Person-Centered Technology for Older Adults: Benefits,Limitations,and Considerations in Design and Use

Applications of study findings to gerontological practice, policy, and/or research

• Nursing homes, assisted living communities, and other environments that care for older adults should thoughtfully consider staff training before implementing a new technology for the care of older adults.

Introduction

Technology has transformed the healthcare industry over the last half-century. Advancements such as ventilators, dialysis machines, magnetic resonance imaging scanners, artificial heart valves, and implanted defibrillators have directly improved the diagnosis, treatment, and prognoses of many illnesses (Thimbleby, 2013). Communication and record-keeping have become computerized; use of electronic medical records (EMRs) and decision support tools has become widespread (Morris et al., 2021); and medical informatics has emerged as an entirely new field (Evans, 2016). Indeed, technology has had immeasurable impact on healthcare, with a net public health benefit.

Use of technology in healthcare is not, however, without its drawbacks. One example is the widespread introduction and use of EMR systems, which has increased administrative burden placed on healthcare professionals, contributed to physician burnout (Kroth et al., 2019), and raised security concerns for patients (Basil et al., 2022)⁾, all with only limited demonstration of improvement in care quality (Graber et al., 2017).

Of particular concern is whether technology can meet individualized goals and provide true person-centered support to individuals, or whether it detracts from person-centeredness. Increasingly, technology is being used to supplement and at times to replace personal contact in care settings—a situation that poses significant risk of reducing person-centeredness by eliminating the one-on-one interaction upon which person-centeredness depends (Dyb et al., 2021). Examples include robots for socialization (Trainum et al., 2023) and safety devices that use cameras and artificial intelligence systems to identify falls (Potter et al., 2016; Zimmerman, Xiong, & Netscher, 2024). Furthermore, new technologies tend to be disseminated when they automate repetitive tasks and lower production costs, a process that requires standardization and mass production, which means that technologies that standardize will always receive more investment and attention than those that provide customized attention to a given person (Thimbleby, 2013).

The scientific literature, while replete with studies about innovative technologies, has rarely examined them using a lens of person-centeredness, which emphasizes how the technology serves an individual’s interests, values, goals of care, and needs (American Geriatrics Society, 2016). Therefore, it is worth evaluating whether and to what extent new technologies enhance or inhibit person-centeredness, and whether they are being implemented in ways that promote person-centered care and a person-centered lifestyle for persons residing in independent living settings and those in long-term care.

Therefore, to better understand the relationship between technology and person-centeredness in care of older persons, we conducted two on-site discussion with providers of dementia and long-term care services for older adults, and two virtual meetings with experts in the field. Drawing from these sources, this special article discusses the ability of technology to both facilitate and limit person-centeredness and provides suggestions for how technology should be designed by engineers, implemented by organizations, and used by individuals to maximize its person-centeredness.

For this special article, technology is defined as any digital or physical tool that is used in care settings for persons who are older or disabled; that is not routinely used in daily life outside of care settings; and that requires special skills to implement. A book, for example, is technically a tool but does not meet this definition because it requires no special skills to utilize. On the other hand, an “app” (i.e., computer application) used to communicate care issues between caregivers meets this definition because it is digital and its use requires specialized understanding and training.

Participants in one on-site discussion group involved two interviews with 12 staff from a continuing-care retirement community, to elicit opinions about technology designed for care of older adults; participants included a nurse, two resident assistants, four dining staff, and five medical technicians. The second on-site discussion group was conducted at the Alzheimer’s Association Dementia Care Provider Roundtable, with 30 individuals representing a range of settings including assisted living, nursing homes, and home and community-based services; participants included certified nursing assistants, nursing directors, and directors of both for-profit and not-for-profit settings.

In addition, we conducted two 90- to 120-minute virtual discussion groups with diverse experts with experience in technology design and evaluation for older persons, and in aging-related health and function. Members were selected by a combination of literature searches and networking, so as to include individuals from diverse locations with a variety of perspectives. Participants included four principals in technology companies that featured products targeted toward seniors, three researchers/academics, and two advocates working in areas related to improving care and equity for older persons.

The first group included:

• the state chair of a non-profit advocacy organization for long-term care residents;

The second group included:

• the principal of a company distributing an electronic device to detect falls;

The meeting facilitator provided general questions for discussion, but the questions did not restrict the discussion. The introduction noted many uses of technology, such as related to safety and security, social communication, care and support, social engagement, work-related communication, and artificial intelligence. Discussion addressed technologies that were considered especially person-centered (and not person-centered) in any of these areas; whether there were limits or guidance as to how technology should be used in relation to person-centeredness, and solicited suggestions regarding areas where novel technologies would be especially beneficial.

Discussion identified four key issues related to technology in the context of person-centeredness: technology can both facilitate and impede person-centeredness; all stages of technology development should incorporate potential users; advanced design and implementation planning should focus on ease of use and adoption; and implementation in a manner that reduces racial, geographic, and income-related disparities is an ongoing challenge. Each issue is discussed below, with representative quotes for illustration.

