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Ambient Assisted Living (AAL) systems must strike a careful balance between interaction and automated assistance. This is particularly the case for older people, who may not have the skills for conventional interaction with computer interfaces. Findings show that current AAL systems do not specifically address the older person's auditory, visual or physical needs or support changes to these needs that result from the normal ageing process. The resulting interaction with these systems often provides information in a format that the older person finds difficult to interpret and utilise. This research proposes an Ambient Assisted Living Flexible Interface (AALFI) that is tailored to individual interaction requirements, and is capable of detecting the context associated with an event or activity. Previously identified limitations are overcome by the provision of two distinct forms of assistance: feedback designed to analyse recurring events in order to provide longer term assistance and intervention assistance designed to make the older person aware of urgent issues that require immediate action. During the implementation of AALFI the features and functionality were assessed by carrying out usability testing with 8 university students. These results were found to be positive as no major initial usability issues were found. Usability studies have been found to be useful in giving an indication on AAL system usability. AALFI was found to have good usability. This laid the foundations for further development and formal evaluation at a workshop at Age Northern Ireland, a group which champions the needs of the older person. AALFI was evaluated by 10 participants including older persons, care providers and health professionals. A final workshop, split between two sessions was conducted with the target demographic, older people and the results obtained provide further validation of the choices that have been made and assistance that is offered. The features, functionality and complexity of the assistance and interaction techniques were assessed by potential users and the underlying ideas behind the implementation were validated. Analysis of the results demonstrates that interactions between AALFI and the potential users are understandable and the assistance offered is timely, meaningful and worthwhile.

Objectives: The context of the increase in life expectancy and the demographic shift towards a more elderly population in the UK presents a number of challenges to society‟s perception of old age and to the likelihood of increasing demands upon health professionals and psychologists who work with the elderly. Existing studies have focused on the effectiveness of therapeutic endeavours with older people, yet have failed to discretely examine the constructs of old age among psychologists who work in the field. Given the prominence of the ageing population and the likelihood of an increase in demands for therapeutic interventions, the aim of the present study was to explore how psychologists discussed and constructed old age within the context of their therapeutic work with older people. The research questions focused on the way in which psychologist who have experienced working with older people talk about old age, the way they construct ideas of therapy with old people and how those constructs of age relate to wider cultural and social constructs of old age. Method: Individual in-depth interviews were conducted with eight psychologists, who were aged between mid thirties to late fifties, all of whom had a minimum of two years experience working therapeutically with older people. The interview transcripts were analysed using the discursive analysis methods of Discursive Psychology and Foucauldian Discourse Analysis. The analysis focused on the way the psychologists used discursive resources when discussing old age and the implications of their subject positions in their therapeutic work with older people. Results: The results identified a number of discourses of old age; old age as heterogeneous, old age as dichotomous, that the therapeutic intervention with older people can be seen as complex and challenging as well as a rewarding pursuit for the therapist, that the choice of the therapeutic model has implications itself and that old age can be seen as an internal attribute. Discussion: The study demonstrated how constructions of old age influenced psychologists in terms of their expectations, their therapeutic delivery, their willingness to integrate a number of therapeutic models, and in their ability to set goals with their elderly clients. The clinical implications of the present study are discussed and the study concludes with recommendations suggesting additional training aiming at furthering psychological knowledge of old age and current theories of ageing.

This thesis focuses on the voices of older people as they describe their experiences of health crisis and subsequent care in one primary care trust and its partner health and social care providers in the United Kingdom. The significance of listening to older people to inform care delivery is recognised as healthcare organisations respond to meeting the needs of this increasing population. Developed countries are reconfiguring their healthcare services by moving care traditionally delivered in acute hospitals to community settings; a term adopted is 'care closer to home.' However advocates of older people have recognised disparity between service provision and older people's needs. Achieving participation from the oldest old of the UK population, this qualitative research utilises an embedded multi-case study design, incorporating a convenience sample of six older people aged seventy five years and over. Led by the older person and their respective care pathway this research, by application of a snowballing technique, further expounds on surrounding carers, healthcare professionals and organisational information to contextualise the older person's experience. Multiple data collection included forty three semi-structured interviews, extracts from documents and medical records and nonparticipant observation. Application of a developed intrinsic analytical framework conSisting of situational and dimensional analysiS maintains a focus on the older person's perspective of their experience whilst achieving contextualisation of their sudden and potentially complex pathway of care. The findings revealed contributing factors influencing positive and negative experiences and perceptions of older people when experiencing unplanned healthcare; leading to the development of a salutogenic model. This salutogenic approach may improve the older person's ability to cope at a time when active involvement in care is crucial to support recovery, future life choices and expectations. This. research re-affirms the importance of facilitating inclusion of older people in research to inform person-centred care.

