The possibilities of technology

What this means

Technology, including assistive technology, is often underused – or used in a way that makes people feel uncomfortable (such as by replacing the personal element of care and support). However, there are enormous opportunities opening up with technology – in terms of flexibility, choice, reduction of stigma, and efficiency.

We always need to ask the question ‘In whose interests is the technology being used?’ Is it being used to improve lives, or to increase professional ease and/or reduce costs? These aren’t always mutually exclusive, but people with care and support needs deserve to have their interests put first.

The research

Studies consistently show that people worry that technology will replace the ‘human’ side of care (Ninnis et al., 2019) – so ensuring people feel that technology is working for them, rather than feeling that duties have been delegated to technology instead of people, is essential. Technology is part of complex personal and social realities, as people perceive and interact with technology in a highly personal way. Technology might complement, improve, or challenge, ways of living. The Living in the Place We Call Home group also highlighted this as important, as did the Communities Where Everyone Belongs group, and there is useful material in those sections as well.

The evidence around occupational therapy (OT)'s role in adult social care is helpful to look at here. OT has traditionally supported:

• Promotion of health and wellbeing.
• Prevention.
• Housing adaptations and the provision of equipment.
• Reablement.

(Pearman, 2021)

A key principle when thinking about the possibilities of technology is to always start with the circumstances of that particular person, rather than first considering what has worked for others with the same condition. For instance, in a study looking at assistive technology supporting people with neuromuscular conditions, the person’s home environment and the role of a family carer were both important variables on whether the assistive technology was ultimately successful - even when two people’s conditions were very similar (Pousada Garcia et al., 2019).

In order to do this, occupational therapists work collaboratively with the person; deciding together which occupations to support, setting goals, supporting interventions and measuring outcomes (College of Occupational Therapists, 2015). As De Coninck et al. (2017) argue, ‘…a high quality OT intervention takes into account a number of characteristics… for this reason, OT interventions will vary, because they are tailored to the personal and environmental characteristics and will therefore rarely be rigidly prescribed.’ Taking this person-centred approach, involving what a person themselves is motivated to achieve (rather than a pre-defined set of tasks that it’s thought people ‘should’ achieve) is more likely to yield positive results (Newton, 2012).

This principle of person-centred practice also runs through the use of technology and digital ways of working, something occupational therapy has increasingly embraced. It’s about how technology can support achieving what people want to achieve, rather than dictating what it’s felt someone ‘should’ do. Technology may be rejected, despite fulfilling the job it’s designed to do. One older study (Riemer-Reiss & Wacker, 2000) suggests 30-50% of assistive technology is abandoned, resulting in significant costs to health and social care systems.

Known barriers to use include: affordability, uneven access, insufficient instruction, concerns over reliability and durability, and perceived usefulness. Some studies have also explored the psychological component of assistive technology; Coughlin et al. (2007), for example, identified pride as a significant barrier: adopting assistive technology means older people worry that they will be seen as vulnerable, frail or incompetent, with the use of assistive technology damaging to their self-image.

More recent and universal technology can potentially address some of those psychological concerns. Technology such as voice assistants (like Alexa) and other innovations like online shopping and banking support convenience in everyday life. Vieira et al. (2022) reported a wide range of tasks that a voice assistant supported for disabled people, from being able to turn the television on without asking someone else, to reminders of medication. Moreover, the use of voice assistants ‘reduces disparities between people with disability and people without disability, providing similar conditions and autonomy’ (Viera et al., 2022, p.16).

A significant concern for people – both across the general population, but particularly for older people - is about cybersecurity and safety, especially when thinking about internet-connected devices (Vieira el al., 2022; Han & Yang, 2018). This is a very valid fear; Citizens Advice in the UK has found that almost three-quarters of people in the UK had been targeted by a scammer in 2022, a 14% increase since the previous year. However, there remain concerns about the accessibility of cybersecurity systems for a range of people with disabilities (Renaud, 2022).

What you can do

If you are in direct practice (particularly if you are an occupational therapist): Research suggests that the successful use of technology for older and disabled people is not just about the ability to use it; it’s also about the willingness, confidence and perceived utility that it can bring to people’s personal outcomes. How are these considered alongside the more direct work of teaching or supporting people to use technology? How are concerns around scamming and security addressed?

The co-produced Practice Tool from Research in Practice, Digital inclusion: Using digital technology positively and safely includes a tool to use with people to help understand their skills and preferences in digital technology, and work through any action to take. It is adapted below:

If you are in senior management: How confident are you in knowing about new assistive and digital technology, and how it can support better lives for older and disabled citizens? How is technology conceived in your organisation – is it initially thought of in terms of cost, or primarily for how it can support wellbeing?

It’s really important to keep up with the cutting edge of assistive technology – thinking of not just what’s out now, but what may be coming in the future. (A very basic way to keep up is to read the blogs and news from AbilityNet, and sign up to their newsletter.)

Further information

Read

Research in Practice has a Frontline Briefing on Occupational therapy in adult social care.

Connect

AbilityNet has a network of volunteers who can offer free tech support to older people and disabled people. They also have a free helpline (0800 048 7642).