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The Encyclopedia of Elder Care  by Mathy D. Mezey, Barbara J. Berkman, Christopher, M. Callahan, Ethel L. Mitty (Prometheus Books) Elder care has become a growing concern for many families, communities, health professionals, and the many establishments that provide living arrangements for the elderly. To work in elder care, as a professional caregiver or a family care provider, requires a command of current information from multiple disciples, including nursing, medicine, social work, counseling, as well as dentistry and physical therapy. Now, for the first time, this information has been gathered in a single source.

THE ENCYCLOPEDIA OF ELDER CARE features nearly three hundred articles providing practical information on how to care for elders. Written by more than three hundred experts, this accessible state-of-the-art resource addresses home care, including family-based care; nursing-home care; rehabilitation; case management; social services; assisted living; palliative care; and more.

Each article concludes with references to pertinent Web sites. Easy to read and extensively cross-referenced, this comprehensive resource on geriatric and social care will be an indispensable tool for all who care for our nation's elders.

Technology for Adaptive Aging by Richard W. Pew, Susan B. Van Hemel (National Academy Press) Emerging and currently available technologies offer great promise for helping older adults, even those without serious disabilities, to live healthy, comfortable, and productive lives. For this promise to be fulfilled, what technologies offer the most potential benefit, what challenges must be overcome, and what problems must be solved? How can federal agencies like the National Institute on Aging best use their resources to support the translation from laboratory findings to useful, marketable products and services?

Technology for Adaptive Aging is the product of a workshop that brought together distinguished experts in aging research and in technology to discuss applications of technology to communication, education and learning, employment, health, living environments, and transportation for older adults. It includes all of the workshop papers and the report of the committee that organized the workshop. The committee report synthesizes and evaluates the points made in the workshop papers and recommends priorities for federal support of translational research in technology for older adults.

The Workshop on Technology for Adaptive Aging was designed to identify high-payoff areas in the development of technological devices that assist people who are aging normally, as well as those with disabilities and impairments. From the many candidate domains identified as important in the daily life of older adults, the steering committee focused on six: communication, employment, health, learning, living environments, and transportation. This volume consists of commentary by the steering committee on the workshop topics together with the complete set of papers presented.

Excerpt: The life-span effects of aging include changes in sensory, perceptual, and motor performance and in cognitive functioning and the ability to operate in the world. While much is known about changes that can be measured in tightly controlled laboratory tasks and environments, less is known about the implications of these changes for everyday tasks and activities under natural conditions. The steering committee recommends National Institute on Aging support of research designed to develop such knowledge, to support design of technologies that will be useful and usable for older adults.

There is a need to develop research designs and measurement and analysis techniques to enable more naturalistic studies of proposed and emerging technologies for older adults. In particular, longitudinal studies

are needed to learn about how use and acceptance of technologies evolves over time. The steering committee recommends support of such methodological work by the National Institute on Aging.

TECHNOLOGY IN DAILY LIFE

Many factors could potentially affect the acceptance and success of any new technology for older adults. The steering committee developed a list of such factors for consideration when applicable in each of the selected domains: access, cohorts, culture and language, customization, expectations, legal constraints, stereotyping, privacy, safety, training, trust, usability, and control, autonomy, and dignity.

Communication Exciting possibilities exist for new technologies to support older adults and their caretakers and to enable the maintenance of social contacts for those whose mobility is reduced. Technology developers must understand the special communication needs and the cognitive, affective, and sensory characteristics of older people and take these into account in developing technology for this population. Three major barriers impede communication with and for older adults: overaccommodation to aging, word retrieval, and multitasking; each has implications for the design of communication technology for older adults. Specific technologies of interest include "mobile communication and computing devices" or MCCDs, which can combine features currently available in mobile telephones, personal digital assistants, and more. The challenges involved in designing MCCDs to be acceptable to and usable by aging users include usability, the need for adaptive interfaces, and privacy concerns. Development of successful technology solutions will require cooperative work by technologists and behavioral and social scientists.

Employment Recent and predicted future changes in career and retirement patterns in American society and in the age-related demographics of the U.S. population have implications for the development of technological innovations. The size of the older population will increase rapidly as the baby boomers age, with a concomitant reduction in the proportion of younger adults. The research literature documents age-related changes in abilities and work performance, as well as in occupational trends. Technology has specific effects on work and especially on older workers, with significant differences in cohort responses to new technology. Technology can help older workers remain employed and maintain or upgrade their skills, as well as support the transition to retirement, through adaptive interfaces and other means of supporting computer input and output, software to provide planning and cueing assistance, and health monitoring devices. Research is needed on behavioral,social, and technological issues relating to older workers, particularly given the many influences that are converging to require society to develop new responses to the employment and retirement issues of these workers.

