“Who Doesn’t Think about Technology When Designing Urban Environments for Older People?” A Case Study Approach to a Proposed Extension of the WHO’s Age-Friendly Cities Model
2. Technology That Serves Ageing Populations
3. Essential Features of Age-Friendly Cities by the World Health Organization
4. Smart Cities and Towns
5. A Case Study of Milton Keynes—an Age-Friendly Urban Planning Perspective
6. Scenarios for the Integration of Technology
Doris is a 93-year-old lady who moved from Yorkshire 80 years ago with her parents. She lives independently in her council house which she used to share with her husband. However, Stan died 25 years ago; she has five children, seven grandchildren and four grandchildren. Some of her grandchildren and great grandchildren live abroad, however, the majority of her family still live close by. Each week, two of her children pick her up and take her out for the day, either to do the grocery shopping, for lunch, or a day trip. Doris is partially sighted, and relies on her children to help her, although she can still cook her dinner and lunch, she does have trouble walking outside on her own, and needs assistance.
Her children would like to ensure her safety when they are not with her and are wondering what type of technology they could use. They are not really tech savvy, but several of her grandchildren use a smartphone and have social media platforms. Doris also welcomes the concept of having her children/grandchildren keeping an eye on her for safety. Although she has stated she does not want cameras up and around the house, because she does not want to feel as though she is been watched or spied on.
Ralph is a widower, who has a dependent child (multiple learning disabilities), called Jona, and they live in a village on the outskirts of Milton Keynes. Ralph moved to this area 20 years ago; he has a brother (Johan—49-years old), his sister-in-law (Eva—44 years old) and their two children, Jacob (14-years old) and Sabine (12-years old) who live in Edinburgh.
Ralph works as a freelance IT consultant and realizes that he is the primary carer for Jona, who attends a special education school which provides him with an enriched programme of education. Both Ralph and Jona, play digital games together, they enjoy streaming movies and TV programmes from online platforms. Ralph is part of several community networks, that offer him support; he still misses companionship and adult conversation, but he tries to attend community meetings and events as often as possible, while he is able to keep up to date with their online Facebook groups.
To date, Ralph is in good health, however, this could change very suddenly (such as having a heart attack or a stroke) and although he leads an active lifestyle which is important to him, he is still acutely aware that life could change very quickly. As a family, Ralph and Jona enjoy going to the swimming pool every week and cycling on the redways. They eat healthy and Ralph does not smoke or drink. Whilst family history on Ralph’s side does not show any history of strokes or heart attacks, etc., Ralph still wants to ensure Jona is able to live independently as best he can and for himself to positively age-in-place. He thinks technology could be beneficial within their home, offering both of them different opportunities to become independent and him complementary support as an older carer.
Fred and Mavis have been married for 40 years and have recently moved into Bow Brickhill, after spending most of their lives in London. Mavis recently retired 18 months ago after experiencing a couple of transient ischemic attacks (TIA). Health practitioners have recently informed Mavis and Fred that there are signs of early dementia. Fred has decided to retire earlier than he anticipated; although neither of them are legible to receive their UK state pension, they both have savings and Mavis has her private pension. They do not have any children.
Both Mavis and Fred have discussed this situation and they want to explore what kind of assistive technologies are available which could offer support to each other. They have a niece, Racheal, who lives 30 min (approximately) away and she has offered to help them whenever she can. They are surrounded by nice neighbours who have offered to help them with anything they need (such as shopping, gardening, health checkups, and socializing). While Mavis’s condition has not deteriorated too much, the future is very uncertain, and they still enjoy socializing with friends through the Church.
Stuart and Lucie live in a 2-bedroom city apartment in a European city. They have Bella who is two years old. Currently, Lucie works part-time as a teaching assistant at a bi-lingo primary school. Stuart works for a large international car company as a shop floor manager. They are both tech savvy; they use Facebook and Instagram as a means of communication with their friends and family back in Ireland.
They enjoy meeting up with their friends and work colleagues on the weekend and public holidays in the parks and at each other’s houses. They want to explore the possibility of making their apartment more home automated. They would like to grow their family in the future and may also consider moving to a district outside of the inner city to experience more of the green space. They both use smartphones and Lucie’s cousin, Finbar, has recently installed a virtual assistant into his house, which his wife Alisheen and their three children thoroughly enjoy interacting with. Lucie thinks this could be useful for her and Stuart but wants to know more information before they decide to install these devices throughout the apartment. Stuart is keen to learn how their home could become ‘smarter’ and in the future, he is keen to build his own home, which would offer them greater opportunities to implement existing and future smart devices and sensors.
