Assistive Technologies for Healthy Living in Elders: Needs Assessment by Ethnography

Cases 9 & 10:Betty and Neville

Social, cultural and historical context

Betty, aged 86, and Neville, aged 84, used to run a tenant farm where they lived and worked for almost 60 years. Their son runs the farm now. Neville officially retired at 60 but carried on working on the farm until he was 70. They now live in an originally two- (now one)-bedroomed terraced house in a small village, just down the road from the farm where their son and family live. Both have been active in their local community in many ways throughout their lives and know many people locally. They are very involved members of the local church. Neville was also a magistrate for 30 years, retiring at the age of 70.

Participant's experience of ageing and ill health

Betty had a hip replacement about 20 years ago and she feels that her other hip is “giving notice” that it needs replacing. She is greatly troubled by backache and finds it difficult to stand for any length of time, such as going round the supermarket. She also has a hiatus hernia. Neville says that when they retired from the farm “it was like going on holiday for Betty” because she had been in such pain with her hip. Betty’s hands shake, which makes it difficult for her to carry a cup of tea from kitchen to the lounge.

Neville also has a problem with shaking, which mainly affects the fingers of his dominant (right) hand. He wears a foot splint to correct foot drop caused by nerve damage after a fall, and has arthritis in his neck which causes him pain. He has had a knee replacement for arthritis, and both his knees are still weak. He also has visual impairment from glaucoma. He had cataracts removed from both eyes about 7 years ago.

During the study Neville went out to the Library van up the road and came back “wobbling all over the place”. He went to the GP who couldn’t find anything other than the arthritis, so he prescribed strong painkillers. This made Neville feel disoriented and lethargic so he stopped taking them and went back to paracetamol. At the time of the study Neville had been feeling particularly ill and they had considered bringing a bed downstairs for him. He didn’t like that idea and he jokes that he saw it as a threat so he got better!

People in the participant's life

Betty and Neville have one son and two daughters. They all live within a 5-mile radius, and they see each of their children about once per week. One daughter has no family and she pops in often to see how they are. When they go out to the lunch club meal once a month she comes in and does whatever housework Betty and Neville haven’t been able to manage. They don’t ask her to do anything in particular. Their other daughter calls in less often because she has a full time job, four children and two grandchildren as well as various community activities. One grandson, who is also a farmer, comes round to cut the hedges. Betty and Neville are often invited round to family members’ houses and attend a lot of family celebrations.

Betty and Neville help their son out at the farm by collecting supplies and machinery parts. They also collect the post from the farm; Neville files it and Betty does the accounts. When the accountant comes round, it’s Betty and Neville she comes to see. They write cheques for the business and drive round the local area delivering them once a month.

Betty and Neville are still involved in the community, although to a lot lesser extent now. They attend church every week, they are members of a local history group (Neville has given a talk there on how farming has changed over the years) and they go to a meal at the village hall once a month. However, they know fewer people in the village than they used to because of the changing nature of the village. There are a lot of rented properties now with business people who commute out; the population is more transient and people don’t all come to village events. Neville also thinks the fact that it is a “ribbon’ village” makes it more difficult to get to know people.

What matters to these participants?

Being part of the family, the farm business and the local community are very important to Betty and Neville. They consider themselves very lucky compared to some people they know who really struggle with no family nearby. They know that if they need help their son is only down the road and they can contact him on his mobile phone, even if he’s out in the fields.

Neville enjoys sitting on the settee by the lounge window in a morning to get the sunlight. In the evening he sits in his armchair to watch TV. Both he and Betty like their morning routine of collecting the newspaper from the front door and doing the puzzles, which they hope will keep their brains “ticking over”. They both enjoy reading the paper right through, although they find some of the writing quite complex these days and have to read an article two or three times to understand what’s being said.

Betty has always been very involved in the Women’s Institute and this is the first year she has not been on the organising committee for the annual show. However, she is still very much connected to the show because her daughter is organising it this year. Betty helped out this year by sitting at a desk and selling tickets.

