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humanidades políticas de bienestar social HOST project partners: OPAC du Rhône (FR) - Polibienestar Research Institute, University of Valencia (ES) - ADAMA / AVIZEN (FR) - AGIM, Université Joseph Fournier Grenoble (FR) - Bio Result (IT) - CNR-ITC, National Research Council Construction Technologies Institute (IT) - ERASME, Conseil Général du Rhône (FR) - FINABITA (IT) - Nottingham Community Housing Association (UK) - TriplePlay (UK)

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ICT and Housing for Elderly in Europe. HOST project conclusions contains seven chapters related to the project during the period 2011–2014.

Readers will find the relevance of socio-technical models to improve the efficiency and quality of services addressed to elders, how to design adequate products to respond elders’ needs through a participatory design and, finally, the impact of HOST products on three samples from France, Italy and the United Kingdom. Last but not least, it is analyzed the challenges and opportunities of the social housing sector and new technologies to encourage ageing in place.

Jordi Garcés-Ferrer, Francoise Abry, Ascensión Doñate-Martínez

The HOST project (funded under the Ambient Assisted Living Joint Programme of the European Commission) is aimed to develop a digital infrastructure for social housing operators to address social isolation and promote autonomy of elderly users. The proposed product offers highly configurable and easy-to-use services to older people living in social housing flats, providing a simplified and effective interface to interact with their users.

ICT AND HOUSING FOR ELDERLY IN EUROPE HOST project conclusions

JORDI GARCÉS-FERRER FRANÇOISE ABRY ASCENSIÓN DOÑATE-MARTÍNEZ ICT AND HOUSING FOR ELDERLY IN EUROPE HOST project conclusions

políticas de bienestar social

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ICT AND HOUSING FOR ELDERLY IN EUROPE HOST project conclusions

CONSEJO CIENTÍFICO DE LA COLECCIÓN Spain: Jorge Garcés Ferrer Universidad deValencia

Esther Raya Díez

Universidad de la Rioja

Inmaculada Domínguez Fabián Universidad de Extremadura

Pedro Sánchez Vera Universidad de Murcia

Manuel Esteve Domingo

Universidad Politécnica deValencia

Estrella Durá Ferrandis Universidad deValencia

Francisco Ródenas Rigla Universidad deValencia

Europe: Jean Bousquet

University of Montpellier in France

Donna Henderson

Service Development Manager; NHS24/Scottish Centre for Telehealth and Telecare, Scotland

Jeffrey J Anderson Georgetown University

Elena Curtopassi

RegioneVeneto in Italy

Hein Raat

Erasmus MC, Rotterdam

Martin Knapp LSE, UK

Stephan Leibfried Bremen University

Sigurveig H. Sigurðardóttir University of Iceland

Halldór Guðmundsso University of Iceland

Otros: Evert vam Leeuwen

Radboud University Medical Centre, Nijmegen

Procedimiento de selección de originales, ver página web: www.tirant.net/index.php/editorial/procedimiento-de-seleccion-de-originales

ICT AND HOUSING FOR ELDERLY IN EUROPE HOST project conclusions

JORDI GARCÉS-FERRER FRANÇOISE ABRY ASCENSIÓN DOÑATE-MARTÍNEZ

tirant humanidades

Valencia, 2017

Copyright ® 2017 Todos los derechos reservados. Ni la totalidad ni parte de este libro puede reproducirse o transmitirse por ningún procedimiento electrónico o mecánico, incluyendo fotocopia, grabación magnética, o cualquier almacenamiento de información y sistema de recuperación sin permiso escrito de los autores y del editor.

En caso de erratas y actualizaciones, la EditorialTirant Humanidades publicará la pertinente corrección en la página web www.tirant.com.

