Bakgrund: Välfärdstekniska hjälpmedel kan möjliggöra sköra äldre personers kvarboende i den egna bostaden och är därför viktiga att utveckla. Applikationer (appar) för mobilt trygghetslarm är ett exempel, för att skapa trygghet i aktiviteter i och framförallt utanför den egna bostaden, vilket bidrar med delaktighet i samhället för användaren. Det är dock oklart hur äldre personer ser på dessa hjälpmedel. Syfte: Syftet med studien var att beskriva sköra äldre personers aktiviteter utanför den egna bostaden samt deras attityder relaterat till framtida användning av mobilt trygghetslarm vid dessa aktiviteter. Metod: En enkätundersökning genomfördes på en geriatrisk slutenvårdsavdelning (n=47). Analyser, bland annat gruppjämförelser genomfördes via Chi2-test (χ2) och Mann Whitney U-test. Resultat: Antalet aktiviteter utanför bostaden en vanlig vecka ­var lågt (                         =3) och respondenterna avstod dessa aktiviteter då de ofta var otrygga (n=21), ensamma då de gick ut (n=30) eller kände oro (n=27). Ensamboende och kvinnor avstod i högre utsträckning aktiviteter utanför bostaden jämfört med sammanboende och män. Slutsats: Flera deltagare ansåg att appen skulle öka deras aktiviteter utanför den egna bostaden och respondenterna hade generellt en positiv attityd relaterat till framtida användning av app för mobilt trygghetslarm. / Background: Welfare technology aids can enable frail elderly people to age in place and are therefore important to develop. Applications for mobile security alarms are an example to create security in activities, especially outside the home, which contributes to engagement in the society. However, it is unclear how frail elderly people look at these aids. Objective: The purpose of the study was to describe activities of frail elderly people outside their own homes and their attitudes related to the potential future use of mobile security alarms in these activities. Method: A survey was conducted in a geriatric department (n=47). Analyses, including group comparisons, were conducted by Chi-Test (χ2) and Mann Whitney U-Test. Result: The number of activities outside the home a regular week was low (                          = 3) and the participants abstained from these activities because they were insecure (n=21), alone when they went out (n=30) or felt unease (n=27). Lonely living and women engaged significant lower in activities outside their home compared with cohabitants’ and men. Conclusion: Several participants considered that the application would increase their activities outside their own home and the participants generally had a positive attitude related to the future use of mobile security alarm applications.

Abstract The political principle concerning services for older people in Finland emphasises home care. The public authority set the national targets concerning service provisions and attempts to encourage the older population to remain in their own homes for as long as possible. In this regard, the national government employs a typical sociological or gerontological concept, known as ageing in place. Although the structure of social and health care services significantly shifted to domiciliary services in the 1990s, Finland is still considered to maintain relatively institutionalised welfare programmes. Due to continual ageing and pressures to reduce expenditure on social services, it still remains unexplored as to what extent encouraging ageing in place is realistic from the aspect of the living environment. This study is conducted as a single case study focusing on sixteen local districts in the city of Oulu. The forty-three projects researched, covering all categories, namely residential homes, sheltered housing and rental accommodation for older people, and ranging from central location to suburban districts, are systematically analysed using the building permits and the collected data in addition to the researcher’s neighbourhood surveys. The collected data are primarily analysed in quantitative manners and measured in multi-disciplinary ways. The outcomes of the analysis overall suggest that the living standards of all the housing projects studied here do not necessarily help older residents to cope with every possible environmental problem while real meanings of diversity among the projects studied are considered to be rather limited regarding the aspect of the possible lifestyles of residents. The degree of the realisation of ageing in place depends on the definition of the concept adopted by the various stakeholders (national and local authorities, developers, service providers, older people). The realisation of ageing in place seems to require wider and deeper discussions. Discussion of the ageing-in-place concept points to a lack of preventative objectives which aims at minimising services by providing appropriate living settings for older people instead of pursuing the best combination of care services and accommodation. There are special roles which only housing facilities can address. / Tiivistelmä Poliittisesti Suomessa painotetaan vanhusten palveluissa lähtökohtaisesti kotihoitoa. Viranomaiset ovat asettaneet valtakunnallisia tavoitteita palvelujen tarjoamisesta vanhuksille ja pyrkivät edistämään vanhusten kotiasumista niin pitkään kuin mahdollista. Tässä mielessä valtio toteuttaa ageing in place -toimintamallia, joka on laajalti vakiintunut sosiologian ja gerontologian konsepti. Vaikka sosiaali- ja terveydenhuoltopalveluiden rakenteet siirtyivät 1990-luvulla merkittävästi kotipalveluiden suuntaan, Suomea pidetään edelleen maana, jossa hyvinvointipalvelut ovat suhteellisen laitoskeskeisiä. Johtuen väestön etenevästä ikääntymisestä ja paineista vähentää sosiaalipalvelujen kustannuksia, on vielä epäselvää missä määrin ageing in place -mallin edistäminen on realistista asuinympäristön näkökulmasta. Tämä tutkimus toteutettiin tapaustutkimuksena, joka keskittyi kuuteentoista Oulun kaupunginosaan. Tutkittuja neljääkymmentäkolmea kohdetta, jotka edustivat erilaisia vanhusten asuinkategorioita, siis vanhainkoteja, tehostettua palveluasumista ja ikääntyneiden vuokra-asumista, ja olivat sijoittuneet niin keskustan alueelle kuin lähiöihin, analysoitiin systemaattisesti käyttäen avuksi rakennuslupia, kerättyä dataa ja tutkijan naapurustokyselyitä. Näin kerättyä dataa analysoitiin pääasiassa kvantitatiivisesti ja mitattiin monitieteellisin menetelmin. Analyysin lopputulokset viittaavat yleisesti ottaen siihen, että tässä tutkimuksessa tarkastelluissa asuinrakennuskohteissa asumisen taso ei välttämättä auttanut ikääntyneitä asukkaita selviytymään kaikista mahdollista asuinympäristöä koskevista ongelmista, ja toisaalta asukkaiden erilaisten elämäntyylien kannalta rakennusten välisten erojen nähdään olevan todelliselta merkitykseltään varsin rajoittuneita. Ageing in place -mallin toteutumisen aste riippuu siitä, miten eri tahot (valtion viranomaiset ja paikalliset viranomaiset, kehittäjät, palveluntarjoajat, vanhukset) kyseisen konseptin määrittelevät. Vaikuttaa siltä, että ageing in place -mallin toteuttaminen edellyttää jatkossa laajempaa ja perusteellisempaa keskustelua. Ageing in place -konseptia koskevassa keskustelussa ei ole nähtävissä sellaista ajattelutapaa, jossa pyrittäisi minimoimaan palveluiden määrä tarjoamalla vanhuksille sopivanlaiset asuinolosuhteet, vaan sen sijaan keskustelussa on keskitytty etsimään parasta hoitopalveluiden ja asumisen yhdistelmää. On kuitenkin tiettyjä ongelmia, joita voi ratkaista vain sopivilla asuinympäristöillä.

