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Numéro
Mov Sport Sci/Sci Mot
Numéro 97, 2017
Technologies et techniques des sports : le regard de l’histoire et des sciences humaines et sociales
Page(s) 27 - 33
DOI https://doi.org/10.1051/sm/2017015
Publié en ligne 10 juillet 2017

© ACAPS, EDP Sciences, 2017

As a result of improvements in health care, and increased life expectancies, older adults represent the most rapidly growing segment of society, with estimates suggesting that by 2030, 20% of the U.S. population will be over the age of 65 (U.S. Census Bureau, 2014). Technology is one reason why we are living longer, but it is also changing the ways that we age. While older adults may represent an increased portion of populations in developed countries (United Nations, Department of Economic and Social Affairs, Population Division, 2013), sociologists of sport have taken little interest in their sport, exercise, and health experiences. With increasing concerns about the “burden” of older adults on the health care system (Pickard, 2011), the medical community is increasingly turning to technology to address the issues of caring for older adults.

Improvements in health care, primarily as a result of technological advancements, are a major contributor to the increased life expectancies that are seen across developed countries, particularly in Europe and the United States (Gale, 2012). These technological advancements, however, also change the quality of life for older adults, and what aging looks like. The current generation will spend a significant portion of their lives as older adults, and thus improving the quality of that life is important. But managing the health concerns that can accompany aging is also seen as a primary motive for technological advancements by groups such as Aging 2.0 whose mission is “to accelerate innovation to improve the lives of older adults around the world” (Aging 2.0., 2015). These technological advancements can include increased monitoring of older adults through video surveillance, monitoring the number of steps they take daily, their physical activity, heart rate, or if they fall. There can also be increased communication with loved ones who may be physically far away, through applications such as Skype. The role that technology will play in aging, and how it will shape the experiences of older adults, is a timely question. We are at the cusp of many radical technologies being deployed into the marketplace, and a thoughtful consideration of the implications of these technologies is warranted. These technologies range from self-driving cars to automatic pill dispensers, and raise the question of how intrusive these technologies may be, and whether they serve to improve the quality of life across the life span, or increase surveillance on individuals who are seen as bio-Others (Rail, 2015).

The departure point for this paper was the keynote address given by Rail (2015) at International Sociology of Sport Association in Paris, France. As she discussed bio-Others, the imperative towards wellness, and ‘rescue missions’ designed to keep us all healthier, I reflected on another meeting I had been to the week prior. It was the Annual California Senior Injury Prevention Educational Forum, held in Emeryville, CA. At that meeting, representatives from technology groups in the San Francisco Bay Area came to present the ways that technology could transform aging. With the presentation of self-driving cars, and robots that monitor the safety and mood of older adults, it was argued that technology could keep older adults in the community longer, as well as keeping them safer. The reaction after a video of the robot which followed family members around, talking to them, answering their questions, transmitting video to their loved ones, and monitoring their facial expressions to ensure their well-being, was mixed. While some in the audience members welcomed the technologies, others had concerns over privacy, and the potential lack of human contact and touch, with increased reliance on technology. The underlying tension in the consideration of information and communication technologies (ICT) is the balance between benefits of living independently in the community, and concerns about privacy and autonomy (Mortenson, Sixsmith, & Woolrych, 2015). The purpose of this paper is to discuss some of the technologies of aging that are emerging and their implications for the lives, health, and autonomy of older adults.

Rail (2015) uses the term “bio-Others” to describe individuals who do not conform to the imperatives towards health and well-ness that are being promoted within the current neo-liberal climate. Despite calls to exercise, eat right, be healthy, independent and well, bio-Others simply are not healthy enough. Rail states that “bio-Others are dangerously undisciplined and in great need of policing” (p. 4). Among those she identifies as bio-Others are older adults. Because of assumed declines in ability and well-ness, older adults require increased surveillance and monitoring. Bio-Others are “unfit, unwell and unproductive” (p. 4). Rail is not the only theorist to see the marginalization of older adults as problematic, or to draw upon Foucauldian notions of normalization and good citizenship as imperatives to social order (Mortenson et al., 2015; Pickard, 2011; Powell, 2009). Pickard notes that normality is associated with health, and as aging is seen as inherently unhealthy, older adults are not able to conform to the standards of citizenry, and thus require intervention. Using technologies to help maintain fitness and health is an important methodology to discipline the bodies of older adults, so that they are less problematic to society. Pickard also argues, however, that “fourth agers unable to retain full moral citizenship… are targeted by the intensively individualized technology of case management” (Pickard 2011, p. 336). When older adults are constructed as bio-Others, they are deemed not healthy, potentially problematic, and are therefore in need of being rescued. The primary mode of rescue most recently has been through technology. It is through technology that we can encourage health and wellness among older adults.