Directores de la colección: JORDI GARCÉS-FERRER Catedrático. Departamento de Trabajo Social y Servicios Sociales Universidad deValencia: Estudio General Mª CARMEN ALEMÁN BRACHO Catedrática de Trabajo Social y Servicios Sociales UNED

© Jordi Garcés-Ferrer Françoise Abry Ascensión Doñate-Martínez

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Índice Introduction

Jordi Garcés-Ferrer Ascensión Doñate-Martínez 1. BACKGROUND................................................................................ 15 2. THE HOST PROJECT........................................................................ 18 3. REFERENCES................................................................................... 23

Innovations and methodologies in ICT services for the elderly Nicolò Paraciani, Paolo L. Scala, Filippo Fabbri, Davide Di Pasquale, Luigi Biocca & Marco Padula

1. INTRODUCTION............................................................................. 25 2. BACKGROUND................................................................................ 32 2.1. Impact of ICT usage on elderly people’s quality of life............................ 33 2.2. Use and acceptance of ICTs by the elderly.......................................... 34 2.3. Effects of training on ICT use......................................................... 37 3. PROBLEM STATEMENT..................................................................... 39 3.1. Overcoming digital divide for increasing ICT use by older people............. 40 3.2. Providing older people with ICT solutions that can improve their quality of life.......................................................................................... 41 3.3. Assistive ICTs: impact on caregivers and services providers..................... 42 4. REFERENCES................................................................................... 44

Benefits of participatory design with older people

Wendy Olphert, Professor Mark Hepworth, Solène Brignoli, Juliette Sablier, Bertrand Boudin, Lionel Ben-Ahmed, Vincent Rialle, Luigi Biocca, Marco Padula, Nicolò Paraciani, Davide Di Pasquale, Paolo L. Scala & Filippo Fabbri 1. INTRODUCTION............................................................................. 49 2. THE ENGLISH CASE STUDY............................................................... 51 2.1. Methodology............................................................................. 52 2.2. Evaluation of the Co-Design Workshops and Outcomes.......................... 56 3. THE FRENCH CASE STUDY................................................................ 58 3.1. Methodology............................................................................. 58 3.2. Results, lessons learned and recommendations.................................... 59 4. THE ITALIAN CASE STUDY................................................................ 64

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Índice

4.1. Methodology............................................................................. 64 4.2. Results and findings..................................................................... 69 4.2.1. Interactive co-design meetings........................................ 69 4.2.2. Iterative development: constant user feedback to developers and service providers........................................................ 70 4.2.3. Direct implication of the Social Housing Institutions and service providers.................................................................. 70 4.2.4. Tools: evaluation questionnaires...................................... 71 4.2.5. Possible improvements................................................. 71 5. CONCLUSIONS................................................................................ 72 6. REFERENCES................................................................................... 74

Needs and barriers of older people using ICTs at home: a qualitative approach of the French case study Sonia Mirallès, Françoise Abry, Juliette Sablier, Solène Brignoli, Bertrand Boudin, Lionel Ben-Ahmed & Vincent Rialle

1. INTRODUCTION............................................................................. 77 1.1. Background to the study............................................................... 78 1.1.1. OPAC du Rhône and the HOST project............................ 78 1.1.2. Organisation of the HOST project in France....................... 79 1.2. Ageing isolation and housing in France.............................................. 79 1.3. Methodology adopted for the study: inductive method and qualitative interviews....................................................................................... 81 2. NEEDS AND BARRIERS OF SENIOR CITIZENS USING ICTs IN FRANCE...... 81 2.1. Perception of new technologies....................................................... 82 2.2. Motivation to participate in the project............................................. 84 2.3. Previous use of social landlord services.............................................. 85 2.4. Participants’ needs regarding ICT tools............................................. 86 3. CHARACTERIZATION OF SENIOR CITIZENS FACING SOCIAL ISOLATION. 87 3.1. Multiple causes of isolation............................................................ 87 3.1.1. Separation: divorce and uprooting................................... 87 3.1.2. The end of one’s professional life..................................... 88 3.1.3. Loss of loved ones....................................................... 88 3.1.4. Health problems: physical and mental health....................... 89 3.1.5. Physical health........................................................... 89 3.1.6. Mental health............................................................ 90 3.1.7. Financial insecurity...................................................... 90 3.1.8. Unemployment.......................................................... 91 3.2. Social networks.......................................................................... 91 3.2.1. Family network.......................................................... 92 3.2.2. Networks of friends..................................................... 92 3.2.3. Professional network................................................... 92 3.2.4. Network of neighbours................................................. 93