Health Systems have been developed for monitoring the health of older adults in their homes and for enabling independent living for as long as possible. Changing views of healthcare see it less as a way to respond to disease than as an attitude of "How can we help you live your life well?" A transition in healthcare delivery systems is taking place, from today's clinic-centered model to a community-centered model, with the maintenance of good health as a primary goal. There is a large literature on aging and health that describes the changes in health status that commonly accompany aging. One important development is that of "tele-health" systems, which can be embedded in a person's living environment. Useful technologies include wireless broadband, microelectronic mechanical systems, lab-on-a-chip devices, and activity sensors. It is essential to develop the software needed to transform the huge amounts of data generated by these systems into information useful to healthcare workers, caregivers, and clients. New technology must be developed in ways that avoid information overload, provide useful outputs, and respond to ethical, acceptability, and liability concerns, especially those related to privacy.

Learning occurs in different learning settings, and there is a large literature on the learning characteristics of older adults, particularly in the context of on-line learning and information retrieval situations. How developers present on-line instruction has implications for older learners, and how older adults currently use technology has implications for their technology-related learning needs. Developers need to ensure that learning technologies for older adults take account of the learners' changing abilities and preferences, as well as of individual differences that increase

with age.

Living Environments Functional changes in their abilities often motivate older people to choose environments in which more assistance is available. As in the health domain, in-home monitoring and assistive technologies to support independent living are of great interest. Specific technologies include cognitive orthotics, such as various types of reminder systems, to support the independence of those with memory impairment or other cognitive deficits, and systems to monitor biological and other activity, which raise both privacy and data reduction issues. Social communication aids include regularly updated profiles of the older adult's status on various monitored variables, which are represented visually in

the caregiver's environment. The challenges to developing successful technology in this area include cost, ease of use, reliability, and privacy.

Transportation The automobile is not the only transportation mode available to older adults, but because it is so important to most people in America, the steering committee concentrated on issues involving personal automobiles, older drivers, and their driving safety. The special characteristics and needs of older drivers include behavioral, cognitive, and sensory changes that can affect their behavior and their ability to use technology effectively. Adaptive technologies include vehicle control de-vices, like adaptive cruise control, rear-view cameras, and backup proximity warnings; driving assistance devices, such as navigation and traffic information systems; and "infotainment" and comfort devices, including entertainment, Internet access, and communications systems. Technology developed for use in the automobile should be designed to be appropriate to the needs of older drivers. The issues include physical, visual, auditory, and cognitive design, as well as design of the driving environment; examples abound of unintended bad outcomes of well-intentioned but poorly designed and tested technology. Driver training could be required to ensure that new technologies are used properly and return the in-tended benefits. The steering committee emphasizes the call for user-centered design.

LESSONS FROM THE WORKSHOP

Although a goal of the workshop was to list technologies that are ready for transition to commercialization, what actually transpired was the identification of opportunities and the need for further focused multi-disciplinary collaboration among three groups: (1) specialists in the disciplines related to aging, (2) specialists in user-centered design, and (3) technologists who wish to foster product development for the market' provided by the growing population of older adults.

Rather than letting the initiative of individual investigators define the research agenda and market forces alone drive the development of product requirements, research and development should be driven by in-depth analysis and understanding of the needs, capacities, and limitations of the aging population across all six domains. In the field of human factors engineering or user-centered design, there are well-developed methodologies that support consideration of the user throughout the product development process. When applied to the development of technological support for older adults, these methods include systematic observation of older adults' behavior in their working, living, and recreational environments to establish their requirements and the constraints on potential products. The methods include the interactive development and quantitative evaluation of prototype products and services during the formative stages of development. They include systems analysis studies of the larger context in which products will be introduced to look for cost-effective gains and unintended consequences.

The National Institute on Aging is well positioned to support studies that bring about this multidisciplinary focus and that apply the kinds of methodologies that will ensure development of technologies truly useful to the aging population. Projects could be specifically targeted for collaboration between major U.S. corporations interested in tapping into the market created by the aging population and specialists interested in developmental aspects of aging.

This multidisciplinary focus should also be brought to the education and training world. University faculty and graduate students from laboratories for aging could be supported for sabbaticals, summer positions, and internships in industrial settings. Reciprocally, specialists from industry could be sponsored for leaves to interact in university laboratories.

Finally, there is an urgent need to hasten the development of infra-structure to support the kinds of technology of interest to the older population. This is especially true for communications technology. Many of the developments for support of the elderly at home require high-bandwidth communication access and wireless networking in the home. While these developments are widely forecast, they will be slower to be achieved, especially at a cost that the older adults can afford.

It was clear throughout the workshop that technological opportunities abound and that it is the responsibility of the kinds of specialists who attended to ensure that the most valuable, accessible, cost-effective, and user-centered alternatives are developed. The welfare and happiness of future cohorts of the population depend on it.

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