This thesis explores the potential of exergame and visualisation technologies to assist older adults in home-based falls rehabilitation. Rehabilitation, involving strength and balance exercise, has proven effective as part of a multifactorial intervention to significantly reduce the risk of falling in older adults. However, low adherence to rehabilitation progranunes in the home implies that older adults often do not receive the required amount of exercise therapy necessary to reduce their risk of falling. This work proposes that exergames can encourage greater participation in home exercise by facilitating a more enjoyable experience for the user in the home. Furthermore by delivering real-time feedback on user performance, visualisation could improve the quality of therapy (regarding the correct range and pace of movement) that older users, at risk of falling, receive in the home. An interview with health experts and two design workshops with older users were first carried out to gather the requirements necessary to design the technologies, to maximise the effectiveness of these tools with regard to therapy and engagement. This investigation uniquely involved older adults in the collaborative design of assistive technologies for home-based falls rehabilitation. Several useful designs were revealed, through this process, which contributed to the development of the teclmologies, as described in this thesis. Informal and formal user tests, utilising user-centred design methods, were later carried out in the laboratory, and in the home, to improve the usability and accessibility of the technologies for unassisted use by older adults. The findings from these user tests showed high levels of usability and acceptability, and important user recommendations were made regarding the redesign of the teclmologies to facilitate effective long-tenn use in the home. Once the development and testing work had been completed an empirical investigation, based on a randomised controlled trial (RCT) design, was carried out over 12 weeks in the home. The aim of this study was to explore the potential of the exergame and visualisation technologies to improve adherence, functional outcomes of balance and mobility, and balance confidence. The results indicate that the technologies can potentially increase adherence to exercise and reduce fall risk in older users, versus standard rehabilitation care (involving the use of booklets). The users also expressed high levels of usability and acceptance of the technologies for home rehabilitation use; and they made further recommendations for the redesign of the technologies, to enhance their use by older adults in the home. However, the home study discussed in this thesis was a pilot RCT; therefore it was limited mainly by the sample size, and as such these results did not achieve statistical significance. Nevertheless, future work can benefit from this work, as the findings reported on in this thesis can inform the design of a larger conventional RCT. Finally, based on the work presented herein, this thesis makes several recommendations regarding the design of exergame and visualisation technologies to improve the effectiveness of falls rehabilitation programmes in the home. It is believed that designers and researchers can learn from this work and employ these recommendations in the design of effective technology based rehabilitation tools in future.

Adult social care is undergoing a period of 'radical reform', shaped by concern over changing demographics (the 'ageing population'), diminishing resources, increasing demands for independence and a focus on individual and community responsibility. Within this context, access to local authority social care funding and support is limited to those who, after assessment, are deemed to have 'eligible needs' . This research examines social care assessment for older people and family carers, utilising an ethic of care perspective to challenge the contemporary policy focus on ' independence' and 'individual or community responsibility'. Through original, qualitative interviews with older people, family carers, charity workers, care providers and those working for the local authority, this research investigates how assessment is conducted and experienced in two local authorities, updating and increasing understanding of assessment practice. By utilising an ethic of care perspective, the research highlights that the views of older people, family carers and social workers on 'the person', the role of the state and the purpose and conduct of assessment call into question many of the assumptions which underlie current and future adult social care policy and legislation. The research focuses on how ethic of care perspectives challenge the current assessment process but also highlights where Tronto's (1993) elements of care are already present in assessment practice. It argues that changes in line with an ethic of care, building on the elements in practice, would improve the experiences of those going through the process as well as those who conduct assessments. This analysis emphasises areas which are missing from the wider debate on adult social care, highlighting the value of an ethic of care as an evaluative framework but also, as an ethic of care perspective reflects the views of those involved in the system, as a foundation for a future assessment process.

Later life can be subject to an 'impoverishment of experience' (Jay, 2004): cut-price cultural expectations and community services. The argument maintained in this exploratory, interdisciplinary study is that such experience is aesthetically grounded. This research operationalises aesthetics through its foundational definition of perception through the senses, the enduring influence of Kant's (179011987) enlightenment variant on Western perceptions of ageing, and the transformational, pragmatist aesthetics of Dewey (1934) and contemporary aestheticians of the environment and the everyday. Creativity as a correlate of aesthetics is considered in inclusive, action theoretical terms (Joas, 1996). The aim: to establish whether an applied aesthetics better illuminate the everyday values and challenges faced by older men and women. This addresses a gap in the knowledge base, aesthetics in ageing studies conveyed through representational practices, the arts, or surface appearances. Fieldwork has involved a multi cultural sample of 31 older people, recruited from urban, social hubs and groups for the visually impaired. Methods have integrated auto-driven photo-elicitation or written reflections with in-depth interviews, organized around themes exploring participants' cultural attachments and social networks. Data were analysed through performative/dialogic and discourse methods (Reissman, 2008; Rose, 2007). Resultant data qualify the formative, aesthetic experience, often through senses other than sight, this foregrounding body-environment permeability. Secondly, both aesthetics and creativity, as detached from cultural imperatives, underscore the value in later of life of material, aesthetic bonds, constituting individual authority and ontological security. These considerations infer an ethical construct, a truth to the materiality of late life. This prioritises action and aesthetic sensibility towards the voice, the body and the social and physical environments that sustains both, over normative, dispositional approaches to later life support. On this basis an applied aesthetics provide an alternative voice in environmental and cultural gerontology, with practical potential for the enrichment of community services for older people.

