Reflections on Older People in Relation to ICT-AI

Elizabeth Mestheneos

and Ilenia Gheno

NGO 50plus Hellas, Athens, Greece

AGE Platform Europe, Brussels, Belgium

Keywords: Older People, Human-Computer Interaction, Monitoring, Accessibility.

Abstract: The rapidity of innovation in ICT/ AI generates issues on the role of older citizens in understanding, accessing

and using these new technologies. Co-creation, system reliability, ethical issues such as social justice and

inequalities, monitoring and data privacy, freedom and autonomy, safety, security and liberty, and the various

dimensions of accessibility that need to be considered, need to be carefully considered by innovators and

policy makers. Resources are being given to research and practices to support the health and well-being of

older people but to be successful will need to include them.

1 INTRODUCTION

The extraordinarily rapid speed of technical

innovation through the digital revolutions of ICT and

AI in the past decades has left many older people

excluded from or ignorant of these developments.

The implications from the implementation of ICT/AI

innovations are yet unknown.

The digital revolution saw the introduction of the

mobile phone in the 1980s, mobile computers 1981,

the internet and world wide web 1990, Google 1998,

the smart phone in 2007, tablets 2002 and the iPad

2010. The dates indicate the rapidity of changes

impacting on social interaction, business, the state

and the citizen. The 4

Industrial Revolution

currently underway extends well beyond

communication to robotics and AI, nanotechnology,

quantum computing, the Internet of Things,

biotechnology, Blockchain, 3D printing and

autonomous vehicles. The large variations in the ages,

educational level and experiences of older peoples

impacts on their access to and use of digital

technologies. (EC 2018). Inadequate and rapidly

changing data and, for those over 74 years, missing

data, means there is inadequate information on older

people's use and experiences of ICT.

The socio-economic context for the introduction

of ICT/AI includes increasing life expectancy not

matched by an equivalent growth in healthy life

expectancy, continuing urbanization of world

populations, and globalization in commerce,

production and communications. The dimensions of

such changes generate high complexity in

management and for future planning, while

contributing to inequalities in access, knowledge

about and usage of ICT/AI particularly evident

amongst older people.

2 HUMAN – COMPUTER

INTERACTION

2.1 The Critical Importance of

Co-creation

Technological ICT/AI innovations designed to help

older people have all too often not encouraged an

active and reflexive role for older citizens. While EU

funding research programmes increasingly mention

co-creation with users and professionals, this is not

always understood by technical designers and

professionals as providing extra value in innovation.

Assumptions that older people are technophobes arise

from ageist attitudes presuming older peoples'

incapacity to deal with modern life, the lack of public

support for later life learning and the absence of peer

support. Older people may also be ageist but may also

be hesitating in the adoption of technical and ICT

innovations for reasons that arise from their very

different and varied perspectives and life histories.

Mestheneos, E. and Gheno, I.

Reﬂections on Older People in Relation to ICT-AI.

DOI: 10.5220/0008346200070012

In Proceedings of the 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2019), pages 7-12

ISBN: 978-989-758-368-1

2.2 System Usability and Reliability

While smart phones and tablets have simplified ICT

usage, other aspects, in addition to costs, stop older

people using them easily, including a lack of

confidence, a lack of social and technical support in

using them from ICT buddies, and the fear of

breaking them or rapid redundancy.

As organizational systems, both in the public and

private sectors, become increasingly based on ICT,

older people never trained or with no access to the

technology become increasingly excluded. They must

rely on their children or paid help e.g. digital tax

declarations in Greece. So, although services overall

may be more efficient and better, many older people

become marginalised and more dependent on others.

Older people with cognitive problems and cognitive

decline also become increasingly excluded.

What about those who do not wish to use ICT? Do

they get excluded as citizens if they refuse to use the

technology? Technologies which contribute to

infantilizing or disabling the older person rather than

supporting him/her, and those taking away or

supporting a maximum degree of their autonomy are

unhelpful. There is also a kind of risk associated with

misuse: if the user relies very much on technology,

there comes a point when s/he is basically giving up

certain of his/her abilities and skills: laziness is a risk

with physical and mental consequences.

