getting under its skin

by Clara Berridge
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For the past few years, the Gerontological Society of America has hosted technology-themed events as part of its annual conference. Last month, attendance at Tech Day swelled to hundreds at the IAGG in San Francisco. The proximity to Silicon Valley enabled attendance by multiple tech start-ups, and speakers encouraged the academics in the audience to emulate them. We were asked, “How many of you represent start-ups?” followed by “How many of you want to be more like a startup?” Hands shot up. This would be rich material for an anthropologist, and I hope one is documenting this moment of infectious enthusiasm over self-driving cars and companion robots.

Due to the strong focus on health and managing chronic conditions at home, the vast majority of the technological innovation in the aging space is focused on the transmission of data and data analytics. In nursing homes, nurses and CNAs report so many sensors going off that they stop responding to them. One of the main tasks of gerontechnologists today is to make all the new data collected about people in a range of settings actionable rather than “burdensome.” Continuous remote monitoring technology that conveys new information about one party to another is what I focus on as a researcher because it raises a number of questions about autonomy, privacy, and one’s subjectivity. My field is Social Welfare (in the U.S., “welfare” references means-tested programs), so I concentrate narrowly on the experiences and policies touching marginalized older adults – positionalities that bring some of these issues related to power into sharp relief.

In 2010, when I was a graduate student researcher with the Center that helped grow GSA’s Tech Day, I was in search of conceptual and theoretical tools to engage new socio-technical practices in elder care. To this end, I organized a symposium on ethics in gerontechnology for the conference. At that time, there were few researchers in the U.S. studying ethical aspects of new forms of monitoring people in their homes. In order to fill the symposium, I turned to speakers from abroad who don’t typically attend GSA. This group represented diverse disciplines, and Professor Rick Moody facilitated a dynamic discussion. In this blog, I want to briefly outline some lessons I’ve learned since then, focusing on the contributions of scholars who have taken up the study of technology in generative ways that align well with critical gerontology. I discuss three thematic contributions, including the ideas that technology embodies and reinforces values, reductive representations of older people and their needs will lead to impoverished solutions, and resistance by older adults isn’t futile. I conclude by suggesting that more cross-national, interdisciplinary, and public facing work is needed.

Theme 1: Technology embodies and reinforces values, and in this way, is profoundly human (Neven, 2015; Lehoux, 2008).

This first theme is foundational to the study of technology in elder care from a critical gerontological perspective. I am sure that by now you have heard some version of the idea that we can employ technology for good or we can employ it for bad—that it all depends on the chosen use. Yet, we must also consider how technologies themselves are not value neutral. Engineers, like any of us, are always socially positioned, and they are typically young men designing for old, often disabled women or their caregivers. Designers and engineers have an idea of an end user in mind when they design for them. Researchers like Louis Neven (2010) have shown us why designers’ representations of older adults matter and how solutions prioritize social values, whether it be risk management, human interaction, cost efficiency, or privacy. A basic tenet of Science and Technology Studies (STS) is that values are embedded in technologies and technologies reinforce values (Pols 2012; Lehoux, Williams-Jones & Proulx, 2017; Lehoux 2006; Oudshoorn and Pinch 2003). It’s useful to think of a device as social because it mediates care relationships and introduces new norms, shaping and shaped by people who use it (Oudshoorn and Pinch 2003; Oudshoorn, 2011; Pols 2012). Ideas about technologies as social are reflected in questions such as those Joseph Coughlin raised at Tech Day, “How far do we push your dignity to protect your safety?” It is worthwhile to examine the values embedded in a given technology, as well as how those values play out and interact with other values in practice.

Theme 2: Reductive representations of older people and their needs will lead to impoverished solutions.

This second theme will be intuitive for gerontologists who take issue with the overgeneralization of attributes to older adults as a single population. In their theory article on surveillance, Ben Mortenson, Andrew Sixsmith and Ryan Woolrych (2014) warn that “Careful consideration is necessary to ensure that programs, policies and technologies that are intended to contain costs by ‘protecting’ the health of older adults do not further disempower this already potentially marginalized group of individuals.” Indeed, in practice, reductive interpretations of older adults’ needs, and certainly desires, in technologies can lead to disempowerment, conflict, or to discontinued use (Berridge, 2016, 2017a, 2017b). Here, there is a direct match with the intent of critical gerontology that aims to identify underlying assumptions about older adults, old age, and aging. Questions to help reveal the assumptions built into technological solutions include “Whose priorities are designed for? Are there other priorities that may conflict with or challenge these priorities? At what level – individual, community, institutional – is the underlying problem located and the solution targeted?”

A further question to ask is, who has access to which technology? Who’s going to be left with the robot to reduce the costs of human assistance and company, and who is going to be empowered to program their own robot to creatively achieve their ends (see Lehoux et al., 2014)? Are the robots going to speak in first-person like a robot that was celebrated at Tech Day? It used “I” statements, including “I think horses are amazing animals,” which could potentially mislead a person with dementia into thinking it is a mutually caring being. On the one hand, robots offer the experience of endless patience and can repeat information as often as an older adult with dementia wants. On the other hand, as Critical Information Studies scholar Ronald Day once asked in a discussion of robots, “Is that really what we want to be saving our subjectivity in old age?” Moreover, what do our technological solutions mean for the practice of caregiving and what do they teach us about societal views of aging, old age, and older adults? In practice, in what ways do they open or close ways of being an older person?

Theme 3: Resistance isn’t futile.

