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

Case 03: Elsie

Social, cultural and historical context

Elsie is an 82-year-old white British retired export administrator. Widowed 25 years ago, she now lives alone in a 2-bedroomed terraced house on a large social housing estate in a deprived suburb of a large city. She has lived there for over 50 years and owns the house.

Participant's experience of ageing and ill health

Elsie has heart disease; she recalls a heart attack and an operation to insert stents some years ago. That and her chronic obstructive lung disease make her short of breath, especially on exercise. She has a lot of hospital appointments (6 different clinics), mainly for the heart and lungs. She is unsteady on her feet (hence tries to spend her time sitting down rather than standing up) and has arthritis in her hands, leg and neck, which makes many movements slow and painful. She has shaky hands so cannot do fine movements. Her vision is not as good as it used to be. She has to go to the toilet frequently to pass urine, and gets caught short if she leaves it too long. She has trouble sleeping. She fell and broke her hip four years ago, and fell again while at the shops recently, partly as a result of new bifocals which didn’t really help her see; this required a night in hospital and left her very bruised.

People in this participant's life

Elsie has two sons – one lives 200 miles away; she sees him about once a year but he phones twice a week. Another son lives about 20 miles away; he works long hours so visits rarely. She visits him along with her sister (who lives five miles away) once a month. An old friend (now in her late 60s) comes round once a week or so and cleans (unpaid). This is a longstanding arrangement but the friend is getting health problems of her own now. The physio from the Falls Clinic came once recently and gave her exercises to improve her unsteadiness.

Elsie has no other visitors to her house, though she is friendly with two sets of neighbours whom she has known for years. A friend takes her to Age Concern every week. She relies on taxi drivers to get her to and from the shops. (The taxi man brings the shopping trolley into the house for her. She says she’s nice to them, listening to their complaints, so they’ll help her in with the shopping. – field notes).

What matters to this participant?

Making things matters to Elsie. She runs a craft class at Age Concern and she still makes her own clothes. She also makes celebration cakes (she is making a wedding cake for a relative, though shopping for the ingredients is difficult because they are heavy – she has to get them a few at a time). Food matters: Elsie does not like the ready meals from the supermarket. She likes making her own meals with lots of vegetables in. And exercise also matters: although Elsie finds it difficult to go up and down stairs to go to the toilet, she likes to use the stairs for exercise.


Things Elsie is making: a skirt and a multi-tiered wedding cake

Money matters, since getting out and about is increasingly costly. The cake specialist shop is about four miles away; she can no longer walk as far as the bus stop and the taxi fare is expensive. She used to drive but the insurance became very expensive so she sold her car. A taxi to Age Concern (where she runs her Craft Club) costs £7 each way but she says she has to pay it otherwise she wouldn’t get out.

Repairs matter. Her shower hasn’t worked for a fortnight now. The local ‘Care and Repair’ service has had funding reduced so she will have to wait 5 weeks for the repair. Her armchair, purchased because the settee was too low, has also broken and she has to keep it propped against the wall to stop it from falling apart, which means she can’t relax in it.

Elsie likes keeping in touch with friends by email, and helping people. She is a service user representative at the dental school. She is concerned about crime and her own vulnerability living alone. A family of troublesome older boys, allegedly drug dealers, live close by.

Technologies in participant's home and life

Elsie has a pendant alarm, a Tunstall phone and an emergency buzzer in the hall near her front door. Her home is equipped with a flood and fire detectors. She has numerous conventional living aids such as a tray trolley, jar and can openers and a Breville water heater for making drinks (the kettle is too heavy and her hand shakes). Her numerous medications come in a dose dispenser.

In the spare bedroom (used as a workroom), Elsie has a TV, sewing machine, overlocker (specialist sewing machine) and a computer that she uses for shopping on eBay and ordering craft supplies. Inside, she has a standard burglar alarm and outside, she has a CCTV camera that she bought. She also locks internal doors from the kitchen and lounge so that if an intruder got in they would get no further. She keeps a can of hairspray by the bed.

As part of a project at Age Concern, Elsie tried out a Wii and fought some rounds of virtual boxing with a friend. This was picked up by the local press who ran an article on it, calling her ‘Evil Elsie’ because she had ‘knocked out’ her friend several times. Both Elsie and her friend found this very amusing.

Elsie CCTV

Elsie’s CCTV screen (in living room) from which she can see her back yard

Materiality and capability

Elsie’s physical condition fluctuates, and she must adapt her living patterns accordingly. When crossing the road at the pelican crossing, she goes halfway then waits at the island until the next cycle as she knows she is too slow to make it across in one go. She can only go out on her good days. When she feels well, she makes a large casserole or cottage pie and puts them in individual portions in the freezer, ready for the days when she feels ill and cannot cook.

The physical structure of Elsie’s house is not well matched to her physical capabilities but it has strong symbolic value:

Interviewer: “Would you ever consider a bungalow?”

Elsie: “No. My whole being is in the structure of this house. I’ve been her over 50 years, I brought my kiddies up here, my husband died here. No, I couldn’t do it.”

Real incidents of using (or choosing not to use) an ALT

Elsie had an attack of angina and was wearing her pendant alarm. She considered pressing it but thought that if she did so they would send the paramedics round and she did not want that, so she rang her GP surgery and one came to visit.


Elsie’s many chronic impairments combine to cause slowness, unsteadiness, mobility problems and difficulty with fine movements, all of which restrict the size of her physical and social world. Whilst she has very few visitors, the combination of virtual interaction (telephone, email), short outings to the shops, and her craft and cooking hobbies (including her weekly Age Concern class) keep Elsie busy and fulfilled. This case illustrates how the skilled use of familiar technologies can compensate up to a point for physical impairments and how making things (and especially helping others to make things) gives purpose to an older person’s life. The Wii example shows that older people can use advanced technologies playfully, and that a particularly fulfilling use of ICTs is for social interaction (games). But the Wii was a one-off, and so unusual that it was featured as a newspaper story.