1 The technologies

There are an abundance of technologies that have emerged to ostensibly help older adults in their everyday lives, as well as to monitor them. A few examples of these technologies include:

  • the self-driving car. According to Google, “Aging or visually impaired loved ones wouldn't have to give up their independence” (Google Self Driving Car Project, 2015). These cars, which are currently being tested on the road, are anticipated to be available within the next decade. These vehicles could afford individuals who cannot drive the opportunity to go shopping, socialize, and leave their homes without being reliant on others;

  • ingestible chips. In 2012, Proteus Digital Health received approval from the Federal Drug Administration for the first digital pill. A small copper and magnesium chip is embedded in medications. The chip is paired with a wearable patch, which senses when the pill has been ingested, and sends a signal to a phone or tablet. The chip can also monitor heart rate, temperature, and body position (Murray, 2012; Proteus Digital Health Announces FDA Clearance of Ingestible Sensor, 2012);

  • pill bottles with monitoring caps. To remind patients to take their medication, pill bottles now have monitoring caps that light up when it is time to take medication, and send a signal to a monitoring system when the bottle has been opened. When used in conjunction with the embedded chip, patients' doctors can be assured that not only have they opened the pill bottle, but that they have also ingested the medication (Trout, 2011);

  • the monitored home. Currently systems are being designed to allow consumers to monitor nearly every aspect of their homes remotely. These include the capacity for video surveillance, temperature monitoring, energy efficiency, security, and even reports of the contents of the refrigerator (Fedde, 2016). Increasingly there is a call to use these systems to monitor older adults. In order to identify individuals who have fallen, these systems include visual, acoustic, and pressure sensors, as well as accelerometers, motion detectors, and heart rate monitors. If the individual's movements are identified as non-normative, alerts are sent to family members or emergency personnel, based on how significant the aberration in behavior is (Wang, Zhang, Li, Lee, & Sherratt, 2014). Proponents of the monitored home suggest that high levels of monitoring can help keep us safer, as we live in homes that are fully under surveillance;

  • wearable technologies. There are a variety of wearable technologies that monitor body positioning and alert loved ones or emergency personnel if someone has fallen (Yoshida et al., 2007);

  • robots. The development of in-home use robots continues, and expectations are that robots will be available in homes within the decade. One robot demonstrated at the SIPP conference could follow family members around the home, respond to their questions, and monitor their facial expressions. If there were concerns about the individual's welfare, family members could be contacted. Paro, another robotic device, is designed to look like a plush toy in the form of a white seal. It responds to an individual's voice, purrs, moves, and makes noises in response to being pet. There are 6000 currently in use world wide, primarily with individuals with Alzheimer's disease. Popular media and research report that there is less agitation among patients who use Paro, and that they appear to enjoy their time with Paro (Batalka, 2010; Jøranson, Pedersen, Rokstad, & Ihlebæk, 2015). HERB, the Home Exploring Robot Butler, can fetch household items, clean, and engage in other household tasks. Finally, HECTOR developed at the University of Reading, at the Intelligent Systems Research Laboratory, has an interactive screen, and can remind patients to take their medication, assist in the event of a fall, and help the individual keep track of where they have left their glasses (Bilton, 2013).