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3.2.5. Networks created as part of associative activities or clubs....... 93 3.2.6. Networks of medical, social, home-care professionals............ 94 3.3. The environment........................................................ 95 3.3.1. Housing and neighbourhood.......................................... 95 3.3.2. Intercultural mingling.................................................. 95 3.3.3. Proximity to shops and services...................................... 96 3.4. Living old age............................................................................ 96 3.4.1. Psychological state...................................................... 96 Feeling of isolation-Feelings of loneliness........................... 96 Depression and suicidal tendencies................................... 97 The risks of long term isolation-Diogenes Syndrome............. 98 3.4.2. Notion of time and space.............................................. 98 3.4.3. The ageing process...................................................... 99 Fears/loss of autonomy................................................ 99 Moving house............................................................ 100 4. TACKLING SOCIAL ISOLATION THROUGH THE USE OF NEW INFORMATION AND COMMUNICATION TECHNOLOGIES................................... 101 4.1. Motives to participate in the project................................................. 101 4.1.1. Carve oneself a new role............................................... 103 4.2. The HOST Comm application (virtual social network).......................... 103 4.2.1. Definition................................................................. 103 4.2.2. Communication via HOST Comm................................... 103 Seeking social links...................................................... 104 Freedom of use.......................................................... 105 Evaluation of ageing in others......................................... 105 4.2.3. Level of skills in new technologies................................... 105 Family ............................................................... 106 Isolation ............................................................... 106 Norms of politeness.................................................... 106 Birth of a community................................................... 107 4.3. Usage patterns........................................................................... 107 4.3.1. Frequency of use........................................................ 109 4.3.2. Motives for non-usage of HOST Comm............................ 109 4.4. Key-points................................................................................ 111 4.4.1. Fears....................................................................... 111 4.4.2. Risk of addiction......................................................... 112 4.4.3. Isolation................................................................... 112 4.4.4. Financial insecurity...................................................... 113 4.4.5. Communication to be moderated?................................... 113 5. DISCUSSION.................................................................................... 114 5.1. Main results.............................................................................. 114 5.2. Conclusions............................................................................... 115 REFERENCES........................................................................................ 117 ANNEX I- Usage table by users.................................................................... 119

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Índice

Needs and barriers of older people using ICTs: the Italian case study Filippo Fabbri, Assunta D’Innocenzo, Roberto Fabbri, Rossana Zaccaria, Paolo Casacci, Gianfranco Borrelli, Massimo Pistoia, Luigi Biocca, Marco Padula, Nicolò Paraciani, Davide Di Pasquale & Paolo L. Scala

1. INTRODUCTION............................................................................. 121 1.1. Context of the experimentation...................................................... 122 1.1.1. Localization of the experimentation sites........................... 123 1.1.2. Destination of the experimentation sites............................ 123 1.1.3. Facilities and accessibility.............................................. 124 1.2. Characteristics of the users............................................................ 125 1.2.1. Family type and health conditions.................................... 125 1.2.2. Mobility and social relationships...................................... 126 1.3. Users’ lifestyles and habits at home.................................................. 126 1.3.1. Habits and activities..................................................... 126 1.3.2. Barriers and limitations................................................ 127 1.3.3. Technologies present in the house.................................... 128 1.4. Categories of required services....................................................... 129 2. IMPLEMENTATION OF THE HOST SYSTEM IN ITALY.............................. 130 2.1. Overview................................................................................. 130 2.2. System architecture..................................................................... 131 2.2.1. Development strategies................................................ 133 2.3. Devices and User Interface............................................................ 134 2.4. Implemented services................................................................... 136 3. IMPACT OF THE HOST SYSTEM IN ITALY.............................................. 139 3.1. User evaluation of the HOST devices................................................ 139 3.1.1. Problems with the tablet............................................... 140 Internet connection..................................................... 141 Audio volume............................................................ 141 Turning on/off........................................................... 141 Battery life/recharging................................................. 141 3.2. User evaluation of the implemented services....................................... 142 3.2.1. Most frequently used services......................................... 143 3.2.2. Main service usage problems.......................................... 143 3.2.3. Benefits generated by the HOST system and services............. 144 3.2.4. Users’ suggestions to improve the HOST platform and services.. 144 3.2.5. Impact of the HOST platform and services on the users’ quality of life...................................................................... 145 3.3. HOST platform evaluation by the Social Housing Cooperative: home maintenance and management services...................................................... 146 3.3.1. The procedure........................................................... 146 3.3.2. Results for the Cooperative........................................... 147 Evaluation of the HOST system...................................... 147