Technology Can Both Facilitate and Impede Person-Centeredness

To be person-centered, technology must be a “tool that can bring engagement or make life easier or more successful.” In so doing, a person-centered technology should enable older adults to achieve goals that they have set for their lives, including goals such as extending life, optimizing function and experiences, or symptom relief. Furthermore, principles of engagement, adaptability, and meeting the individual’s needs must be met for a technology to be person-centered.

Participants reported that many widely used technologies have limited potential to be person-centered, especially when they are difficult to implement in a person-centered manner, are not adaptable, or offer limited options for use. For example, care planning templates that provide limited choices are not person-centered when their inherent rigidity impairs the user’s best effort to match the output to the user’s needs. Furthermore, it was felt that to be person-centered, technology requires personal interaction, and so many technologies have limited potential to be person-centered. As one participant noted “A content platform in and of itself doesn’t know who it’s delivering content to. It’s up to the person using the platform to ‘person-center’ it… (and it) has to be (made) person-centered by some other person making sure that the right content or the right application or solution is getting to the right person.”

One nuance of this issue is whether technology must be used by the individual it is serving or whether enhancing caregiver function can be considered in the context of person-centeredness. Some participants felt that if a technology focused on improving caregiving workflow, it was not person-centered because the older adult is not engaged or having their needs met by this utilization. On the other hand, some argued that when a technology increases a caregiver’s efficiency, it allows the caregiver more time to engage directly with the older adult on a human level, thereby making the technology inherently person-centered.

In this context, some technology used by caregivers can indirectly promote an older person’s autonomy. For example, security technologies such as automatic stove turn-offs, tracking devices, and surveillance cameras, when used by family caregivers who live elsewhere, have the potential to promote autonomy and aging in place. Consider an older woman who lives alone and is increasingly forgetful. Her son, who lives in another city, worries about his mother’s safety if she continues living alone. In this scenario, devices that permit the son to monitor his mother, lock her door, and turn off her stove from his cellular phone “prolong the time that seniors can age in place, which is often considered the gold standard for autonomy.” However, from another vantage point, such devices can be viewed as intrusive and therefore as interfering with autonomy.

Designing Technologies in a Person-Centered Manner Requires Participation of Potential Users, Including, as Appropriate, Older Adults, Caregivers, and Clinicians in Every Stage of Development

Participants noted that technology is often designed without direct user involvement. They emphasized that disconnects often develop between the intentions of the engineers who design technology and their target populations. Therefore, from the earliest stages of target use identification and prototype development, designers of new and/or modified products should involve potential users (older adults, clinicians, and caregivers, as appropriate), because that involvement will help identify needs to address and anticipate problems in usability and implementation.

A case in point is the fact that many technologies are created out of curiosity without clarity on the problem and/or users to target. In such situations, the driving force behind product development is the developers’ personal belief in the “rightness” of the idea. This process results in a technology being developed and then going “in search of users,” rather than identifying a problem first and designing technology to fill the existing need. One participant described it thusly: “I’ve got one hell of a hammer. Now, where’s the nail that’s going to be right to fit?”

The solution to this potential mismatch is to engage older adults, and as appropriate their caregivers and clinicians, from the beginning. This process of involving intended users at all stages of product development assures that the focus of the process will be end-user goals and needs, which can vary across individuals and frequently diverge markedly from the often-naïve opinions of the engineers who are designing the product. As one participant noted, “Technology often assumes that everyone wants to be on the wellness or optimal health path, which may not be in the person’s goals. Not enough time is spent on the front side of tech development thinking about whether a person wants it or not.”

Particularly valuable, according to several participants, are interdisciplinary teams that include all potentially relevant users as well as developers. Such groups are better able to focus on a meaningful problem which if addressed by an innovative technology could significantly improve care or quality of life, and on designing the product that will be useful to and accepted by target users. This process itself is person-centered because it is “centered on the real person and their real goals and their real needs in a practical, operational way.”

The last stage of development is evaluation of the technology. Overwhelming, participants strongly felt that outcome measurement must focus on the outcomes related to the person’s experience. Specifically, “Outcomes have to be patient-centered outcomes such as patient surveys, prompts, patient activation measure...the qualitative part brings in the patient’s perspectives.” In response, another panelist noted that there is little incentive in measuring these outcomes because “the person’s experience as an outcome is not what gets paid and it’s not (considered) the return on investment that matters to people who are writing the checks for the technology.” This discussion highlights a critical obstacle to ensuring person-centered outcome measures are used for evaluating technology; they are often not tied to financial return.

In Advanced Design and Implementation Planning, Ease of Use and Adoption of a New Technology Should Be at the Forefront

In older adult populations, adoption and use of technological innovations is often lower than in the general population. Products with a steep learning curve are often accompanied by user frustration, leading to abandonment of the technology without exploring its potential to improve the individual’s life. One participant noted that many older adults prefer using tablets with styluses over smart phones because the tablet and stylus mimics the pen and paper model with which they are already familiar; relatedly, uptake of tablet-based technologies tends to be greater than that of smartphone-based products. Insights such as these help developers design products away from general, often youth-focused, models, to better target the older adult population.

