Transcript Slide 1

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
e-mail request to
[email protected]
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 2000-2010 starting at age 60
is a different experience than starting at age 10
GERONTECHNOLOGY ADDRESSES THE
DYNAMICS OF THE PERSON-ENVIRONMENT
INTERACTION
Person
Receptors Internal
Structures
Effectors
System
Output
Measure
Interface
Social Built Natural
Environment
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,
Person
System
Output
Measure
Interface
Environment
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
Person
System
Output
Measure
Interface
Social Built Natural
Environment
Environment has three components—
Social, built or manmade, natural
Fozard, Figure 1
Person
Receptors Internal
Structures
System
Output
Measure
Effectors
Interface
Environment
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
Person
Receptors Internal
Structures
Effectors
System
Output
Measure
Interface
Future
Social Built Natural
Time
Environment
The arrows represent changes
over time, from Past to future
Past
Person
Receptors Internal
Structures
Effectors
Human
aging
System
Output
Measure
Interface
Future
Social Built Natural
Time
Environment
Past
Over the same period of time, people of
different birth cohorts age (Human aging)
Person
Receptors Internal
Structures
Effectors
Human
aging
System
Output
Measure
Interface
Secular
change
Future
Social Built Natural
Time
Environment
Past
Over the same period of time, changes occur in the
social, built and natural environment (Secular changes)
Person
Receptors Internal
Structures
Effectors
Human
aging
System
Output
Measure
Interface
Secular
change
Social Built Natural
Time
Environment
LESSON: BOTH age-related
and secular changes affect
system output dynamics
Past
Future
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 selfesteem. Gerontechnology, 2005, 4, 63-76.
• 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
Planning Practical Application of
Gerontechnology Concepts
IMPACT?
IMPACT?
INTERVENE:
Prevention
Enhance
TYPE, SITE?
Prevent
Compensation
Person:
Compensate
Care/organization
Care/organization Train, motivate
Select
Enhance
Personality
Demographics
FUNCTION? Environment:
TARGET?
Physical
Physical
Mental
Cognitive
Emotional/social
Emotional/Social
Built, social, natural
Device on person
Device: located
Fig.2
near or Fozard,
remotely
Person
System
Output
Environment
Time
Health and self esteem
•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.
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 ageassociated 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, 210-217.
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 tenyear horizon
• Gerontechnology model reveals complexity of
the Healthy People model as shown in the next
slide
Person
Receptors Internal
Structures
Effectors
Human
aging
Health
Status
Indices
Interface
Secular
change
Social Built Natural
Time
Environment
Established Policies and
Interventions; Access to
Health Care
Past
Fozard, Figure 5
Future
Gerontechnology paradigm and a
better Healthy People 2000 model
• Policies and interventions are shown as specific
environmental determiners of the personenvironment 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
Health
Labor
Force
History
Wealth
Family and
Household
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
Receptors
Person
Internal
Structures
Effectors
Human
aging
Measure
of WellBeing
Interface
Secular
change
Social Built Natural
Time
Environment
Health, wealth, social integration
Labor force and family history
Demographics—age, gender, race, etc.
Past
Future
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.179-208
• 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 selfesteem’: 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
REMOTE
STATUS
PHYSICAL
ENVIRONMENTAL
SOCIAL
PERSONAL/
COGNI-
MOBILE
TIVE
PRIM-
SECOND- TERTI-
ARY
ARY
ARY
LEVEL OF PREVENTION
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
Steps used in Practical Application of
Gerontechnology Concepts
IMPACT?
IMPACT?
Prevention
Enhance
Prevent
Compensation
Compensate
Care/organization
Care/organization
Enhance
INTERVENE:
TYPE, SITE?
Person:
Train, motivate
Select
Personality
Demographics
FUNCTION? Environment:
TARGET?
Physical
Physical
Mental
Cognitive
Emotional/social
Emotional/Social
Built, social, natural
Device on person
Device: near or
Fig.2
remotelyFozard,
placed
Person
System
Output
Environment
Time
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