A community centre located in a large European city provides assistance, advice and information to many immigrants and refugees. There are only a couple of permanent members of staff, while other members of the staffing team volunteer their services for free. Whilst there are individuals who can translate for those individuals who need it, and others have a basic understanding of English, conversation and ensuring correct information is passed on is a problem.
For many who visit the centre, the language difficulties include reading street signs, government information, instructions and information surrounding health and education. There are pamphlets that provide information written in a myriad of different languages; staff and visitors are wondering whether there is anything more that can be done to offer visitors easier access to information while they are still learning a new language?
Across the Milton Keynes area, there is a large homeless and vulnerable community. Whilst there are several local organisations that assist the community in providing warm meals, overnight accommodation, drug and alcohol support services, in addition to information relating to housing, finding long-term accommodation and employment. Each person has their own story and using organisations such as the ‘Winter Night Shelter’  or the YMCA  can assist individuals who have ended up in a particular circumstance. How can technology assist members of the homeless community and the respective organisations?
7. High-Tech the Solution for Challenges in Urban Ageing
8. Marrying Technology with Regular 21st Century Society
Although Doris noted to her family that she did not want cameras surrounding the inside or outside of her house, one of her children showed her some technology that they have installed in their home. After reviewing the images via her children’s smartphone, Doris has agreed to cameras being integrated by her doorbell and throughout her house. Similar to the Figure 15 and Figure 16, Doris’s children will be able to view visitors and monitor their mother. Two of her children have access to the app via their smartphone, and although Doris thinks technology is great, she feels she is too old to learn how to use a smartphone.
When entering old age, carrying heavy vacuums can be difficult, and dangerous if one is vacuuming the staircase. Therefore, having a networked vacuum (Roomba) connected within the home environment can ‘learn’ the floor plans and via the smartphone the user can instruct the vacuum to clean the specific room or floor. With this type of ‘robot’, it can also empty itself, which can be convenient if you are vacuuming daily or have problems bending down, carrying heavy objects. In Figure 16, a camera has been placed on the outside of the house which enables the residents, whether they are inside or out at work, on holiday, etc., to view who is at their door.
Doris has never enjoyed being too hot in the house and always ensures the windows are open during the summer months, especially on an evening to let some cool air through. Connecting a temperature monitor to your smart home is a great way to monitor whether one’s bedroom is too hot or cold.
Although we have the camera sensor technology available, the take-up and integration are low. This type of feature is not part of housing developments and, thus, future housing developments should consider implementing it either at an additional cost at the owner’s choice/decision or as a standard part of the building development. Therefore, future homeowners would have this type of technology already existing and it would be up to the owner whether they choose to activate it or not. However, for some owners they may be concerned about privacy issues, data storage, etc. But the future development of housing developments needs to explore the integration of IoTs at the time of building and not as an afterthought and left to the owner.
For some owners who are tech savvy, they may wish to adapt the specification of the integrated IoT devices and sensor’s, and future homeowners need to be able to do this, if homes are to be viewed as a space for positive age-in-place. This also relates to internal door frames and staircases. Architects, planners and builders need to ensure that internal door frames and staircases can offer homeowners the option of wheelchair access and lifts. It does not matter whether this is for an older person, a person with disabilities or a child, such access and movement around the home is critical for successful age-in-place.
Technology use and integration in this scenario is exponential, based on the learning, and motivation needs of the child. In this scenario, both Ralph and Jona enjoy playing games together and Ralph is a tech savvy adult. Jona has been born into a world where technology is perceived to be the norm and part of everyday life. Using reminders via a virtual assistant (i.e., calendar/reminder function, smart home connection) may offer young adults and carers the opportunity to maintain a sense of routine in their home environment. Whilst Jona may have multiple learning disabilities, he is capable of using technology and setting up different technological devices. Given that he is an older parent, and a potential carer, technology has great promise for Ralph. Although we have not explored physical disabilities and associated needs and requirements, those with varying and complex needs based upon one’s disability may also welcome greater integration of technology into their home. This could especially be the case for those who have problems conducting daily tasks (for instance, opening the curtains).
Because Ralph is hoping that Jona learns to become independent, this may take time, and one of the key concerns when children are growing up is giving them their own set of keys for the house/apartment. Having the function to lock or unlock one’s apartment remotely could offer Ralph reassurance that Jona is learning to remember to lock the door when he leaves for school. If Jona forgets, then a notification will inform Ralph that he has left the home, but the door was not locked, alternatively, another notification will inform Ralph that Jona has locked the door.