Ease of use is also important in design of products for caregivers in home and long-term care settings. These individuals often juggle numerous tasks and demands, so they are unable to invest a large amount of time in learning or using a new technology. Therefore, ease of access, simplicity of use, and modest training needs are important for adoption. One participant said this about a technology that he believed had exciting potential: “A lot of people were just afraid to take on a new task because they were overloaded. Training (on the technology) is investment of time even though, if the tech is done right, it should save you time and give you all kinds of benefits.” Therefore, even if a technology were to markedly improve staff’s ability to care, its potential would not be realized unless it fits readily into work flow, is easy to learn, and is easy to use.

Early interest from users is critical to adoption of a new technology, which depends on the product being easy to learn and perceived as helpful; these outcomes can be promoted by including end-users in all stages of the design process. Clinicians should also be involved, as they play a crucial leadership role in care settings. As one participant said: “(A) tech may look great in theory but in reality it doesn’t work, because there is no buy-in from clinicians”—illustrating that more than one user is often needed for a technology to be adopted.

Indeed, how the technology is received by the intended user is thought to be the crux of its ability to fulfill the goal of achieving person-centeredness. Older adults need to feel empowered to use the technology in a way that enhances their life, and staff and clinicians need to be able to train quickly and perceive that the technology will add value, not burden, to their work. In terms of reception from caregivers, technology should supplement the personal relationship, not replace it. If technology can aid completion of simple caregiver tasks, it can free time for staff to address more complex needs, including meaningful interactions with the older person.

Implementation of New Technologies in a Manner That Reduces Racial, Geographic, and Income-Related Disparities Is an Ongoing Challenge

Repeatedly, the concept of equity arose when implementation was discussed by participants, particularly around long-term care settings. They noted marked differences in resources and infrastructure among care settings, ranging from resource-poor rural or inner-city settings to highly resourced, private pay-dominant, often suburban settings. This wide range of resource availability by geography and payment sources was known to be associated with disparities along racial lines, with Black and other minority older persons often being concentrated in a few low-resourced settings.

As such, the range of settings where target users live must be considered in technology implementation. For example, a participant who has experience working with resource-poor nursing homes and assisted living communities stated that many high-tech “solutions” are simply not possible in communities that are already struggling to carry out basic tasks: “The things I’ve seen in assisted living don’t come close to the solutions [other panelists] talked about. For example, these facilities don’t even have a license for Music and Memory, so staff try to replicate it in other ways.”

A related issue is that, although the world is increasingly dependent on the internet, many residents and staff in home and long-term care settings remain cut off from reliable Wi-Fi access, either entirely or having it available only in certain areas such as an office and day room but not bedrooms. Participants agreed that Wi-Fi access remains a principal issue and is key to bringing rural and “lower-end” urban settings into the modern era, where they can reap the benefits of new technologies. Otherwise, technology will only reach the wealthier communities and further exacerbate disparities.

There are multiple strategies to increase digital access, but equity is dependent on public policy. As one participant commented, “as much as private sector and large companies and wonderful startups or smaller companies have done, high quality internet access is still a public policy issue.” To that end, some panelists suggested municipal Wi-Fi programs and/or pressuring departments on aging to prioritize digital access for older adults.

A widespread problem, particularly with data-driven technology, is that many long-term care communities do not have sufficient staff to utilize data generated by electronic systems. In such settings, implementing technology into a system that cannot act on it will have no net benefit and may instead strain limited human resources. Comments about this issue include “if there is no caregiver support to address needs identified from the technology to improve health, there is no net benefit” and “we need to get people available to act on tech.”

From an equity perspective, simple devices are often more person-centered because they are easier to distribute widely. For example, an inexpensive handheld speech amplification device, such as can be purchased at an electronics store, if made available for use by any visitor who enters a long-term care community, may well improve interaction better than more sophisticated devices such as hearing aids. Thus, a focus on simple technologies might improve person-centeredness both at the individual and the community level, thereby reducing disparities based on income and resources.

Conclusions and Implications for Practice, Policy, and Research

Consideration of the insights from discussion groups on the interface between technology and person-centeredness identified both challenges and opportunities. A key observation of these discussions is that technology can serve as either a barrier or facilitator of person-centeredness depending on what it does and how it is used. Other observations focus on conceptualization, development, roll-out, and application, stressing that this continuum must involve older adults, direct care staff, clinicians, and—if appropriate—families. If done properly, resulting innovations are more likely to be person-centered and more easily adopted into the busy routine of care provision. A final observation involved consideration of the possibility that technology may promote care disparities, as resources are needed to adopt and maintain most innovations; therefore, policy makers and regulators must both encourage development of simple, inexpensive solutions to problems and foster their dissemination into low-resourced settings. The literature supports all four of these observations.