The potential positive outcomes of these technologies have been investigated. Robots like Paro increase quality of life, and reduce anxiety, agitation, and depression (Jøranson et al., 2015). Surveillance devices and medication management tools improve safety. There are positive health outcomes, help comes faster after a fall or emergency, and individuals are able to remain safe in the home, and adhere to medical protocols, and be in contact with family, loved ones, and medical personnel as needed (Siciliano, Redington, Lindeman, Housen, & Enguidanos, 2013). Telemedicine is seen as a way to reduce health care costs and hospital admissions while maintaining patient satisfaction (Darkins et al., 2008; Davalos, French, Burdick, & Simmons, 2009; Whitten & Sypher, 2006). The authors of these studies all argue that telemedicine and ICT are ways to improve the health care of older adults, maintain their safety, and contain costs associated with the increased number of older adults who are living longer and with more chronic conditions, which require monitoring. Falls are of significant concern among the aging population, and monitoring devices could help monitor older adults, and alert medical personnel quickly when a fall has occurred, a potentially lifesaving benefit (Currie, 2008). Citing research showing improved efficiencies, decreased mortality, hospitalization rates, lowered health care costs, these studies focus on how to increase resistance by medical care providers, older adults, and their care takers to increase utilization of technologies. Thus, proponents of technologies are able to make a compelling case as to the utility of the cutting edge technologies that are emerging in the marketplace. Some technologies, such as robots that can monitor the well-being of patients with dementia may also be able to relieve the stress on caregivers, who may be able to leave the home for errands without excessive worry, and these robots could also answer repetitive questions, and reduce agitation, as in the case of Paro. But there is little research as to whether these technologies do indeed reduce this burden (Palm, 2011).

In the United Kingdom, there has been a clear move towards the use of distance care, as the department of health has initiated a plan to increase telecare use across England (Knight, 2008). These systems are promoted as being of great benefit to clinicians and patients, as patients' health can be constantly monitored, without having to come into the clinicians' office. Kapadia, Ariani, Li, and Ray (2015) conducted a literature review to identify what the barriers were to the adoption of ICT, citing that “the major driving force for ICT success is the improvement of business efficiency” (p. 898). Some of the reasons that were found for not adopting ICT were a lack of perceived need, concerns that ICT would lead to social isolation, concerns over the ability to control being monitored, false alarms, confidentiality, privacy and security, and a negative attitude toward robotic technology and ICT. In each case, the authors' dismiss the concerns stating that the older adults or health care professionals expressing the concerns lack an understanding of the ICT. Through education or coercion, potential users' concerns can be allayed. Studies such as this demonstrate a lack of consideration of the sociocultural implications of increased technologies, and lack a nuanced approach to the application of the technologies. Technology is simply seen as the clear answer to a problem.

2 Sociocultural considerations

Several theorists (Mortenson et al., 2015; Powell, 2009; Wigg, 2010) have used the frameworks of Foucault (1995) to discuss the surveillance of older adults through these new technologies. They raise concerns that these moves towards higher levels of surveillance bring older adults under the gaze of the health care industry, and governmental agencies.

Proponents of new digital and technological innovations suggest that this is the way of the future, and that the problem to overcome is gaining the trust of older adults and their caregivers to adopt the technology. Concerns about privacy, reduction in staffing, and surveillance are pushed aside with the promise of safety, reduced response times in the case of an emergency, and the ability to live at home and “independently” for longer. One study considering emerging ICT noted that 63% of older adults did not see a need for ICT and were not interested in its use (Kapadia et al., 2015). In my own work with a colleague, we also found that older adults reported that they were not particularly interested in using technology in their exercise activities, and in fact, several were reducing their dependence on technologies because of concerns regarding identity theft, and lack of “real” interactions with family members (Butryn & Semerjian, 2012). As a potential solution to these concerns regarding the use of technology, the authors propose that family members use verbal praise to encourage the use of the new technology. Apparently coercion is one way to encourage older adults to use technology that they do not feel that they need. After noting that older adults had concerns about surveillance, they stated that their concerns for privacy could be overcome by emphasizing their safety and independence. One wonders if the suggestion that their independence would be taken away if they do not submit to such surveillance is meant to be an effective tool towards acceptance of the technologies. The authors also found that health care providers had concerns that robots and ICT would threaten their jobs. The authors' response was that “one of the potential explanations for this fear was that the health professionals had limited knowledge of robotic technology” (Kapadia et al., 2015: p. 896). When technology is used appropriately it often highlights the need for more human interaction (Sharkey, 2008; Wigg, 2010), but generally it has been used to reduce staffing, because fewer people are needed to monitor a larger number of individuals (Boissy, Corriveau, Michaud, Labonte, & Royer, 2007). Indeed, staffing at residential facilities has arguably been reduced because of monitoring systems, and these concerns are well founded.

