Social, cultural and historical context
George is a 90-year-old single man, originally from Jamaica. After working in the US during World War 2, he returned to Jamaica. Shortly after, he decided to come and live in the UK. He knew no one when he first came and he lived in a Salvation Army hostel. He started work in a manual job but eventually became a hospital technician. He lives in an extra care sheltered housing scheme where he has lived for the past 21 years. It was originally a home for Caribbean elders but now the tenants are more mixed.
Participant's experience of ageing and ill health
George felt fit and healthy until the last twelve months, but now his legs have become weak. He started having falls about a year ago and on one occasion he fell outside Age Concern and they called an ambulance. The hospital couldn't find any reason for the fall, apart from mild anaemia. The tests also identified a pre-cancerous lump in his gut, which they removed. He hasn't fallen since the operation but his legs are still weak. He's still worried about the falls because they came out of the blue and he doesn't know what caused them.
George also has high blood pressure and high cholesterol. He has medication for this but sometimes he doesn't take the statins because of the side effects (aching muscles) so he takes garlic pills instead. He has a hand tremor and has been referred to the local memory clinic.
People in this participant's life
George has never been married and has no children. He had a relationship when he was younger but she returned to Jamaica and he never saw her again. He has lots of relatives in the US whom he phones, which is why his phone bill is quite high.
Since his walking deteriorated, almost the only people in George's life are the tenants of the sheltered housing scheme. Three of the ladies who live there are very helpful to him ("anything I want, at any time, they go and get it for me outside. Indoors, I'm alright, I can do what I like").
Whilst George is independent with personal care, the women bring meals, do laundry, clean, do his shopping, check up to see what he needs, and go to the Post Office to pay his bills. He pays them for the jobs they do. If he wants to go out to purchase something very specific (e.g. Canadian healing oil, for strains and sprains), one of the ladies goes out with him in a taxi.
George plays games, mostly dominoes, with these ladies and other neighbours in the communal living room. He walks down there three or four times a day since his leg problems started, mostly for the exercise. If there are people there he will stop and chat and maybe play dominoes. Occasionally they have parties there.
George had lots of friends ("dozens and dozens") when he was at work. He has one friend living in East Ham, who George used to visit but his friend is ill now so they just chat occasionally on phone. George says he doesn't want any other friends outside the home.
"To tell you the truth, I don't trust them. When I say I don't trust them, they're after what they can get from you. You get used to them they want borrow this, lend us that. And their kind of life is not really mine. They like to go betting shops, all them type of things, you know, parties [laughs]. And that's the reason why I don't have no friends outside. These in here are just right."
George has one other female friend living at the bottom of the road, whom he says would help him if the ladies living in the housing scheme couldn't. The other people in George's life are the staff of the housing scheme. There is a warden on site weekdays from 9 am to 6 pm and someone from the housing scheme rings him in the mornings on a Friday, Saturday and Sunday to see if he's all right.
What matters to this participant?
George's faith is important to him. He prays in the morning and before he goes to bed, and he likes to gives thanks for what he has. He used to enjoy attending a Seventh Day Adventist Church but he was unhappy with the preacher who had criticised a person in need of help, so he left the church.
What George really likes to do is help others. He says that he has helped a young girl financially over a number of years and he's still helping her even though she lives abroad now.
"This may sound funny to you, but the only thing I would really like to do is if I can get this chance to help people that are really in need. Other than that I don't see nothing more… Because I have no problems myself with health and finance."
George likes gardening and when he first moved into the accommodation the residents were involved in the gardening, but this changed. He also used to water and prune a section of indoor plants in the hallway and keep the spot clean and tidy, but the cleaners now do this once a week. George says he wouldn't be able to take part in that now due to his difficulties in bending down.
In the research scrapbook, George wrote;
"I like to see the various things of nature how they grow, how they behave, like to see people going about their business in a happy and loving way. I don't like to hear people quarrelling fighting swearing at each other, crying or worried about life as a whole I like peace and love not only in a home, but throughout the world."
George enjoys reading and listening to music on CDs. He has a radio in the kitchen and he likes listening to the weather, sport, news and music. He mostly listens to Radio 5 and a Christian radio station. But what he really likes about where he lives now is the peace and quiet ("it's all right here man; it's quiet, peaceable").
Body outline from George's Home and Life Scrapbook: "I feel tired and worn out"
Some days George feels tired and worn out but a good laugh and a chat with some of the residents makes him feel much better.
"Take for instance like how I feel this morning. I was really down and out, and one of the tenants visited me, and we chat and laugh as if I was never pain or, you know, uncomfortable situation in the world. But as soon as they're gone, you know when you sit down, you start to feel, as if you want someone to chat again to. But I get used to it, so, I just take it easy."
He says it doesn't matter who he chats to or what the conversation is, it makes him feel better. He says he has enough opportunities for this type of chat, although he does not visit other tenants unless there is a specific reason. They visit him any time of the day. When asked if he would be interested in the idea of Skype or similar to communicate with his realtives abroad, he says no because he feels "past it".
George says the tower block where he used to live had a damaging effect on him, it made him feel locked in. Now, he doesn't feel locked in, even though he can't go out much. The change in him, when he moved to this accommodation was apparent to others.