Connecting and networking the lights throughout the home is very convenient for everyone across the life span, Especially, if you forget to turn them off if you are abroad or out shopping. In the case of Fred and Mavis, getting in/out of bed could become problematic, while for safety reasons, going to the bathroom during the night, or arriving home at the front door during the winter months. Being able to switch both inside/outside lighting on or off is a positive way to ensure the safety of yourself and others.
Being able to unlock and lock the doors and the garage is an extra safety feature which in the case of Fred and Mavis may become integral, especially if Mavis’s health deteriorates over the coming years. Having this function via a smartphone app enables the person who is pulling up to the driveway in a car to unlock the garage and front door to the house, before getting out of the house.
Fred has always been interested in his cars, and he would be interested in having the option to connect his car to his smartphone. He recently bought himself a Škoda—Karoq and whereas previously he inserted the key into the door to open it and get in, he now just holds the key fob close to the door which it then unlocks. Fred is potentially interested in having his car networked which would offer him the ability to lock, unlock or remote start.
A family comprising of a young child and one on the way may decide to incorporate as many sensors and devices as possible into their home and connect their vehicles if possible. In such an environment, the parents may choose to network and connect security cameras into their children’s bedrooms and garage. This approach could be used to monitor a baby, similar to using a portable baby monitor and if you have been burgled previously or you may suspect a stranger is using items in your garage this installation could be very practical. Similar to Doris in Scenario 1, using the Roomba vacuum would offer the family a greater ease of cleaning within the home environment, especially when there could be a lot of mess from children playing, or in the later stages of pregnancy.
Similar to Fred and Mavis who may find having lockable doors and garages as one pulls up to the driveway a convenient feature, this feature also offers Stuart and Lucie a greater sense of ease when taking the children to and from the car into the house. When carrying children, a baby changing bag and groceries, etc., reaching for one’s keys can be difficult. Therefore, accessing the system via the pre-program network is vital to ensure safety, ease of access and organisation.
Bella, the little girl, loves to be wrapped up in her duvet on an evening, whether it is the summer or the winter. Through searching the concept of smart home automation on the internet, Lucie has found out that there is a temperature monitor that can be networked into the home (Figure 17a,b). She thinks this would be a great way to monitor the temperature of the nursery when their baby is born. Also, Lucie does not like to be too warm, and although she changes the winter duvet from the summer duvet now that she is pregnant again, she knows she will become very hot.
For immigrants and refugees living in a strange city, urban or rural environment, who are unfamiliar with the language, both spoken and written and possibly different pronunciations and tones, one solution is to offer street signs in multiple languages (written) as illustrated in Figure 18. If we think about future decades, and the embedding of technology into an age-friendly environment, could it be possible for citizens to listen, hear and learn how to pronounce the street sign(s) in their mother tongue language as well as in the language of that specific country? As displayed in Figure 18, there are several languages displayed on each of the street signs, and given the rapid developments of technology to date, there could be a mobile app(s), sensors, holograms available to citizens to select at that moment in time or store for later to listen to the specific information.
Moving to a new country can be difficult on various levels ranging from emotional upheaval, to physical and mental trauma, depending on the reason for moving or displacement. This too can be a steep learning curve, without having to worry about speaking in another language on specific topics such as bureaucracy and paying of bills. For some immigrants, the use and ability of networking the heating/air-conditioning to one’s smartphone may offer them assurances, while they may also choose to start learning a new language even if it is every day words such as please, thank you, can you help me, I am lost, etc.
The homeless community have the right to access technology and with assistance through outreach workers, citizens of this community could have the opportunity to discuss and put forward the needs of this community. Within a city or urban environment, citizens in this community would most likely prefer to access charging points (for free) and have free Wi-Fi access. As Marston and Samuels note , the consortium partners in the respective project  are aiming to identify suitable methods to support outreach workers and citizens of the homeless community. Accessing public space for Wi-Fi is important for this displaced community to gain information (for instance, health related information), in conjunction with traditional forms of information via leaflets, to ensure health and service information is provided. For some members of this community, owning a smart/mobile could be advantageous and cause more issues and concerns (i.e., theft, mugging/violence, charging the battery). Therefore, exploring the needs, expectations, behavior and impact of mobile phone use and any other associated technologies by citizens within the homeless community in conjunction with the outreach workers is important to ensure full understanding and implementation is met.
Scenarios #5 and #6 offer readers an insight into how technology can be implemented into a smart age-friendly ecosystem for displaced residents who are intersecting between old age and immigration; homeless people are also benefiting from this type of improvement. Within the current age-friendly documentation, there is little discussion focusing on displaced communities and the role(s) in which these respective communities can benefit from existing age-friendly initiatives.
