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


Co-production refers to an on-going process of ethnography, participatory co-design and customisation in use. When applied to assisted living technologies (ALTs), the aim is to inform development of technologies and services that meet the real needs of end users within their contexts:

• ethnography enables understanding of ALT needs in the context of people's real lives;
• co-design brings all stakeholders together to jointly decide on requirements for technologies and services;
• customisation adapts ALTs to people's specific circumstances and (changing) needs.

Despite the promised potential of ALTs and services to enable people to 'age in place' (that is, avoid or defer institutional care in later life and remain active participants in society), the benefits achieved to date have been modest.

Our work in the ATHENE project demonstrates that this problem cannot be resolved without a richer understanding of the complex and diverse living experiences and care needs of older people. More than that, it suggests that if the needs of older people are to be met, then industry, health and social care providers must evolve ways to work with older people and their informal carers (family, friends, neighbours) to 'co-produce' useful and useable ALT and service designs.

Our findings are that successful deployment of ALTs often depends on 'bricolage' (pragmatic customisation, combining new with legacy devices), by the user or someone who knows and cares about them. Also, the ways in which ALTs mediate the interactions of older people with health and social care professionals ('channel shifting') are often unsatisfactory, making them less inclined to use support services. If ALTs and services are to be fit-for-purpose, their design and deployment must be grounded in older people's lived experience. Currently, this is not being achieved. Stakeholders need to rethink how they produce ALTs and services and, in particular, how they involve older people and their informal carers.


Bricolage can mitigate these problems by enabling ALTs to be personalised to individual needs. It allows users and informal carers to take the initiative in 'co-producing' solutions. Bricolage also exposes that making assisted living 'work' relies on collaboration, involving not only formal carers (health and social care professionals) but also informal ones (family members). Yet, the latter's role has gone unnoticed by technology designers. Where the former's role is designed for, its configuration can create vulnerabilities in care provision.

Bricolage is a pragmatic response to failures of design, but there are ways in which design can support it, e.g. by providing customisable features. However, this will fail unless attention is paid to how assisted living is routinely performed. Twenty years ago, the 'turn to the social' marked a fundamental shift in conceptualising ICT design challenges. It is time this was acknowledged by ALT designers and service stakeholders.