Mortenson et al. (2015) suggest that older adults have long been under surveillance, particularly in institutional settings, and that with technological advances this will continue to become increasingly common and pervasive. They use the work of Foucault (1995) and Goffman (1959, 1962) to consider the implications of increased surveillance. Technologies are being used to reduce staffing by increasing the ease of observation of residents in institutionalized settings. Surveillance in these settings, particularly those that serve individuals with dementia, has been the norm, but the increase of ambient assisted living (AAL) has allowed “surveillance creep” (p. 512) to occur into the home, once considered a private sphere. Early examples of monitoring systems were those worn by individuals, and could be used to alert others in the case of a fall or other emergency. But with ICT these surveillance devices are now located throughout the home, monitoring residents' movements.

As Rail and others' point out (Mortenson et al., 2015) Foucault's (1995) discussions of governmentality are relevant here. ICT and AAL can be used to change the behaviors of citizens, to better their health outcomes, through “technologies of domination” and “technologies of the self”. While these technologies can influence people to engage in healthier behaviors, they can simultaneously be used to identify those at risk, and who “need” to be institutionalized. Rail states that these technologies:

appear to safeguard the rights of autonomous persons, offering them the tools for self-surveillance and self-regulation so that they can become entrepreneurial managers in the development of their own wellbeing. Sport and physical activity become instrumentalised in such a venture. In reality, however, the optimized biocitizen is tied to a neoliberal bio-industrial complex inculcated into a regime of truth that ultimately hijacks the subject in the guise of freeing it (Rail, 2015: p. 8).

Furthering this notion, Mortenson et al. (2015) also use Goffman's (1962) notion of total institutions “places of residence and work where a large number of like-situated individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered round of life.” But they extend this beyond the nursing home, where it has clear implications, and argue that with AAL the home becomes the “individualized total institution” where an individual's every move can be monitored and regimented remotely. Because many of these systems rely on “normal” behaviors being non-problematic, deviations in routine set off alarms, literally. They argue that the space that Goffman (1959) identifies as back-stage areas, private spaces where we have less concern about our public presentation and performance of self, become eroded with AAL, because how there is no distinction between private and public space. We are always on display. And this, they argue, can reduce an individual's sense of autonomy and control in their own home. Even after a senior has hired an in-home care provider to be in the home, when they leave, the space returns to a private space. ICT do not allow for this privacy. There is continuous surveillance, and the Mortenson and colleagues express concern that this “surveillance has the potential to change habitual patterns of behavior, thus creating a powerful tool for influencing how older people move in and across space and how they interpret a sense of self within the home” (Mortenson et al., 2015: p. 526). And that this could lead to “further disempower this already potentially marginalized group of individuals” (Mortenson et al., 2015: p. 527).

Welsh, Hassiotis, O'Mahoney, and Deahl (2003) state that while “perceived by some as a sinister Orweillian tool of repression and social control, the new technologies offer comfort and security to others” (p. 372). While they note that privacy is a concern when individuals are placed under surveillance, they also state that if that surveillance is “applied with the intention of maintaining a person at home, or free from a locked door in residential settings, where is the greater breach of rights?” (p. 373). Here the critical issue of balance between independence and autonomy becomes clear. If surveillance gives individuals more freedom and opens doors, then it can indeed counterbalance concerns regarding increased intrusiveness.

Furthering this argument, Wigg (2010) explores the ways that technology can be used in working with patients with Alzheimer's disease. She conducted observations at two residential facilities. One used locked doors to keep residents safe. The other used surveillance techniques and allowed residents to go outside when they wished. There were monitors on the doors, and tracking devices on the residents. If a resident went outside, a staff member was alerted, and followed them. This freedom to wander significantly reduced anxiety and agitation. In this case there was more supervision needed of the residents to ensure that a staff could leave the building, but gave the residents far more independence. Wigg recognizes Foucauldian critiques of surveillance, but importantly points out “that distinctions exist between surveillance technologies that chiefly engage in social control and surveillance technologies that encourage greater independence and interpersonal interaction between staff and resident” (Wigg, 2010; p. 299). It is precisely these types of distinctions that need to be made as we consider the ways that we all use technologies, to monitor our own exercise, and health, as well as to monitor those who are most vulnerable in our society.

