JUDITH DAVEY discusses the practical and ethical considerations of introducing assistive technology into aged care.
There are all kinds of technology – digital technology seems to be taking over the world. Transport technology can get us where we want to go faster (but also contributes to traffic jams) and, in planning for an ageing world, we often hear talk about ‘assistive’ technology. What is it? And what can it do for us?
The World Health Organisation defines assistive technology (AT) as “An umbrella term for any device or system that allows an individual to perform a task which they would otherwise be unable to do or increases the ease and safety with which the task can be performed.”
In that case, AT includes walking sticks, which have been around since time immemorial. But someone must have realised that putting extra little legs on a walking stick helped people to be steadier – improved safety – and we have seen the evolution of ‘walkers’, with frames, panniers and built-in seats – great for getting about when the legs don’t work as well as they used to.
While I’m not sure a reclining chair with a foot rest could be defined as AT, tipping chairs certainly ease the getting-up process.
But what people more often think of as assistive technology are more high-tech gadgets. These may be active – I do like the idea of a disk which cleans the floor (and provides something for adventurous cats to ride on) – or they may be passive, in that they monitor activities and wellbeing, even though they are incredibly ‘smart’.
An increasing number of assistive technologies aimed at the older adult are currently being developed. In Japan, beds that incorporate automated toileting and washing systems have been developed, plus others that can be separated and turned into wheelchairs.
Electronic toilets can incorporate health monitors. The HRS-I system monitors health by capturing data, such as electrocardiograph signals and body surface temperature, and then transmitting that data to a mobile phone or PC where a health professional or family member can access it remotely.
Exo-skeleton suits – normally associated with sci-fi films or military use – could potentially help nurses and carers to lift and move bed-bound residents safely.
Enter the robots
And then there are the robots.
A prototype ‘teddy bear’ has been developed with a sensor linked into a screen in the nurse’s station in a rest home or hospital. This helps the nurse to monitor the older person in case of falls and other episodes. It can alert staff to unexpected changes and record answers to questions. Yes, you could call it a robot.
What about a therapeutic robot in the form of a baby harp seal, called Paro, which responds to its name and being stroked, moves its tail and flippers and reacts by opening its eyes and moving its face toward the sound of a voice? Paro can show surprise, happiness and anger, and will cry if it is not receiving sufficient attention.
Professor Wendy Moyle from the Griffith Health Institute’s Centre for Health Practice Innovation in Australia reports that her robot seal and prototype teddy bear have achieved incredible results with people in reducing symptoms of agitation. Both are used with older people to reduce stress, anxiety and social isolation.
La Trobe University and the global electronics firm NEC Corporation have developed ‘social robots’ that can talk, sing, dance, play games, tell the weather and read the newspaper and even have names – Charles, Sophie, Matilda and Jack. They are the first of their kind to be used therapeutically for mild dementia sufferers.
More elaborate robots – like Meccano’s Spykee – have wi-fi and Skype capability and are also designed to help fend off loneliness. They can see, hear and speak, take pictures and make videos, helping people keep in touch with family and friends all over the world. They can also provide environmental security and contact health services in case of emergency.
Other robots and devices have the potential to improve the quality of life for older people with disabilities and could extend their independence. As well as health monitors and ‘Pill Pets’, which provide reminders when it’s time to take a pill or go for a check-up, there are now practical housekeeping robots that can clean the floors, load a dishwasher and do laundry – and even just pick something up off the floor for those whose mobility is limited. Voice-activated commands are becoming commonplace with digital devices.
Many of these technologies can help to reduce the workload of family carers and reassure them of the safety and security of their loved family members, not to mention reducing the expense of elder care.
There have been claims that robots could deliver a higher standard of care than poorly skilled care workers in residential homes and could standardise care. Managing incontinence in older people might be preferable to human care and make the job less onerous.
Using complicated technology requires special training and supervision if high standards of safety and care are going to be achieved and maintained. How acceptable will robotics be among care workers?
Robots may be extremely helpful, but can they provide a substitute for personal contact, which is a vital component of psychological, and therefore physical, health? A poorly skilled carer needs training and monitoring, not removing altogether. Would we be restricting the social interaction experience of isolated older people even more if we substituted machines for the touch and voice of another human being? Robots can be a bit scary. Not everyone is as comfortable as some Japanese seniors when it comes to the idea of robots in their daily lives.
Consider this. A 90-year-old woman with dementia is prone to wandering at night, putting her at risk of hypothermia and other dangers. As she opens her front door, a voice says, “Go back to bed, Mum, everything is all right.” It is not her daughter, but a recording of her daughter’s voice. Is this a good thing or a bad thing? Surely it is good that the woman is prevented from wandering out into the cold and darkness. But it is deceptive – her daughter is not there. Is that ethical? And what if there was a fire?
Acceptance of sophisticated new technology and its capacity to deliver benefits may depend on the extent to which ethical and privacy issues are seriously considered. These must be given high priority, respecting the choices and autonomy of older people, allowing their voices to be heard in decision-making that affects them, and protecting people who are especially vulnerable or who have special needs. So we are left with many questions, such as:
- How can we ensure basic safety (which includes the prevention of injury as well as a rapid response in emergency situations) and assistance with daily living while also protecting privacy?
- How acceptable is the monitoring of daily social interactions and patterns of movement? In what situations and in relation to which older people can such monitoring be ethically applied? How will appropriate levels and types of monitoring be defined?
- What are the special requirements in relation to people with dementia?
- How will personal electronic devices be integrated with environmental control systems and how much control will the users have over these systems?
- What is the role of informal caregivers/professional carers in relation to these systems? What information and training do they need and how will they receive it?
Whiz-bang technology certainly has value, but let’s not allow ourselves to become carried away without some profound consideration of human feelings and rights.