Digital Transformations / Transforming the Digital – Just and Democratic Futures for Ageing Societies

Insights and personal reflections from a session held at the Royal Geographical Society (with the Institute of British Geographers) Annual International Conference, London, 2024

by Judith Tsouvalis with contributions from Emilene Zitkus, Ruhamah Thejus, Melissa Martinez-Perez and Alice Ashcroft

Older adults have long been identified as lesser beneficiaries of the digital economy. According to the UK-based charity Age UK, around 1 in 3 over 65s or 4.7 million people in the UK are currently off the Internet and lack essential digital skills, risking access to vital banking-, shopping- and health services. During the COVID-19 pandemic, digitalization – notably in health and social care but also more broadly – accelerated at an unparalleled pace, leaving little room for reflection on how the digital transition impacts our lives – including those of older adults – and whether it meets the criteria of reflexive, experimental, anticipatory, and responsible science and innovation (Chilvers and Kearnes, 2020).

To explore this, Dr. Judith Tsouvalis, with colleagues from the DigiAge project run by Lancaster University and University College London, organised a session held at the 2024 Annual Conference of the Royal Geographical Society (with the Institute of British Geographers)  in London in August. Titled Digital Transformations / Transforming the Digital – Just and Democratic Futures for Ageing Societies, session contributors were invited to reflect on what Science and Technology Studies (STS) scholars refer to as Sociotechnical Imaginaries (STIs) – here, of digital futures envisioned for older adults. STIs are “collectively held, institutionally stabilized, and publicly performed visions of desirable futures, animated by shared understandings of forms of social life and social order attainable through, and supportive of, advances in science and technology” (Jasanoff, 2015, p 6). STIs often emerge in response to crises or challenges that seem near insurmountable, such as the energy crisis, the climate emergency, or the challenges posed by ageing societies and carer shortages. They envisage large-scale systems transformations and propose a technofix to problems that hinge on social, cultural, behavioural, institutional and organisational change, often ignoring that negative unintended consequences of science and technology are inherently unavoidable and unpredictable.

Current STIs of future health and social care like those of the Organisation for Economic Co-operation and Development (OECD), the World Health Organisation (WHO), or the National Health Service England (NHS) tend to portray digitalization and the digitisation of patient data as a silver bullet. As a result, large sums of money are being channelled into science and innovation aimed at advancing telemedicine and telehealth, Artificial Intelligence-driven diagnostics, wearable devices for self- and remote monitoring, and robotics for surgery and elder care with the promise of transformative benefits in efficiency, accessibility, and quality of care. Regarding older adults, one aim is to improve digital technology-enabled self-care, which, the reason goes, will allow people to live independently at home for longer. As a result, pressures on care- and hospital systems will be reduced. However, there are issues and questions that need to be urgently addressed in order to evaluate the costs and benefits of digitalisation promised here. For example,

• What does “ageing at home” with digital technologies mean for older adults and those around them? How does it impact their lives, relationships, sense of self, and well-being?
• How does digitalization reconfigure practices and understandings of ‘care’ and ‘caring’, at the personal, social, and professional level?
• What kind of STIs drive science and innovation around the digitalisation of health and care of older adults? Who promotes them? Who benefits from them, and what motifs underpin them?
• How could digital science and innovation be made more reflexive, responsible, participatory, and anticipatory? Do we have any “best practice” examples to draw on?
• How does the “digital divide” impact older adults and their carers?
• What political and ethical dimensions are there to the digitalisation of health and social care? 

  

 

Contributors to our session were invited to reflect on these and other questions connected to the digitalisation of society and how it impacts older adults, and our first presenter, Dr Kadri Leetmaa from the University of Tartu, responded with a case study from Estonia. Talking about Digital divides in an advanced e-country: from double exclusion to co-creating smart society with ageing rural communities (co-authors: Mariia Bochkova, Kadri Kangro, Triin Kubar, Katri-Liis Lepik, Ingmar Pastak, Bianka Pluschke-Altof), Leetmaa explained that although Estonia was famous for its early adoption of e-governance solutions and digital transformation of society, not everyone benefitted equally from this. As in the UK and many countries across Europe, older adults in sparsely populated rural areas have been identified as at risk of what Leetmaa and her colleagues refer to as “double-exclusion”.  Although digitalisation could, in theory, bring rural populations closer to the centre and less peripheral, in practice, this has proved difficult to achieve. Not only, she noted, are most smart solutions designed in the context of dense urban environments, but they were also created from the perspective of younger population groups who found it easier to adapt to technological change. Leetmaa presented findings from a qualitative study that involved interviews with older adults in four Estonian rural municipalities (Hiiumaa, Paide, Rõuge, and Toila). These were conducted between September 2023 and February 2024 and focused on older adults’ needs and experiences of smart technologies. The study also encompassed four roundtable discussions and fifty individual interviews with professionals working with older adults on a daily basis, including social care workers, librarians, community leaders, and others. To overcome the double-exclusion faced by older adults identified in rural Estonia, Leetmaa and her colleagues highlighted the need for first, a better understanding of how older adults adapt to the “smartification” of society, and second, what the notion of a “smart society” means for them, what achieving it involves, and what the benefits are that older adults living in rural communities hope to derive from it.