They have lived in the area for 60 years and they enjoy the local history club with others they have known for many years. Going to church is still important to them. Neville was a church warden for 40 years. There was a lot to do when the church didn’t have a vicar for 18 years. He jokes that he’s a “church warden emeritus” now. Betty used to be on the rota for cleaning the church but she can’t manage that now. However, she is still a sidesperson giving out the hymn books and still on the Parish Church Council.

Betty goes to Mother’s Union meetings once a month at a church in another village. They have speakers, a cup of tea and biscuits. She says she goes for the company. She goes to the Women’s Institute meetings in the next village, where she’s attended for over 50 years.

They want to stay together in the house as long as they are mobile but they are philosophical about not knowing what the future may hold for them. As Neville says:

“I didn’t want us to reach the stage where we were separated, one of us in a nursing home, one of us not. No we didn’t want that, so I just thought of ways and means!”

They have thought about other ways of managing if they become less capable, for example, if they can’t cook they have thought about having meals on wheels or buying ready meals. And if they can’t get to the shops they are sure their daughters or granddaughters will help them out.

They enjoy watching TV but they are very selective about what they watch and sometimes they will switch it off and read instead. They always watch ‘Pointless’, one of the quiz shows, “to keep our brains ticking over”. Betty has a huge dictionary at the side of her armchair to help with solving crossword puzzles; she calls it her ‘lifeline.’ Both Betty and Neville listen to a lot of music CDs and they enjoy reading, although Betty’s eyes get tired. They appreciate the library bus that visits the village and parks not far from their house. The bus has a good selection of books. They talk about the days when everything was delivered to people’s homes, such as the postman (who also brought groceries and newspapers), the coal man, butcher and bread deliveries. It was a bit of company for people on their own and there was always someone keeping an eye on older people who lived alone.

Betty used to doing painting – one of her paintings hangs in the lounge – and painting pottery, but she can’t do any of those things now because of the arthritis in her hands. Betty used to do all the gardening but she can’t do more than a few minutes now because of her bad back. Up to two years ago they used to go for a walk every day but their mobility difficulties mean they can’t do that now.

Betty and Neville really enjoy the meal they have once a month at the village hall, provided by a farmer’s wife who used to be a chef. They pay £6.50 each for a three-course meal, a glass of wine and coffee. They would be happy if it was once a week! Betty says it would save her from having to think what to have for a few more meals. They pick up a lady of 93 and take her to the meal. It’s quite a struggle to get her in and out of the car.

Technologies in participants' home and life

Betty and Neville do not have any assistive technologies at the moment, nor do they feel they need any. They have a perching stool in the kitchen to help Betty with the cooking but she rarely uses it. She’s says she would rather stand above the cooking than sit down at the side of it. She does use it when her back is really bad. They have a microwave that Betty uses a lot (but not for ready meals) They have a tumble dryer and Betty she uses this a lot because she can’t get the washing out on the line because of her bad back. They have had an extra banister put on the stairs and they have two grab rails to help with showering and an easilever at the side of the bath. They don’t need an easilever on their bed because the walls are near enough to help them getting out of bed.

In the lounge, Neville has risers on his armchair to make it easier to get in and out of the chair and Betty has an extra cushion on her chair to help with her back pain. If they did have an emergency they say they would ring for an ambulance, they could go to neighbours and they would phone their children. And of course, they have each other.

Materiality and capability

Betty and Neville have adapted their house to accommodate their difficulties with ageing and ill health. In the bad winter of 2010 they decided it was too dangerous for Neville to keep going outside to bring in the logs for the fire so they replaced the open fire with an electric fire. They both struggle getting upstairs so they had a downstairs toilet put in. They own the house next door (they bought both properties in the 1960’s to house farm workers) and they thought about selling both and buying a bigger house. They didn’t do this because they decided they didn’t need a bigger house and they didn’t want to move anywhere more isolated.

Whilst both Betty and Neville have various health complaints that are slowly getting worse, they have so far largely maintained their independence. They both manage to do some housework. Neville does the vacuuming as Betty can’t manage it because of her bad back. Betty does the cooking and Neville does the washing up. Betty still drives but not very often now. Neville gave up driving two years ago after a couple of accidents.