Whilst we aim to start the discussion and provide an insight into several technological solutions for our six scenarios, we also believe as part of this new age-friendly framework that policy makers and grass root networks should also be involved in the development phases of consultation.
9. Proposed New Age-Friendly Framework
- Changing the inner circle from ‘The age-friendly city’ to ‘The age-friendly living environment’ relates to the actual living space (i.e., house, apartment etc.) of a person or families. This has not yet been captured; in the existing and future climate, the ‘living space’ is important. This can include assistive devices, smart automation, intergenerational relationships, health and wellbeing.
- The ‘age-friendly physical space’ sphere relates to the physical environment—the urban development and the design of villages, towns and cities which are associated with age-friendly living, not only for contemporary ageing populations but for younger generations too.
- The ‘Technology and associated ICTs’ sphere relates to all types of devices, software, and usability intersecting and connecting between the central, inner and outer hubs.
10. Conclusions and Recommendations
- A multi-faceted theoretical underpinning should be adopted and integrated to ensure that all residential and physical spaces are age friendly. This underpinning may require non-tech, low-tech and high-tech solutions.
- Future consultations should include citizens and actors from all sectors of society, including citizens who are not involved in community or grass root networks (for instance, non-ICT users), and citizens from the homeless communities including outreach workers. Citizens who are childless can offer a different insight into how a smart age-friendly ecosystem framework may work for them.
- Children and young people need to have their voices heard, as this is key for sustainability in their living environment(s). It is seldom that we hear the narratives of young people and for future framework integration, these voices have to be incorporated.
- Consultations and data collections could take a longitudinal perspective of 3–5 years, varying across different countries and continents. This in turn would ensure there are updates and information to build upon and to contribute to a working digital age-friendly eco-system framework.
- Multi-inter and trans-disciplinary approaches and disciplines need to be involved in future strategies and developments associated with the age-friendly movement, bringing together scholars who may not have been considered previously.
- To ensure all forms of sustainability are integrated into a smart age-friendly ecosystem framework [120,121,122,123], this can be considered by providing a multi-faceted approach to volunteering, committees, local government/municipality involvement, scholars, community champions and stakeholders, as well as environmental sustainability. Sustainability and growth are key for the continuation of the age-friendly initiatives and more so, given the projected ageing statistics.
- In the case of Milton Keynes, this city is still growing with new housing developments, schools and shops. It seems that nearly two decades after Edwards  and Potter  reflected and highlighted the issues surrounding the infrastructure and planning of the city, lessons have not been learned. It is beyond the scope of this paper, but future work should review the developments of Milton Keynes and conduct an evaluation of infrastructure, public services including health surgeries, transport, leisure activities, and educational facilities. Given the increased residential development, this type of evaluation could be welcomed to ascertain existing barriers and to identify areas for improvement.
- Building from recommendation 7, future work should take extensive ethnographic and qualitative data collection approaches, following a similar approach to Siren and Grønborg Knudsen  who investigated the use of and attitudes of technology and the digital delivery of public services. Siren and Grønborg Knudsen found that old age per se is not likely to cause digital disengagement. Instead, the use or non-use of technology is the likely reason associated with socio-economic and demographic factors that affect the overall general consumption patterns .
Conflicts of Interest
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|Domain||Age-Friendly Cities Essential Features Related to Technology|
|Outdoor spaces and buildings|
|Social participation||• Good information about activities and events is provided, including details about accessibility of facilities and transportation options for older people.|
|Respect and social inclusion||• None|
|Civic participation and employment||• None|
|Communication and information|
|Community and health services|
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Marston, H.R.; van Hoof, J. “Who Doesn’t Think about Technology When Designing Urban Environments for Older People?” A Case Study Approach to a Proposed Extension of the WHO’s Age-Friendly Cities Model. Int. J. Environ. Res. Public Health 2019, 16, 3525. https://doi.org/10.3390/ijerph16193525
Marston HR, van Hoof J. “Who Doesn’t Think about Technology When Designing Urban Environments for Older People?” A Case Study Approach to a Proposed Extension of the WHO’s Age-Friendly Cities Model. International Journal of Environmental Research and Public Health. 2019; 16(19):3525. https://doi.org/10.3390/ijerph16193525Chicago/Turabian Style
Marston, Hannah R., and Joost van Hoof. 2019. "“Who Doesn’t Think about Technology When Designing Urban Environments for Older People?” A Case Study Approach to a Proposed Extension of the WHO’s Age-Friendly Cities Model" International Journal of Environmental Research and Public Health 16, no. 19: 3525. https://doi.org/10.3390/ijerph16193525