"Because sometimes I may run into someone that was living in the block and they would say 'What, oh you're changed'. When I was living there I didn't notice it myself but I was going downhill. But coming and living here it's peaceful and comfortable, and there's people I chat with them and laugh with them, we play games. It makes a great difference."
George says as long as he has enough food and a few pounds in his pocket he is happy, and then his concern turns to others. He likes to sit and looks at the small green space outside his living room window. He's particularly fond of the roses.
Most of all, he would love his legs to get better so he could do more things.
Wish list from Home and Life Scrapbook: 1) I would like…to get rid of the wasting situation of my weak leg; 2) I would like…I would like to do the things used to do when was a youth; 3) I would like…just a quite life
Technologies in participant's home and life
There is an alarm pull cord in each room (living room, kitchen, bedroom, bathroom, hall) of George's flat. The pull cord in the living room is in one corner, on the opposite side of the room from his armchair, and is fairly inaccessible. The cords are more accessible in other rooms - for example it's right by the bed in the bedroom, and is on the side he gets in and out. The pull cords are connected to a Tynetec control unit by the front door. George is not sure who answers if you pull the cord. He knows they will speak to you to find out what is wrong and then take appropriate action.
Telecare control unit, located by George's front door next to the door entry system
George does not have a pendant alarm. When asked what he would do if he fell somewhere away from a pull cord, he says that the pull cords are all he's been offered. He seems happy with that and does not think he has any other technology needs.
George listens to music a lot on a CD player. He doesn't have a television. He got rid of it several years ago because he got fed up with the poor quality of programmes on TV. He has the radio in the kitchen. He has a telephone but it is not near his armchair, he has to move to the other side of the room to make a phone call. Outside the flat there are handrails all along the communal corridors. The flat has a secure entry system and there is a letter cage on the front door so that he does not have to bend down to pick up the post.
When the researcher asks if there was any technology he felt might help him he says "something to help my legs".
Materiality and capability
One thing that bothers George is that he cannot have a proper sit down bath. He has to climb into the bath to use the shower. He is hoping that the housing managers will organise a walk-in bath with a door for him. Some of the other tenants have level access showers.
George finds writing a bit difficult due to his hand trembling and this knocks his confidence in his ability to write.
"Nervous, like, you know, when you're writing, you try to make a letter then it turn into something, and 'a' look like an 's', because your hand trembles."
His tremor, fortunately, doesn't interfere with his ability to shave or do buttons. ).
The researcher asked George if he had ever considered having a mobility scooter. He says there isn't enough space in the flat to store one. Another resident had one but he parked it in the communal corridor and it caused a lot of problems.
The researcher also asked if a mobile alarm would be useful for him. He says he doesn't need one because when he goes out he takes a taxi or he goes with someone. If he's going out in a taxi he books by phone for the journey out and then gets one home from the taxi rank next to the station, which is close to the opticians and other places he normally visits.
Real incidents of using (or choosing not to use) an ALT
George has pulled the cord in his flat three times. The first time was several years ago when he couldn't pass urine and he was in a great deal of pain. An ambulance was called and he went to hospital. They found he had an enlarged prostate. The other times he pulled the cord was for non-medical reasons; once the heating wouldn't come on and another time there was no hot water.
George is fairly unusual (though not unique) in this sample in being happy with his lot. There are a number of reasons for this. He has been fortunate to have enjoyed good health until very recently, and even now his health problems are less than many others in the sample. He is financially moderately well off - sufficient to be able to pay others to do errands for him and take a taxi when he wants to get out.
He does not wish for a wide circle of friends but the layout of the sheltered housing is such that he can wander down in search of company whenever he wishes. He feels he has everything he needs and he's grateful for that. Whilst his daily routine can be dull ("the same old thing"), he feels much happier when he's had a chat and a laugh with someone.
George is a religious and moral man who wants to do good to others, and is able to achieve this in part because he is materially well-off.
George phones relatives abroad a great deal. Technology could enhance this (and make it significantly cheaper) through using Skype, but George feels he couldn't cope with the equipment. There is surely scope here to develop very easy-to-use tablet computers to keep people in touch with their friends and relatives in the UK and abroad.
There is no room for mobility scooters in the housing scheme where George lives, which highlights the importance of environmental and housing design when considering the needs and wishes of older people. Such design concerns go beyond designing accommodation specifically for older people because so many of such people still live, and still want to live, in their family home. It would not, perhaps, be feasible to design every hall and doorway wide enough for a wheelchair or a rollator - but more could be done in this direction.
As in other case studies, George illustrates how people's needs for assistive technology change as their health deteriorates. He could now benefit from some additional existing technologies - especially a pendant alarm - but he is completely unaware of what exists. In this regard, he contrasts with others in our sample, whose children find useful technologies on the Internet or adapt existing home technologies for their needs. More awareness by older people themselves, and their families, could help create a society where older people were able to ask for aids appropriate for their care, and, importantly, ones that they actually want. Other people in this sample have seen aids and appliances on TV. The media might be a good way to help increase awareness of assistive technologies in society more generally, to flag up of what is available, how it might help, and how to get hold of it.
One final lesson from this case. Whilst technology can assist older people, George illustrates that technology cannot provide a "good laugh and a chat", or the beauty of the roses that he enjoys.