Betty’s hands shake and so she has to concentrate to carry a cup of tea from the kitchen into the lounge. When Neville was ill in bed she had great difficulty getting upstairs with cups of tea and food. She had to take a cup of tea on a tray and take it up stairs one stair at a time, putting the tray on the stair in front of her and hanging on to the banister to get up the step. She says that if she tried to go upstairs with a cup of tea in her hand there would be nothing left of the tea by the time she got there

Neville has some difficulty writing. He didn’t want to complete the research scrapbook partly because he considered his daily life to be the same as Betty’s but also because his finger shake makes it difficult for him to write.

At the moment Betty and Neville have no difficulty using the TV, DVD player, CD player or the telephone. One of their daughters is always on the lookout on the Internet for anything that might help them, such as the neck cushion she recently bought for Neville. It’s not suitable for him but he appreciates that she keeps looking for things.

Betty and Neville go shopping about once every 10 days. Betty doesn’t like shopping, she never has. Now she finds it difficult to get round the store. They recently met a friend in the supermarket who chatted for a long time. Betty was in a great deal of pain by the time they got out of the store. Neville uses a walking stick to get round the store with Betty but, although he’s tall, he finds it difficult to get grocery items off the higher shelves whilst hanging on to the walking stick. There are some seats in the supermarket but they are in the wrong place for helping with shopping because they are the wrong side of the tills. There are wheelchairs available in the supermarket but Betty doesn’t feel using the wheelchair to do the shopping is feasible. Although she doesn’t like shopping Betty wants to keep doing it for as long as she can manage it. The researcher asked her why she keeps doing the shopping when family members would be happy to do it for them.

“Pride, I don’t want to put on anybody else as long as I can do it myself.”

Neville thinks that it would be helpful if the shopping could be delivered but they don’t have a computer to order the groceries online. Phoning in grocery orders is not a service the supermarket offers. Neville thinks maybe they should have learned how to use computers when they were younger. He says they didn’t learn because they didn’t need it for running the farm in those days, unlike today. He thinks Betty would have been very good at using a computer.

Real incidents of using (or choosing not to use) ALTs

Betty and Neville have no assistive technologies at the moment.


In many ways, Betty and Neville illustrate the optimum circumstances for people who are coping with ageing and ill health. First and foremost, they have each other. Betty’s limitations are balanced by Neville’s and vice versa. Together, they undertake activities to maintain their physical faculties and “keep their brains ticking over”. There is more than a hint in this story that they will soldier on together far longer than either would have endured alone.

They also have a supportive family who all live locally, and they can still gain fulfilment from active involvement in the work they loved since their son has taken over the same tenant farm. There is a rare reciprocity in the family relationships: not only do they depend on their children but, thanks to Betty’s skill with the accounts and other paperwork, their children still depend on them. They live in a very safe, supportive and dynamic rural community. They are well known in that community because they have lived in the same area for 60 years and were both active members of various organisations and community groups. They contrast strikingly with Vera (Case 5), who has placed herself in ‘self-exile’ and has limited social contacts.

Whilst Betty and Neville are not well off, they have been able to afford key adaptations to their house to accommodate their increasing physical impairments. The adaptations have been possible partly because these impairments have come on gradually and the direction of deterioration was largely predictable (e.g. stiffness and pain from arthritis worsening). Whilst they have no assistive technologies at all, and consider that they need none, the various house adaptations have made their lives much easier and safer. (Perhaps these adaptations should be considered as part of a continuum of assistive adaptations, which includes assistive technologies.) Despite their advantageous circumstances Betty and Neville still have significant difficulties with their mobility both inside and outside the home and they are both in a considerable amount of pain. But their personal, social and material circumstances have allowed them to develop resilience and accept their pain and difficulties as part of growing old. They are grateful for the support they have and make the most of their social opportunities. They are generally happy with their lives. Indeed, Betty said she couldn’t fill in the parts of the Home and Life Scrap Book that asked how their lives could be improved because she said they were entirely happy with their life.

One final learning point from this case study: Betty and Neville think it might be helpful to them to have their groceries delivered, but they don’t have a computer to place their order online – nor do they want to learn to use one at this stage in life. But a telephone ordering service for groceries would be useful for them. This is an example of a social adaptation rather than a technical one, and suggests that advances in ‘assisted living’ may not always need new technological solutions.