An increase in longevity has had a major impact on demographics in Scotland with the need to shift the balance and reshape care, specifically for older people. The aim of transforming services has been a priority for the Scottish Government following the publication of major health and social care policy documents (2005-2011). This research study aims to highlight how care has been reshaped at a local level in Falkirk, Central Scotland. There is a gap in the knowledge base regarding the impact of telehealthcare and complementary services in transforming service delivery at a local level. The aim of this study is to evaluate a specific service implemented at a local level to reshape care (the assessment and delivery of telehealthcare solutions to frail older people who are community dwellers in the Falkirk area of Scotland) in order to formulate recommendations at a local and government level regarding effective implementation of telehealthcare services in Scotland. The challenge to drive forward the policy agenda (e.g. anticipatory, proactive care services that encourage a self-managed approach to care) are highlighted in this empirical work. The challenge encompasses partnership working, unplanned hospital admission/readmission, delayed discharge, intermediate care, rehabilitation and reablement, the management of falls and the capacity of the workforce to manage transformational change. A purposive sample of multiple stakeholders (e.g. ten frail older people who are telehealthcare users. ten of their informal carers, six assessors and two technology providers) participated in the research study. Findings from the empirical work highlight that the prevention of falls and telehealthcare solutions allow frail older people to meet their defined outcomes and remain living independently in their own home, while reducing unplanned admissions to acute hospital services and speeding up the hospital discharge process. Other findings reveal that frail older people and their informal carers achieve peace of mind and reduced levels of anxiety once a telehealthcare service is in place and that this is a priority for both parties. Thus telehealthcare solutions are having a positive influence and are playing a part in changing service delivery and helping to reshape care in Falkirk. Recommendations are made to further develop/improve the implementation of te1ehealthcare services at both a local and Scottish Government level (e.g. improvement of the assessment process for telehealthcare, a need for more public awareness of the rapidly developing telehealthcare service, a culture change regarding self-managed care and the adoption of technology across health, social care aod in the public arena). Long-term strategic planoing is required at a local level to sustain and develop telehealthcare services, with strong leadership in place to guide and control the next steps as new technologies advance at a rapid rate. Finally, the impact the Professional Doctorate has had on the researcher's professional practice is discussed. The knowledge gained during the period of study and research has enhanced the researcher's contribution to the redesign of Falkirk Council Care & Support at Home Services and new Change Fund projects that will help to reshape care for frail older people.

The global population is aging. This aging is expected to produce an increase in aging related illness which will, subsequently, place an increased demand on health care infrastructures. Smart homes represent a promising approach to providing support to sufferers of aging-related illnesses, particularly when applied to inhabitants suffering cognitive impairments, such as dementia. Smart homes may provide support in a variety of forms such as, on demand assistance with activities of daily living. This support can increase the independence and quality of life of individuals while simultaneously providing care with reduced overheads. Currently smart homes providing such functionality have several deficiencies related to handling variation in activity performance, providing reusable and flexible activity representations, providing dynamic illustrative guidance and having a reliance on dense sensing. Exploring how to address these deficiencies was the focus of this Thesis. In order to address these deficiencies, this Thesis introduced a number of novel elements that extended the domain knowledge; a flexible and reusable goal model, goal recognition algorithms and processes, a process of determining actions presented in videos and a mechanism to nominate videos to assist with such goals. These elements formed components of a novel goal-driven smart home system and were integrated into a prototype assistive smart home system. Evaluation of the system demonstrated promise. The goal model produced was able to flexibly model inhabitant activity, in a reusable manner. Recognition of an inhabitant's intended goal with a reduced set of sensors was performed with a 100%. 83.3% and 64.45% accuracy across three evaluation scenarios. Analysis of video content to identify stepwise activity was performed with 85.04% accuracy. Finally, matching analysed videos to in habitant goals in need of assistance was performed reliably across 3 evaluation scenarios; with 100%,80% and 60% accuracy.

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