2.3 Justice, Fairness and Inequality

ICT and AI generate new ethical problems for

societies that add to existing moral and value

dilemmas for humans. There has been a large increase

in many EU countries in economic inequalities

(Eurostat 2018) since the 1980s. Many older people

are particularly aware of this, making them more

sensitive to the insecurities faced by younger

generations and local communities. AI and robots are

displacing human workers in many jobs. On line

shopping, for example, kills many local shops and in

some areas, this leads to a reduced sense of

community and jobs available for their families and

neighbours. (Knowles, Hanson 2018) Supermarket

check outs in many countries require the shopper do

the work of checking out their purchases. Banking is

increasingly on line requiring less paid workers in the

community.

Thus, older people are right to point to the uneven

gains that accumulate in the development of new

technologies which leads to their hesitation about

their easy and unproblematic adoption. Growing

economic inequalities, greater job insecurity, tax

avoidance, with their impact on relative wages and

thus social risk, are issues that are being discussed,

though not necessarily acted on, at a very high level.

(World Economic Forum, 2019). We do not know

what the implications are for the future, until now

perhaps risks have affected the more vulnerable, but

AI and ICT will be continuously disruptive for

organizations and jobs. However, they also offer the

possibility that ICT/AI-human interaction will

improve, that ethical issues for citizens concerning

the relationship between AI and humans are

confronted and that citizens become increasing co-

advisors in research and development (Stallcatchers,

2018). Some forms of AI will impact on the care and

support of dependent older people, and this will

require communities of practice which will be in

consultation with older people and their carers.

Ethical issues include what is to be done when people

no longer have good cognitive capacities impacting

on their legal capacities to make decisions. Perhaps

AI will be better at making some kinds of ethical

decisions concerning self-determination than self-

interested, tired and irritable humans? However urban

living, the increasing indication of isolation and

loneliness - perhaps especially though not exclusively

among older people, - suggests that technology, while

able to help in some respects, cannot replace human

care and human contact, and what I believe we all

need – a physical touch and hand to encourage,

reassure, comfort and support us. Even if AI turns out

to be better at diagnosis and some kinds of treatment,

the human support people need when in crisis and

pain cannot be replaced by Facebook, robots, AI and

its likes - though there is a role for these too.

Health technologies for monitoring health conditions

e.g. heart, kidneys, ultrasound, are often developed in

the private sector e.g. Apple Watch, with high costs

for purchase or subscriptions, suggesting that

inequities in accessibility to health care could become

worse for the poorer in the community unless a NHS

underwrites their cost as a way of improving public

health and decreasing acute and long term care costs.

3 MONITORING

3.1 Privacy and the Ownership of Data

Common problems that face us all, including older

people, concern privacy in the use of our data.

Technology to aid older people e.g. Remote

Monitoring, Mobile Health Monitoring, leads to

issues such as who owns the data when collected from

individuals and sent to manufacturers, health and care

services. Reports on AI in the healthcare sector

(Maddox T., Rumsfeld J.S, Philip R., Payne O, 2019)

ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health

suggest that current laws and regulations are nowhere

near sufficient to keep an individual's health status

private in the face of AI development. It will be

feasible for data to be misused and potentially sold on

the open market. In the USA, companies e.g. health

insurance companies, buy anonymous health data, but

their business model is to find a way to attach names

to this data and sell it even if this is unethical.

The EU has attempted to confront some of these

issues via Data protection law and GDPR (General

Data Protection Regulation) which gives some

protection for an individual’s privacy, identity,

reputation, and autonomy, but this does not work with

Big Data analytics and artificial intelligence (AI).

These latter both draw non-intuitive and unverifiable

inferences and predictions about the behaviors,

preferences, and private lives of individuals (Mobile-

Age, 2018). The European Court of Justice has also

made clear that data protection law is not intended to

ensure the accuracy of decisions and decision-making

processes involving personal data, or to make these

processes fully transparent.

3.2 Respect for the Autonomy and

Freedom of the Person

It is difficult for any person to be adequately informed

or to decide on how and to what extent s/he is willing

to work with and provide data via ICT. Do we know

how and in what ways ICTs/AI can and may invade

our privacy and infringe our freedoms? What

safeguards and mechanisms of control over their use

can reasonably be put in place, carefully balancing

security and freedom for each individual? In many

European societies the value of being autonomous i.e.

able to make our own decisions and choices as adults,

is something we believe in and respect. But what

happens when cognitive capacities decline? To what

degree do we encourage autonomy even if this leads

to dangers for the individual with dementia or

Alzheimer type diseases? Thus, there are real dangers

in feeling adequately in control of the technology

being used, knowing when to say no, and not being

abused by those developing the ICT/AI systems.