A concern that is rarely brought up on either side of the discussion is the cost of these devices (Zwijsen, Niemeijer, & Hertogh, 2011). It is presumed that they will become affordable over time, but likely it is those with more capital that will have access to advanced technologies, and likely the technologies will be applied to individuals differently based on class. Already older adults have expressed concerns that they cannot afford technologies such as home monitoring systems (Sixsmith, 2000) and as the technologies become more advanced, and more expensive, it is likely that there will be older adults with the financial means to have access to technologies, while others will not have such access. If indeed some telemedicine practices and technologies improve quality of life, mortality, and health, will there be an ever increasing divide between the health of wealthy and poor older adults? There is the additional question of who benefits from the proliferation of ICT. It is perhaps no coincidence that as the population ages, organizations such as Aging 2.0. (2015) promote the development of these technologies, and essentially are working to make aging profitable. This is a game in which there will be winners and losers, and without question, the winners will be the companies whose devices find their ways into the most homes.

Futurists have presented possibilities of what a world filled with robots could look. In some cases, the robots are benign, and seen to simplify our lives, while in others they take on a more sinister role. How robots might actually become part of everyday life is yet to be seen, but the technology being proposed Lindeman (2015) and others where robots will be able to monitor facial expressions, and are designed to make us feel better, suggests a world somewhat like the one foreseen by Orwell in his book 1984. “In any case, to wear an improper expression on your face…was itself a punishable offense” (Orwell, 1964: p. 54). Lindeman and others have proposed that these robots could follow family members through the house, and through facial recognition determine how they are feeling, and respond appropriately. These are being promoted for use with both children and older adults, as a means for caregivers to feel confident that their family members are safe. One wonders, however, if it is possible that in the future older adults will have to be compliant citizens, who are happy and content, and if they are not, alarms will be raised, and authorities notified.

3 Conclusions

As a user of fitness applications, I am keenly aware of the ways that my friends and I self-monitor our exercise and health. And while one can critique this from a Foucaldian perspective, I still take joy in sharing my adventures, and seeing what my friends are doing. We increasingly share our lunches, our location, and a variety of aspects of our lives through social media (Becker, 2014). We quantify our steps, our health, our calorie intake and expenditure. Are ICTs just a different way of quantifying moving, aging, bodies?

The purpose of this paper was to discuss the use of technologies, both in the context of their utility, but also from the perspective of the ethics of surveillance, and the balance between maintaining independence and autonomy. I also wanted to contextualize that these technologies are used with older adults precisely because they are bio-Others. This level of surveillance is not being levied at able-bodied individuals, or even children. It is within the discourse narrative of older adults as a “burden” that justifies these technologies (Pickard, 2011). Undoubtedly there are ways in which these technologies can improve the quality of life for many. In an ideal setting having a self-driving car that allows individuals who cannot drive independently to go where they like, when they like, has clear positive implications. On the other hand, having a visual monitoring system that allows caregivers to watch their aging parent at all times, or that notifies them if there are changes in their normative behavior could lead to decreased autonomy and privacy. These technologies are used with older adults precisely because their bodies are out of control, and unpredictable. They may fall, not take their medications, be non-compliant. The level of control must be interrogated. When older adults are placed within the panopitcon, we quickly arrive at a world where every move is observable and recorded. These technologies can also potentially lead to increased social isolation if it leads to reduced visits from home health care aides, or visits from family (Rauhala & Topo, 2003). Many of us use technologies voluntarily. We track our activities, our workouts, we note on our Facebook postings where we have been, what movies we have seen, and what we are eating. As a society, we will continue to debate the implications of this level of self-reporting, but when the user of the technology is not aware that they are being monitored, or does not want to be monitored, and is coerced into the use of technology because it is the only way that they are allowed to remain in the home, the nature of the debate changes.

References

Cite this article as: Semerjian TZ (2017) Aging in the face of technology: the surveillance of bio-Others. Mov Sport Sci/Sci Mot, 97, 27–33

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