As a geriatrician I’ve always worried about access for my patients: to comprehensive primary care, essentials like transportation and nutritious meals, high quality palliative and end of life care. But over time my attention has turned to another access issue, a digital one. As digital literacy fast becomes a pre-requisite for health information and even for service delivery, health systems and innovators will need to wrap their arms around a digital divide that often exists between younger and older adults.
My journey into the digital divide began three years ago when a friend and start-up entrepreneur here in Louisville asked for input on a business idea: let’s build a safe, effective digital platform for the oldest old, those in their 70’s, 80’s and 90’s, whether in assisted living or at home, give them the ability to customize their entertainment experience based on their preferences – as opposed to whatever’s on Cable each night – and allow their loved ones to connect with them digitally in a way that neither side would feel was obtrusive or intimidating. The geriatrician in me liked the idea right away. Besides, what could go wrong?
Unfortunately, beta testing quickly revealed a big problem: the digital environment that we find so intuitive isn’t as quickly or easily adopted by our oldest users. The digital paradigm that most of us now take for granted - the way things are presented, what things are called, how we bounce hither and yon through the multi-layered universe on our screens - these were never designed with our oldest users in mind. For most of us the ‘BACK’ and ‘HOME’ buttons make perfect sense, but not everyone shares that intuition. We apparently needed to dig deeper into the hearts and minds of the older technology user: their needs, their expectations, their strengths, their frustrations and fears. So much for a quick-to-market technology!
It might not be surprising to hear that older adults have a habit of blaming themselves when it comes to digital frustration or difficulty, saying things like ‘I’m no good at technology’ or ‘that computer stuff is just for kids’. But for us this did not ring true at all. From early television sets to the smartphone, thousands of new technologies have come on line each decade for the past 70 years, across all aspects of life. At home, at work, on the road. Anyone who has lived from the 1940’s to the 2010’s is a paradigm of technology adoption. The gold standard. For my friend and I, their inherent ability to adopt technology was not - and could never be - the real problem. So we listened, we iterated, we listened again, and again and again... Ultimately the root of the problem became clear: the difficulties our oldest users were having come from the design of the technology itself, both physically and digitally.
So we changed the look and feel on screen, limited the number of steps it takes to reach the information people want. We favored clear wording over potentially confusing icons. Colors are less jarring and contrast improved. And we designed a new remote. We added sensory feedback to the buttons. We consulted with experts in arthritis and neurology so that the physical and visual tools were accommodating to anyone with impairments in those areas. (And if anyone thinks this is only for older adults or persons with various diseases, ask yourself, who in this world doesn’t long for a simpler, more intuitive remote at home?!?). In short, we established a set of design principles that are optimized for the older user, are intuitive and non-threatening, were developed in collaboration with experts and have now been rigorously field tested. These principles are now the starting point for any conversation with a potential customer, partner or investor.
When I think about incentivizing wellness, and the self-management of chronic diseases that has become more and more common, it seems obvious that our technological and digital innovations must be tailored for the oldest old. If they are unwilling or unable to adopt the innovations we create, then we will have inadvertently exacerbated a digital divide that we should have been trying to cross or fill all along.
From the countless hours of trial and error with our focus groups of older users - testing various phones, laptops, pads, touchscreens, remotes, fonts, sizes, colors, you name it - what really stands out in my mind was their enduring optimism and courage. They tried every tool, every device, every layout, and they never complained. Even if a particular round was difficult or unintuitive, they remained bullish on the platform and forged ahead. Here was something both useful and new, so their enthusiasm never waned. I suspect it was this optimism which kept my friend going many a dark night alone as a start-up entrepreneur.
Flash forward two years, the platform is in people’s homes and being used by both older adults and their families - and sometimes caregivers - alike. Wouldn’t you know it… as soon as we customized the tools and the interface to them, they adopted it right away. Instead of falling back on biased assumptions about older users - blaming them for their lack of familiarity; simply offering them more ‘training’ and hope they can catch-up - we based our platform on the strengths of the older user, their experiences and their preferences.
Isn’t that what we are supposed to do for all our our patients when we offer them treatments and care?
My entrepreneur friend’s journey is far from over, but as a geriatrician and advocate for the oldest-old I sense that we are on the right track to closing the digital divide among older users and to improve their access to the health care of tomorrow.
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