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Índice

3.3.3. The end-users’ point of view.......................................... 149 4. CONCLUSIONS................................................................................ 150

Needs and barriers of older people using ICTs: the English case study Professor Mark Hepworth & Wendy Olphert

1. INTRODUCTION............................................................................. 153 1.1. Location of the project in the United Kingdom.................................... 153 1.2. The technology solution................................................................ 154 2. METHODOLOGY AND PROCEDURE................................................... 156 3. PARTICIPANT CHARACTERISTICS....................................................... 157 4. PARTICIPANTS’ INFORMATION NEEDS AND INTERACTION PREFERENCES................................................................................................ 159 5. EVALUATING THE APPLICATION........................................................ 164 5.1. Mid-term evaluation.................................................................... 164 5.1.1. Background and approach............................................. 164 5.1.2. Findings from the mid-term evaluation............................. 166 5.2. Final evaluation.......................................................................... 169 5.2.1. Background and approach............................................. 169 5.2.2. Usage of the HOST system by elders................................ 170 5.2.3. Focus group workshop................................................. 171 5.2.4. Usage of the system..................................................... 171 6. SUMMARY AND CONCLUSIONS......................................................... 174

Evaluation of ICT-based services: HOST assessment and results Juliette Sablier, Solène Brignoli, Bertrand Boudin, Lionel Ben-Ahmed & Vincent Rialle

1. INTRODUCTION............................................................................. 175 1.1. Goal and structure of the chapter.................................................... 175 1.2. Concepts of evaluation: the values issue............................................. 176 2. PARTICIPANTS, MATERIALS AND METHODS........................................ 177 2.1. Participants............................................................................... 177 2.1.1. Overall presentation.................................................... 177 Reasons for dropouts................................................... 179 Living locations.......................................................... 179 2.2. Materials (devices and functionalities)............................................... 180 2.2.1. Overall presentation.................................................... 180 2.2.2. Regular evolution of the technology during the experiment: the issue of technological maturity........................................ 182 2.3. Methods................................................................................... 184 2.3.1. Inclusion of participants and assessment tools...................... 184

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Ă?ndice

2.3.2. Design of experiments................................................. 185 2.3.3. Assessment tools........................................................ 187 Questionnaires........................................................... 187 Standardised scales...................................................... 188 2.3.4. Mid-term visits for evaluation of practice........................... 189 2.3.5. Automatic recordings of the use of the applications............... 190 2.3.6. Additional tools in France............................................. 191 Paper diary............................................................... 191 Phone calls ............................................................... 191 3. RESULTS......................................................................................... 192 3.1. Self-reports on the use of HOST devices............................................ 192 3.2. Performance in the use of the technologies......................................... 193 3.3. Summary of automatic recordings.................................................... 197 4. CONCLUSIONS................................................................................ 198 REFERENCES........................................................................................ 200 ANNEX I. List of tasks related to the performance in the use of technologies in each country........................................................................................... 201

Living well and old at home: challenges and opportunities for the social housing sector Julien Dijol

1. INTRODUCTION............................................................................. 203 1.1. The silent revolution of ageing........................................................ 204 2. RECONSIDERING HOUSING AND LIVING SPACES................................. 205 3. THE ECONOMIC CASE FOR INDEPENDENT LIVING.............................. 208 4. THE AVAILABLE TOOLS IN THE SOCIAL HOUSING SECTOR.................... 210 4.1. New buildings............................................................................ 210 4.2. The existing housing stock............................................................. 211 4.3. Adapting the living spaces.............................................................. 213 4.4. Providing support services............................................................. 213 4.5. Promoting solidarity between generations.......................................... 214 5. A FEW IDEAS FOR THE FUTURE......................................................... 215 5.1. Increasing research capacities for the development of universal design in the field of housing as well as for independent living of elderly people............. 215 5.1.1. Diagnosis.................................................................. 215 5.1.2. Proposal................................................................... 216 5.2. Promoting intergenerational solidarity as part of social and territorial cohesion......................................................................................... 216 5.2.2. Diagnosis.................................................................. 216 5.2.3. Proposals.................................................................. 216 5.3. Boosting services and making jobs valuable......................................... 217 5.3.1. Diagnosis.................................................................. 217 5.3.2. Proposals.................................................................. 217