Dr. Emilene Zitkus from Loughborough University shifted the focus from communities to designers in her presentation on Ageing in a Digitally Connected World: How can design facilitate the transition?  Zitkus noted how today, the digitalisation of services impacts all our lives and how, since the pandemic, working from home, online shopping, and the provision of public and healthcare services have become heavily reliant on digital technologies. Consequently, possessing digital skills has become essential. Zitkus thought it unlikely that the transition to what she called a “compulsory-computing society” would be reversed, making it a must to ensure that when new digital services are designed, vulnerable groups – such as the elderly – are not excluded from them. She stressed that the digital transition was running the danger of creating new forms of dependency whilst potentially limiting citizens’ autonomy. Considering work undertaken with older adults who used digital technologies and those who lacked the Essential Digital Skills for Life identified by the UK Government,  Zitkus argued that digitalisation created particular challenges and opportunities for designers, whom she urged to “design with older adults in mind.” That this can be challenging for the design- and Human-Computer Interactions (HCI) community for various reasons was made clear by the three talks that followed that of Zitkus, which critically interrogated designer’s understandings of “home” (i.e. the lifeworlds of older adults that they designed digital technologies for) and notions of older adults’ “identity”.

Concerning “home”, Ruhamah Thejus, a PhD student based at the University of St. Andrews, shared her perspective on the  Home as Assemblage: Technology-enabled care for ageing in place. She noted how technology-enabled care provided at home was increasingly advocated as the way forward in elder care and how this had generated a multitude of STIs where smart technology stood at the forefront. Drawing on assemblage theory, Thejus unpacked the meaning of technology-enabled “homes” of older adults, arguing that they cannot be simply considered as physical spaces, but need to be understood as a conflation of decisions, influences and actions that may or may not occur within the physical spaces conventionally referred to as “home”. These impact on how “home” is experienced. Based on qualitative research with older adults and their carers in Germany and Scotland, Thejus suggested that there are important considerations that need to be made when trying to understand older adults’ experience of “home” around healthcare technology and that these need to be thought about more carefully before promoting “ageing in place.”

Shifting the focus from “home” to how the identities of technology users are understood by the HCI community, Dr. Alice Ashcroft from Lancaster University – co-chair of this session and fellow researcher on the DigiAge project – introduced the idea of structures of age, gender and intersectionality. Inspired by Black Feminist theory, Ashcroft highlighted the importance of transcending oversimplified classifications of age and gender that currently underpin understandings of individual identity in the design and implementation of digital solutions. Instead, she advocated for an intersectional approach that merges age and gender perspectives.  Based on a comparative analysis of age and gender identity formation in a digital context, Ashcroft emphasised the importance of designers reflecting more critically on the multifaceted, fluid, and situational nature of “identity” and the need for practitioners to cultivate more reflexive, responsible, participatory, and anticipatory approaches as those advocated by Chilvers and Kearnes (2020). She shared her passion for facilitating the development of inclusive digital solutions, which she believes is essential for effectively catering to the diverse needs of users, designers, and researchers.