Within critical gerontology, we try to be attentive to ageism in its many forms and to take older adults and their actions seriously. As I’ve argued, if we are to view older adults “as technogenarians, as potentially capable of shaping technology’s meaning and use (Brown and Webster 2004), those interested in improving access and experiences of technology use for older adults must take seriously the ways in which older adults choose to use it” (Berridge, 2014). Unfortunately, rejection and what’s termed “misuse” of technology by older adults is often dismissed as noncompliance, tech incompetence, or “initial” vs. real resistance (Neven, 2011). But by examining creative use and resistance, older adults’ priorities and intentional actions become visible (Loe, 2015; Berridge, 2017b). Maggie Mort and her coauthors of an EFORTT report argue that respecting these potentially inconvenient “reshaping” actions are integral to ethical use to prevent “totalizing and coercive” practices (2011, p. 16). Just as older adults are not passive recipients of care, they are not passive users of technology. Even in the case of passive remote monitoring that requires no action, I’ve found that older adults do not follow what Neven (2010, 2015) calls the “passive age script”; they adapt technology or resist it to meet their own needs (Berridge, 2017b). This relates to the principle of predictable unpredictability. The impact of a particular technology is not fully predictable before being, in STS terms, “unleashed” into “the wild” and cannot be imposed on top of practices (see Pascale Lehoux’s “dual performative potential” in her book, The Problem of Health Technology, 2006). Technologies should be developed in the context of social relations that enable care (Pols, 2017; Greenhalgh, 2015).

This entertaining, 5-minute film showcased at the top of this page, created by Superflux Lab in the UK for the international ThingTank project, happens to illustrate some of my findings on resistance to an activity sensor system by a group of older adults in low-income independent living apartments. Ninety-eight percent of the residents who were identified by social workers as appropriate candidates for the in-home sensor program declined it, a choice described by management as “irrational.” Interviews with residents and social workers described a mismatch between residents’ priorities and those reflected in the passive monitoring intervention, which sparked creative forms of use and resistance like those enacted by “Thomas” in this film (Berridge, 2017b). I recommend the film for teaching because it is effective at reaching young audiences and people who more readily relate to the adult child in a care dyad. “Uninvited Guests” is worth watching to the last scene of intergenerational solidarity.

Further, as Jeanette Pols (2017) reminds us, “there is no such thing as technology, only different variations of technologies”. There are many technologies, but technology is just a concept. Encouraging undirected hope in technology is misguided, but it is productive to examine each technology in its specificity. Consider the different implications of a few technologies that fall under the gerontech umbrella: humanoids, Paro (see Master of None’s “Old People” episode), assistive technologies like Liftware and intelligent power wheelchairs (see Rushton et al., 2017), or medication management like Proteus Discover, an FDA-approved ingestible sensor embedded in medication to track when it reaches the stomach. These examples of technology are dramatically different! Rather than focusing on what they have in common, understanding their impact and value requires that we study each device’s purpose, embedded values, interactions with care relationships – including power dynamics – and human practices that develop around and with it. An older adult tried to provide this insight during an interview for my research on how to effectively explain GPS location tracking, sensors, and web-cameras in ways that enable older people’s participation in informed decision-making. After the interview, this study participant, who has vascular dementia, challenged me on the use of the word “technology” in the study’s title (remote monitoring technology) and made us look up the word in a big, old dictionary (that was utterly unhelpful). She understood clearly what the three devices did and suggested I skip the word “technology” because it confused matters, noting that her pencil was in fact technology. In ageist fashion, I later realized I had dismissed her critique until it was articulated by an academic whose work I admire.

Conclusion: More cross-national, interdisciplinary, and public facing work is needed.

Barbara Marshall and Stephen Katz (2016) have encouraged researchers to explore how new technologies that collect and interpret data about older adults “are creating new modes and styles of ‘quantified ageing.’” I want to echo their argument that there is far more at stake in these practices than equitable access to them. This makes the field incredibly rich for gerontologists, and it’s growing quickly. To enhance our contribution, movement is needed in cross-national, interdisciplinary, and public facing work.

The ways that technological solutions for aging populations take hold in the diverse socio-political and cultural contexts in which we all work is informative and in need of further study (see, for example Lutz, 2015). In the U.S., policy and practice are moving ahead of research, which also means that technologies are on the shelf (the Internet shelf) without research-based guidelines or tools for understanding how to make decisions about monitoring older residents or family members. Technologies are being implemented faster than researchers are able to identify their ethical implications and define what appropriate use means for different populations. This makes urgent the need to translate and disseminate research beyond academic publications.

One practical avenue for this is the long-term care industry (e.g., facility membership associations, direct careworker alliances, etc.). In my experience, editors of care industry associations’ national publications have been enthusiastic about including a critical framework in their news pieces on elder care technology to balance the tone of techno-utopianism struck by other experts, especially where their members (e.g., nursing home administrators) have real-world experiences with certain technologies that don’t merit that tone (The Internet of Caring Things was the March 2016 cover story in Provider magazine, a publication of the American Health Care Association and the National Center for Assisted Living). It’s also been my experience that interdisciplinary research enables work that is more directly relevant to practitioners. Our presentation of an interdisciplinary socio-legal analysis at the Privacy Law Scholars Conference, for example, sparked a collaboration with Consumer Reports to translate our research for their audience. In another project, I work with a medical ethicist and philosopher to combine empirical social science research with an ethical analysis–an interdisciplinary collaboration that is still uncommon in the study of IoT and in need of further development (Dunn et al., 2012). New technologies are influencing how older adults live and are supported and if we want to offer valuable insight and analysis enabled through critical gerontology, it’s important that we don’t only work with or talk with other gerontologists, or only academics.

In the spirit of cross-national, interdisciplinarity, I hope you will consider joining us at the once-every- two-year International Society for Gerontechnology World Congress. The 2018 conference will be in Florida in the pleasant-temps month of May (7-11). Abstracts are due January 15.

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