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5.4. Preventing vulnerability, in particular energy poverty............................ 218 5.4.1. Diagnosis.................................................................. 218 5.4.2. Proposals.................................................................. 218 6. CONCLUSIONS................................................................................ 218 REFERENCES........................................................................................ 219

Introduction JORDI GARCÉS-FERRER ASCENSIÓN DOÑATE-MARTÍNEZ

Polibienestar Reserarch Institute-University ofValencia

1. BACKGROUND Population ageing is a well-known phenomenon and challenge.

Life expectancy has been increasing in most developed countries worldwide over long time periods. This increase has been significant in Member States of the European Union (EU) since 60s, especially for women. Moreover, life expectancy at age 65 is projected to increase by 4.8 years for men and by 4.6 for women over the projection period 2013-2060 (European Commission, 2015).

Due to the far-reaching of the demographic change, population ageing has become a priority in the EU policy agenda that requires a multidisciplinary and multisectoral approach. Nowadays, our societies, their resources, services, infrastructures and our way of life are not adapted to the needs and requirements of older people. Thus, the creation of age friendly environments is an urgent challenge and approach. In order to respond effectively to the demographic change. The World Health Organization (WHO) proposes eight key topic areas to develop guidelines and policies for the promotion of age friendly environments: transportation; housing; outdoor spaces and buildings; community support and health services; communication and information; civic participation; respect and inclusion; and social participation (WHO, 2007).

According to WHO, active ageing is defined as “the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age” (WHO, 2002). Active ageing goes beyond being physically active or participating in the labour force; it tries to extend healthy life expectancy and quality of life for people as they age. Thus, retired older people can remain active

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contributing to their families, peers and communities through their participation in social, economic, cultural, spiritual and civic activities1.

In this sense, the key goal in the policy framework for active ageing is aimed to maintain autonomy and independence for the older people. At European level, we can find initiatives in this line, as the European Innovation Partnership on Active and Healthy Ageing (EIPA-AHA)2 of the European Commission (EC), which one of its objectives is the promotion of age-friendly physical and environmental innovation and practice, including the use of information and communication technologies (ICT). The work of the EIP-AHA is divided in six Action Groups with different purposes: adherence to medical plans (A1); falls prevention (A2); frailty and functional decline (A3); integrated care systems (B3); ICT solutions for independent living (C2); and age friendly environments (D4). Within Action Group D4, Polibienestar Research Institute leads the ICT group aimed to increase the environment accessibility through ICT solutions and the spatial accessibility group to respond to the accessibility requirements of elderly in the urban environment.

An essential pillar to promote active ageing is that elderly people maintain one’s independence. As aforementioned, one of the main ways to achieve this goal is that elders live independently at their homes as long as possible. This is known as “aging in place”, which is defined as “remaining living in the community, with some level of independence, rather than in residential care” (Davey et al., 2004). Moreover, for elderly people aging in place is seen as a benefit for themselves, as it favours sense of attachment or connection, sense of security and familiarity, and it is related to people’s sense of identity through independence and autonomy (Wiles et al., 2011).

1

2

Based on the Seven Dimensions of Wellness of the International Council on Active Ageing. More information at: http://www.icaa.cc/ More information at: https://ec.europa.eu/eip/ageing/home_en

Introduction

17

Many elders want to stay in their own homes as they age, however there are some barriers and challenges that complicates this decision and willingness. Aging in place involves both the person and the environment in a constant and dynamic interaction (Wahl & Lang, 2003). In this sense, there is a positive interaction when the person disposes enough abilities to adequately deal with his/ her environment; or the demands of the environment are balanced according to person’s abilities. However, it may be disadaptive situations with a negative impact on person’s quality of life when the characteristics of the environment exceed his/her own abilities.

