Blog | Wednesday, November 29, 2017

Technology is unkind to the elderly


In about 1990 we got our first computer. I say “we” because my husband and I shared a desktop which I used infrequently. I mostly used it for word processing, and the Internet was very young. At the turn of the millennium, my children were using computers and they were limited to 1 hour of computer time a day, which was on a shared desktop. By 2001 I was communicating with my grandmother, then in her late 80s, by email.

My grandmother had received, probably just prior to the millennium, an email machine from her son. It was a little thing on which she could type messages to a dear friend who lived in London. She loved the ability to spontaneously send him a message and get an answer in a day or less. She was a retired reference librarian and had worked in the Bay Area school system where an exhaustive knowledge of the Dewey Decimal System allowed her to connect students to the resources they needed. We thought she would be delighted to have an Apple Macintosh. With such a thing she could query the world of data and feed her insatiably curious mind.

This gift was a failure. Nothing about it was intuitive. Scrolling, clicking, using a mouse, returning to a previous screen, all were lessons that she had trouble learning. She would call one of us or her son when the screen inexplicably looked different than it had and she couldn't find her way back to something familiar. I think she started to die a little when she couldn't make that pretty white computer work. In retrospect she just needed the email machine.

A few years ago my father, now in his 80s, gave me an iPad which he had bought and didn't use. By guess and by golly (as my grandfather would have said) we managed to navigate its passwords and get it transferred over to me. It was cute, but certainly no more useful than a laptop, and rather delicate, so I gradually broke its screen and then it was stolen when I was in South Sudan. On a recent trip, my father showed me his new iPad, which he also didn't use, which he thought I might have use for. He had been seduced into buying it at an Apple store and, likely with the help of some bright millennial, had entered a new password and the answers to some security questions. Being wise, he didn't write the password on the machine itself, since he knows how important password security is, so it is gone. Also, having had a long and very complex life, the answers to the security questions were subject to shifting interpretation. Although he and I contacted customer service, there is no remedy. The pretty iPad with the retina display is now an attractive coaster or possibly something under which to press flowers. (Those of you with a penchant for problem solving will ask about “return to factory settings” or even “jailbreaking.” I will just tell you that, after trying these things for 2 hours with someone of legendary computer cleverness, Apple has those options pretty well blocked.)

Technology, by which I mean computers of all sizes including phones and tablets and the like, offers incredible potential to people as they age. Music can fill their ears, raise their spirits and help them to frame their lives as brave and glorious. They can see pictures of far off places which they might not be able to visit again, talk to children and grandchildren while seeing their faces, access reminder notes, pay bills, review bank accounts, donate to charity, play games that tweak their brains in good ways. Computers, at their best, make our worlds larger and extend the capacity of our minds. This is just what we need as we get older. But computers, with their infernal passwords and vulnerabilities to security breaches, their little bitty buttons and sometimes tiny screens, their failing wireless modems and misleading advertising, are making the old feel older.

By the age of 85, about 1 in 3 of people have Alzheimer's disease, per the Alzheimer's Association. This, of course, vastly underestimates the proportion of elderly people with some kind of impairment in their memory, problem solving or ability to learn new tasks. This group of people need, more than we younger folk, to have access to their medical records and to use the wealth of online resources to remain healthy or monitor diseases. It is precisely the group whose health can most benefit from computers and the internet who are left out. Almost all of the elderly patients I see in clinic decline to use the computerized patient portal. Although I think that the portal itself is pretty easy to use, it is the many steps involved in getting to the portal that are daunting, so much so that our older patients hesitate to even try.

In the UK in 2012, the Prime Minister issued a challenge to make the country more friendly to patients with dementia. This included a Dementia Friendly Technology Charter. The Challenge includes making workplaces and communities more kind to people as their brains age, but also to help them get some benefit from technology. There are quite a lot of technological solutions to the problems of dementia, especially for caregivers, but I don't think that producers of hardware such as computers and tablets are stepping up to the plate. It is perfectly possible to create an iPad that doesn't depend of remembering passwords and reduces vulnerabilities to abuse while allowing users to access music and video chatting and photos and information. The UK has made some headway toward dementia-friendliness. The United States has no such challenge in place and from my vantage point, people are just becoming more marginalized as they age.

I would like to encourage the hugely successful producers of technology to respect their elders to the extent that they create products that will welcome them. The makers of software that is useful enough to become a necessity should think twice before requiring that users have excellent memories. And until our technology becomes more friendly, companies should develop remedies so that people who develop dementia (or have brain injuries) are not effectively shut out.

Janice Boughton, MD, ACP Member, practiced in the Seattle area for four years and in rural Idaho for 17 years before deciding to take a few years off to see more places, learn more about medicine and increase her knowledge base and perspective by practicing hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling. Disturbed by various aspects of the practice of medicine that make no sense and concerned about the cost of providing health care to every American, she blogs at Why is American Health Care So Expensive?, where this post originally appeared.