In a European Horizon2020 project,

MATUROLIFE, in discussion groups led by AGE

Platform Europe, there were a variety of definitions

of the meaning of independence that unsurprisingly

vary by individual, culture and age (MATUROLIFE,

2018). We are all interdependent but there is a danger

that in some areas technologies may make older

people dependent. While the current benefits of AI

and ICT may be unclear, in the longer term a better

use of them may be made. AI, although discussed in

terms of diagnosis, offers possibilities in reducing the

current amount of time spent by doctors and health

professionals in administration and allowing more

face to face time and human contact. However, as

citizens will we have to fight for the time and

resources saved through the use of AI, to be spent in

better “hands on” care of people, especially older

people. Care in the home by home based AI interfaces

e.g. for chronic illnesses, can provide real support for

older people who need monitoring, but also the

capacity to consult and receive reassurance about

their health problems. This offers respect and freedom

to some extent. Yet we are still far from such a system

and integrated care systems are still rare in most

Member States, while many digital technologies are

at the experimental stage or already obsolescent by

the time they are ready for deployment.

Longevity is generally positive if you have

money, reasonable health and social networks. But

what happens when partners die, children do not exist

or are few and far away, when local urban community

social life is limited, when public facilities and

environments are unpleasant or dangerous or not

designed to include older people who may be frail. AI

and ICT cannot overcome existing socio-economic

problems but should also not exacerbate them.

3.3 Safety, Security and Liberty

Can ICT and AI systems help overcome some

problems that in particular older people face, in a safe

and secure manner that does not deprive people of

their liberty? The care of older people with diseases

like Alzheimer is already problematic: how far should

one supervise and monitor people who have

significant cognitive problems? AI should be able to

assist people in making their desired decisions e.g. to

go to the local shop, buy the product they want, and

get home and European innovative projects such as

the Horizon2020 Frailsafe project attempt such

support. All ICT and AI systems are based on

programmes and hackers and malicious people can

corrupt these. We already have a lot of experience of

the misuse of various ICT technologies: cheats, liars,

the mischievous and the greedy have always been

with us e.g. false news, scams, identity theft. Trying

to make systems safe and ensure that people are not

cheated and abused in the use of ICT/AI will be a

constant battle.

AI relies on its decision making mimicking the

human brain and it learns from large sets of data

resulting in algorithms. Known as a “black box”, we

can see what goes in it and what comes out, but not

how the outcome was arrived at. (European

Consumer Consultative Group, 2018). Currently we

are very aware that humans make decisions based

Reﬂections on Older People in Relation to ICT-AI

often on prejudice and assumptions – prejudice and

widespread ageism in many of our countries results in

all kinds of inequalities from treatment protocols to

banking loans and insurance. We manoeuvre these

with difficulty but what will happen when AI makes

the decisions and are even less transparent. In this

sense AI generates new problems of freedom, the

capacity to understand how decisions are reached and

the liberty to appeal against them. By and large,

lawmakers haven’t decided what rights citizens

should have when it comes to transparency in

algorithmic decision-making. Our language adopted

the term Kafkaesque to mean situations where

individuals are threatened by remote and inaccessible

bureaucrats and rightfully, we fear non transparent

bureaucracy with power over our lives. AI needs to be

built to provide "recourse," or the ability for people to

feasibly modify the outcome of an algorithmic

decision.

Nonetheless we will continue to use and develop

AI that will almost certainly be valuable in dealing

with social and health problems: AI does not get tired,

sick, fed up nor does it forget: thus, it can act 24 hours

a day to support humans, professionals and patients,

with information and data. ICT systems as they

currently operate appear to create an extra burden of

administration for health and care professionals but

within a reasonable period of time AI will become

intelligent assistants supporting effective

administration keeping records and saving time and

effort. I doubt that anyone believes that AI should

work alone in interacting with individuals with social

and health needs. How to integrate and use AI for the

benefit of all is very much under discussion. It is

likely that Al within the next 10 years will

revolutionise support to older people e.g. facilitating

their empowerment, community inclusion, personal

care e.g. in bathing and toileting, or just general

support. All these are forms of work which can relieve

professional and informal carers and even help avoid

abuse.

A major point that will have to be made clearer

for individuals, especially if they are cognitively

confused, is whether they are talking to a person or a

technology, a machine.