Both the person and the environment have predictable and unpredictable limitations which should be taken into consideration.

In order that elderly can live independently at home they need to maintain various activities for daily living (ADLs) that are essential for self-care (such as feeding ourselves, bathing or dressing) and instrumental daily activities (IADLs), such as cooking or taking medications as prescribed. In spite of an adequate performance of ADLs and IADLs are necessary for aging in place, sometimes they are not enough. In many cases, elders need additional support for different issues, as home maintenance, for self-care or for the monitoring of their diseases. In this regard, home-help services may be a good option to receive assistance for this kind of activities (Garcés et al., 2011; Carretero et al., 2007). Furthermore, telemonitoring of biologic variables (as blood pressure, heart and respiratory rates, level of glucose or weight) through biomedical devices —tablets or smartphones— are very useful for a constant and professional control of elders’ health outcomes and symptoms suffering chronic conditions (Doñate-Martínez, et al., 2016).

Most of the elderly people want to live in their own houses independently as long as possible, even when they experience problems associated to physical or cognitive functional declines. Moreover, currently governments and public administrations are very interested in achieving this goal as supporting elders to remain at their houses is generally less expensive that other living options as residential care (Sixsmith & Sixsmith, 2008).

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Jordi Garcés-Ferrer - Ascensión Doñate-Martínez

One of the key factors to favor aging in place is home modifications according to elders’ needs. Usually the modifications are at physical level that improves quality of daily activity and life. It has been demonstrated that those houses of elderly people which were adapted to answer their physical limitations increases their sense of safety and control (Scheidt & Norris-Baker, 2003). Moreover, home modifications foster elders live longer at their homes than those that not did any adaptation (Hwang, et al., 2011).

Besides home adaptations, there are many efforts put on research and innovation in the field of smart technologies and homes for elderly people. Smart home technologies can assist with aging in place by facilitating performance of ADLs and IADLs, providing safety and monitoring, and compensating functional limitations that the person may have (Cocco, 2011). “Health smart homes” provide different kind of care services and kind of technical supports for elderly people (or people with special needs) who wish to remain independently and living in their home (Rialle et al., 2004). There is a wide range of services and supports for elderly at home: social robots to facilitate the daily living; motion sensors and video surveillance aimed to send signals to a contact person of the user in case of an unplanned event (fall or accident, for instance); reminder systems for upcoming appointments and events; medication devices as pill dispensers; or security devices to monitor security issues. A study about elders’ perception of health smart homes indicates that they consider as main relevant aspects the following: the system should be user friendly both in the interaction and design, and secure/reliable while being adapted to users’ needs and capabilities (Krafft & Coskun, 2009).

2. THE HOST PROJECT The current book presents the experience of a specific initiative joining social housing and new technologies for elderly people.

This is the Research and Development (R&D) project “Smart te-

Introduction

19

chnologies for self-service to seniors in social housing� (from now on HOST), which ran from 2011 to 2014. The project developed a digital infrastructure for social housing operators and a gateway to their services providing to older people and their families userfriendly technologies and services.

HOST is sponsored under the European Commission’s Ambient Assisted Living Joint Programme (AAL-JP)3 which main objective is to create better conditions of life for older people and to strengthen the industrial opportunities in Europe through the use of ICTs. The HOST product developed under the project offers easy-touse services to older people living in social housing flats, providing a simplified and effective interface to interact with the elderly, designed for social housing operators willing to improve communications with their users. It is highly configurable and adaptable, and it can be tailored around users’ needs. The devices adopted are digital tablets, computers, smartphones and set-top boxes connected to a digital TV screen. The system is composed of a central database, connected to the social housing back-office, to other services (such as e-commerce or home care providers).

HOST products have been implemented and tested in rather different ways in France, Italy and the United Kingdom, in order to adapt them to the cultural differences and local constraints and opportunities. For example, in France the system is composed of a central database connected through internet to the information system of the social housing operator, the home care provider, and two applications on an iPad device. The Italian system is composed of a home server at the senior premises able to communicate with various interfaces. And, in the United Kingdom the system is composed of interactive TV sets connected to a server inside the social housing building.

3

More information at: http://www.aal-europe.eu/