Echoing Ashcroft’s concerns, Melissa Martinez-Perez, our final speaker from Lancaster-based consultancy company digital heard, considered how STIs of digital technologies for older adults are shaped by and respond to social dynamics and how they are informed by cultural practices, power relations, societal norms and individual and community identities. Echoing Ashcroft’s arguments and drawing on intersectional feminist approaches recently advanced in technology studies, Martinez-Perez emphasised the need for considering the multiple and intertwined axes of users’ identities in technoscience. She lamented the lack of work undertaken on connections between identity characteristics and the digital access gap and suggested that the overlapping nature of intersectional characteristics results in differentiated digital experiences. Martinez-Perez also noted that while the benefits of digital technology for ageing populations were widely hailed – from stimulating cognitive abilities to improving medication adherence – age and ability expectations surrounding present and future technologies and multiple and compounded dimensions of digital disparity were rarely studied together. However, she doubted that intersectional and reflexive practices alone would make technology here more equitable. Rather, she proposed that the digital divide needs to be analysed as a concept that is itself embedded in intersecting systems of power within social orders. Accordingly, the digital divide has very specific – rather than generalisable – effects on older adults with diverse identity characteristics. The digital divide, so understood, is shaped by the spatial contexts in which it evolves and where it can be further exacerbated by age and ability expectations imposed on older adults by certain STIs. Martinez-Perez concluded that age and ability, alongside gender, race, and social class, all need to be considered as interdependent social constructs and used as categories of analysis, not isolated or additive dimensions of people’s identities.

In the speaker’s own words…

After the session, each contributor was invited by email to share

1) What they had most enjoyed about this session

2) What the key points were that they wanted people to take away from their talk; and

3) What the key points were that they had taken away from other presenter’s talks

In response, Emilene Zitkus, wrote that she had most enjoyed “The possibility to network with established academics, as well as PhD students conducting research in the same area of digital inclusion. However, with a different theoretical approach.” Key points she wanted people to take away from her presentation were that there is “a large number of people who do not have essential digital skills to use the digital services currently available; that there is an impact on independence when digital is the only way of doing something, and that lived stories can help designers and policymakers understand that digital services can be a burden to someone’s life”. The key insights and thoughts that she took away from listening to the other presenters were that “The problems faced by many older adults in the UK are also faced in Estonia; intersectionality must be considered when analysing digital exclusion/inclusion; and the richness of case studies to understand challenges and opportunities.”

Rhuhaman Thejus “was at the RGS for the first time this year, and it was awesome to be with so many Geographers from all over the world and working in so many different areas! It was a reminder of the breadth and depth of Geography! Our session was interesting, firstly for the various disciplines it represented – Computer Science, Sociology and Geography. The topic of ageing within the landscape of ubiquitous technology is so pertinent. It was great to hear different perspectives and approaches to the topic.” From her presentation, she “wanted the audience to conceptualise a new way of approaching technology-enabled ageing at home – to really look closely at the interaction between tech and people and understand what is going on there.” From the presentations of her fellow presenters, she felt “particularly inspired by the many real-life stories collected by the other presenters over years of qualitative research. Listening to the presentations reiterated the insights that I had gained from talking to older people and reflected their experiences with technology as being quite a mixed bag and ranging from really successful to an absolute failure to launch!”

Alice Ashcroft thought that “it was brilliant to see so many researchers from all over the world coming together with a common goal and a passion for supporting older adults in the use of technology. It was also interesting to see how we each approached the area in a unique way based on our backgrounds. This really highlighted how important diversity of thought is.” What she wanted people to take away from her talk was “that age is socially constructed in a similar way to gender, race and other characteristics and will mean something different to everyone. I also hope that people will look more intersectionally at any research they do involving age or any other characteristic.” The key insights and thoughts she took away from listening to everyone else were “more reading and contacts, so this will hopefully lead to some collaboration, but the main thing that the workshop highlighted for me was how complex these issues are. The moment that made me laugh was when it was pointed out how ridiculously quick the numbers timed out for Two-Factor Authentication, and that’s something I’ll be sharing with all the designers I know.”

Melissa Martinez-Perez most enjoyed “the variety of academic backgrounds of the speakers in the panel. It was valuable to learn from different perspectives, and I left the session with so many valuable insights.” The key takeaways for people in the room from her presentation she thought were “that age is socially constructed, and how to identify digital inequalities”.  The insights she gained from the other speakers’ presentations were “the ways in which public policies (and state-led initiatives) could sometimes hinder older adults’ access to basic services through digital spaces; and how older adults’ are widely excluded from multiple digital scenarios, especially with expectations around their abilities (e.g. NHS users expected to use two-factor authentication apps).”

With much to reflect on here – both regarding work presented and work still in need to be carried out, we would like to thank everyone who contributed to making this session such a success. It was great to learn from you!