A blog entry by Maria Nilsson,
Doctoral student in health science at Linnaeus University
The Swedish Family Care Competence Centre (SFCCC) and Linnaeus University, Sweden, are international partners to the Sustainable Care programme. The SFCCC research centre is focused on all carers regardless of age, disease, diagnosis or disability. Halfway through my doctoral studies, affiliated at the SFCCC, I am proud to present our scoping review, which constitutes the first part of my compilation thesis. The review was published just before the end of 2020.
Our article reviews 85 studies, describing interventions mediated via Ambient Assisted Living-technology (AAL), for people 65 years or older and (where included) their informal carers. AAL technologies are defined as information and communication technologies (ICT), stand-alone assistive devices, and smart home technologies which enable individuals to stay active longer, remain socially connected and live independently. Examples are fall detectors, activity recognition systems, mobile and wearable sensors, intelligent houses, cameras, robots designed for company and service, ICT-solutions for support, health-care or social contacts. To be included in the review, the studies had to assess health outcomes for the older participants and be published in 2013 or later.
The result of our review provided a map overviewing the field, with nine intervention categories. We used the WHO framework of healthy ageing presented in the World report on ageing and health (2015), particularly the five domains of functional ability, as an analytical lens. Thereby we were able to show how the field of AAL-technology mediated interventions for older people and their informal carers relates to the concept of healthy ageing. The domains “Ability to be mobile” and “Ability to meet basic needs” were indeed mirrored by several intervention categories. However, the domain “Ability to contribute” was not reflected by any intervention categories, which indicates a gap in this rapidly emerging field.
We then proceeded to analyze the inclusion and role of carers in these studies. We could conclude that informal carers were included to some extent in over half of the studies. However, in most studies where informal carers were included, their situation and health and wellbeing were of subordinate interest. The carers were included as potential resources for alleviating professional staff, supporting or providing information about the person being cared for in various ways. Only 14% of the included studies assessed health outcomes for both the older person and their carers, thereby adopting what we define as a dyadic approach.
Finally, even though the domains of healthy ageing were mirrored by the intervention categories, broader environmental factors, deemed crucial for healthy ageing by the WHO, were not given any attention in the included studies. The AAL-technology interventions had an individual focus, thereby running the risk of reducing health problems and care needs to the individual level missing all other determinants for healthy ageing, such as social, socio-economic, cultural and environmental conditions.
We believe that these findings are relevant for policymakers developing health and social care strategies, including AAL-technology. Ideally, these strategies should promote the health and wellbeing of older people and their carers. Pointing to the gaps in the field is an important point of departure for decision makers as well as researchers concerned with health promotion and sustainable health and social care.
Even though there is well-known potential in the field of AAL-technology, questions remain. The way carers are included shows that we are far from a dyadic approach, and that much remains to be done. In terms of promoting healthy ageing, we need to continue the discussion of how best to use the potential of AAL-technology. I hope to contribute to a broadened vision and use of the technology to address social determinants of health and launch AAL-technology-mediated interventions that actively counteract health inequalities among older people and their carers.
In my second study, which is a discourse analysis of local Swedish policy looking at the e-health strategies and social care operational plans, I focus my analysis on the ideas underpinning the implementation and use of AAL-technology. I will present the findings from this study of policy documents in the upcoming SC conference. I’m looking forward to receiving your comments and reflections and discussing this topic further when we meet online.