4 ACCESSIBILITY

Something can only be accessible if you are aware of

it's existence and potential. Here we need a lot more

education and intergenerational support and

exchange. It will be valuable if everyone is aware of

the questions, opportunities and risks associated in

the use of technology. It also needs to be available e.g.

physically throughout the country in rural as well as

urban areas. 5G apparently has a huge capacity to

help access to AI and ICT technologies and

programmes. The EU appears to be keen on free

access to the internet to ensure non exclusion on that

basis (European Commission, 2018). This will help

with something already mentioned – affordability.

4.1 Inclusive Design

One major difficulty is that introducing adaptations to

houses to make them accessible for all with

disabilities, whether these are physical adaptations, or

digitally smart and inclusive, costs money. Overall

older people are least likely to live in modern homes,

occupying older housing stock, are more likely to live

in rural areas, few have smart infrastructures and,

importantly, they are least likely to be able to afford

or be willing to install adaptations. Those with the

most need for support e.g. older, frail women and

those with multiple chronic health conditions, are

often the least technically aware, and also have less

disposable income. In many countries older people

struggle with the cost of a tablet or smart phone and

the subscription to the internet. Thus, there are doubts

about the private purchasing of AI e.g. IoT, wearable

technologies. They seem cost viable but will need to

be linked to a paid for broadband system. The efforts

by the EU to make broadband accessible to all is a big

step forward.

Sensors are increasingly being used via smart

phones, web cameras, tablets, and smart clothes to

monitor motion in homes and in the community, thus

providing useful interlinks with family carers and

some professional health and care services. The cost

of sensors is relatively low but the problem of

ensuring they are non-intrusive and their data remains

under privacy controls remains.

Considerable work at EU level is undertaken to

ensure that web contents are accessible and that

interfaces can be personalised for users. Standards

exist in the industry with accessibility issues

addressed via a Legal framework (eAccessibility +

European Accessibility Act). All ICT and AI products

and services will have to ensure they are accessible as

well as secure with reference to protection of an

individual's data.

4.2 Transport Accessibility

This sector is under rapid development both for

public and private transport and is based on AI

holding out potentially important help for the

autonomy of older people who, if unable to drive, will

nonetheless be able to move around not just in cities

ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health

but in rural areas where currently public transport is

often uneconomic to provide.

4.3 Service Accessibility

On line shopping for the digitally able who are

physically compromised will certainly help many

older people but will represent a threat, already

mentioned, to local services and communities. Older

people tend to be more attached to their localities and

marrying ICT and AI developments to local

communities will need to be observed and

considered. Digital literacy is key in this.

5 DISCUSSION

Behind all developments in ICT and AI must be clear

human values to ensure the most vulnerable

individuals, including older people needing

assistance, are helped in retaining their functional and

moral autonomy as long as possible. We need to

prevent situations of vulnerability and avoid the

isolation of the sick and vulnerable. Exercising the

rights of older citizens requires that they obtain valid

and understandable information enabling them to

support their autonomy and decision-making

capacity. There need to be established control

mechanisms that prevent family members,

professionals, directors of centres and services or

others from making decisions that should be made by

the elderly person. Finally, it is evident that we all

need to have continuous training and support whether

as end users, which may involve providing basic

health and digital literacy, or as developers and

healthcare professionals.

In AGE Platform Europe we argue for all

Member states and the EU to disaggregate statistics

to better understand the situation of older persons –

rich and poor, rural and urban, healthy or unhealthy,

dependent or independent. Older people are very

varied in what makes their people’s lives worth living,

dignified and fulfilling and this must be under

constant review.

New developments will change and possibly help

many older people e.g. exoskeleton help in walking,

ordinary glasses with a camera and data recognition,

as used by pilots, which will enable the wearer to see

someone's name and any essential data. The health

linked watch to warn individuals of any untoward

events and stimulate physical activity and correct diet

is already with us but not yet linked to our health

systems. But each innovation has potential and not

necessarily desirable consequence e.g.the

medicalisation of everything through mobile apps.

We need to be cautious about expertise and

knowledge and what we measure e.g. changing

opinions and fashions over diet, cholesterol. This is

an exciting time to live in but the inclusion of older

people in debates on ICT-AI innovations can help in

the essential reflexive process.

ACKNOWLEDGEMENTS

Thanks are given to the many AGE Platform Europe

members who contributed as individuals and

organizations to reflections on ICT and AI in many

and varied programmes concerned with standards,

ethics, accessibility and all the many other social

questions that arise from trying to ensure that older

people best use and benefit for ICT and AI. Thanks

are also conveyed to the Secretariat at AGE Platform

Europe for its support and inputs on older people’s

views and perceptions in the field.

REFERENCES

ANEC, BEUC, Cybersecurity for connected products, draft

position paper, March 2018: http://www.anec.eu/im-

ages/Publications/position-papers/Digital/ANEC-DIG-

ITAL-2018-G-001final.pdf

European Economic and Social Committee, Artificial intel-

ligence – The consequences of artificial intelligence on

the (digital) single market, production, consumption,

employment and society (own-initiative opinion), 2016

European Economic and Social Committee, Artificial Intel-

ligence: Europe needs to take a human-in-command ap-

proach, Press Release, 30 May 2017

European Commission, High-Level Expert Group on Arti-

ficial Intelligence, Draft Ethics Guidelines for Trust-

worthy Guidelines, 18 December 2018

European Commission (2018) WiFi4EU, Free Wi-Fi for

Europeans, https://ec.europa.eu/digital-single-mar-

ket/en/policies/wifi4eu-free-wi-fi-europeans

European Commission (2018), 169 million Europeans be-

tween 16 and 74 years (44% ) do not have basic digital

skills. No data for 74 years and over. https://ec.eu-

ropa.eu/epale/en/content/nearly-half-europeans-dont-

have-basic-digital-skills

European Consumer Consultative Group, Policy recom-

mendations for a safe and secure use of artificial intel-

ligence, automated decision-making, robotics and con-

nected devices in a modern consumer world, Opinion,

16 May 2018.

European Parliament, Policy Department C: Citizens’

Rights and Constitutional Affairs, European civil law

rules in robotics, October 2016, http://www.euro-

parl.europa.eu/committees/fr/supporting-analyses-

search.html

Reﬂections on Older People in Relation to ICT-AI

Eurostat (2018), Income inequalities in Member States

https://ec.europa.eu/eurostat/web/products-eurostat-

news/-/EDN-20180426-1

FrailSafe, H2020 project: https://frailsafe-project.eu

Informatics Europe and ACM, When Computers Decide:

European Recommendations on Machine-Learned Au-

tomated Decision Making, 2018, http://www.informat-

ics-europe.org/news/435-ethics_adm.html

Joint Research Centre, Artificial Intelligence. A European

Perspective, Luxemburg 2018. ISBN 978-92-79-

97217-1 ISSN 1831-9424 doi:10.2760/11251,

https://ec.europa.eu/jrc/en/publication/eur-scientific-

and-technical-research-reports/artificial-intelligence-

european-perspective

Knowles B. , Hanson V.L. (2018) Lancaster University.

file:///Users/macbook/Documents/The%20Wis-

dom%20of%20Older%20Technology%20(Non)Us-

ers%20%7C%20March%202018%20%7C%20Com-

munications%20of%20the%20ACM.html, http://

filipposantoni.net/2018/03/09/meaningful-human-con-

trol-over-autonomous-systems-is-out/ - Responsible In-

novation”

Maddox T., Rumsfeld J.S, Philip R., Payne O., Questions

for artificial intelligence in health care, January 1/8,

2019, JAMA. 2019;321(1):31-32. doi:10.1001/jama.

2018.18932, https://jamanetwork.com/journals/jama/

article-abstract/ 2718456?resultClick=1

MATUROLIFE, H2020 Project, Deliverable 3.4 Co-crea-

tion / Ideation workshop for products and service ideas,

October 2018. www.maturolife.eu

Matsakis L. (2018) What does a fair algorithm look like?

https://www.wired.com/story/what-does-a-fair-algo-

rithm-look-like/

Mobile-Age, H2020 project, Policy Brief: Privacy implica-

tions of technologies to address social isolation

amongst older people: https://www.mobile-age.eu/pro-

ject-outcomes/policy-briefs.html

PROGRESSIVE, H2020 project, D2.1 Ethical Framework

for Standards in the Context of ICT for AHA.

https://progressivestandards.org/ethical-framework/

Stallcatchers (2018) https://stallcatchers.com/main

United Nations, Report of the Independent Expert on the

enjoyment of all human rights by older persons,

A/HRC/36/48, 21 July 2017

World Economic Forum (2019) How to manage AI's risks

and rewards, https://www.weforum.org/agenda/2018/

01/how-to-manage-ais-risks-and-benefits

ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health