By 2030, the Government of Canada predicts that over 9.5 million (23%) Canadians will be 65 years of age or older. For this growing demographic of older adults, intelligent home health technologies have been proposed as one beneficial avenue to support and maintain health and wellness as they begin experiencing ageing-related health effects. However, many ethical concerns have been raised regarding the design and deployment of these technologies in ageing-in-place settings such as long-term care and nursing homes. This thesis aims to better understand the ethical concerns that long-term care stakeholders have with a subset of intelligent home health technologies known as Ambient Assistive Living (AAL) technology. To obtain this understanding, a Systematic Literature Review (SLR) was conducted to gather the different ethical concerns that long-term care stakeholders have with AAL technology and to observe the various ethical design and engineering frameworks used to develop AAL technology for aging-in-place settings. 41 publications were analyzed to identify various ethical concerns held by ageing-in-place stakeholders and the different ethical design and engineering frameworks used to address these concerns. The findings from the SLR identified 17 ethical concerns that influenced how the research was conducted with long-term care facility stakeholders. Following the SLR, a Participatory Design methodology in the form of workshops and interviews was developed and implemented with 30 long-term care facility stakeholders to understand their ethical concerns with two AAL devices: the Hexoskin ProShirtTM - a wearable device used to monitor and collect vital signs, and the AWS DeepLensTM camera - a machine-learning enabled video camera used to make predictions. Through data analysis, 35 topics were identified and grouped into 12 main ethical concerns for both devices. Once a better understanding of long-term care stakeholders' ethical concerns with the two devices was gained, a prototype of an ethical design tool - the Ethical DataSheet - was proposed. An Ethical DataSheet is meant to support researchers, engineers, designers, and others in developing a better understanding of the ethical concerns they must consider when designing and developing AAL technology for ageing-in-place applications. To create the Ethical DataSheet prototype, a snowball sampling literature review was conducted. By conducting the second literature review, inspiration from different ethical design tools was used to develop the prototype. The Ethical DataSheet prototype was then used to create Ethical DataSheets for the Hexoskin ProShirt™ and AWS DeepLens™, which present the top ethical concerns that were identified through the workshops and interviews with long-term care facility stakeholders. The findings of this research will be shared with the PATH research community, who are dedicated to providing nationwide testing and services for home health technologies that will accelerate the availability of appropriate smart systems (i.e. AAL technologies) for seniors' and patients' home healthcare.

Through a case study about the impact of IT adoption in a residential aged care organisation, this thesis examines the increasing pressure for service integration as mainstreamed through reform policies. Specifically, the research investigates the role of IT in facilitating the 1997 aged care reform agenda of 'ageing in place' focusing on the levels of transformation from the policy context to the organisational/management context, and to the context of service provision by care staff. A single embedded case study (Yin, 1993) is used in order to meet the general objective to capture the dynamics of the impact of ageing in place in the three social contexts. The research is informed by social constructionism, a theoretical framework that emphasises the significance and effects of language in shaping social realities (Ainsworth, 2001; Hosking, 1999). The framework, therefore, justifies the qualitative analysis of both written (i.e., policy documents) and spoken (i.e., interviews with staff) texts to address meaning in relation to context. Changing technologies can result in altered societal structures (Betz, 2003) at all levels, from the very complex to the very basic. As such, it is important to understand a few basic premises of technology. First, technology is a human invention to improve the well-being of society (Ayres, 1996). Consequently, technological inventions that improve the quality of life are seen by people as a necessity for modern living. In the case of ageing, modernisation and technological advances effectively resulted in people becoming healthier and living longer (Department of Health and Aged Care [DHAC], 2000). Second, technology is a human means to control nature (Betz, 2003). As such, technological advances can be seen as a modernising process of predicting and regulating the effects of the trends existing in the environment, such as ageing. Ageing in the twenty first century presents a challenge to government's development policies because ageing is depicted as a steady force with a long-term economic impact (Johnson, 1999). Third, a technology becomes powerful when it is sponsored by the market (Betz, 2003; Hughes, 1983). Unless a technology is backed by business, it lacks the influence on a large scale. Fourth, technology is used to enable change. By using IT, governments, business and the community are co-operating through a paradigm similar to the business sector. As a result, the service environment is shifting towards more business-like approaches. To sustain the changes brought by a different paradigm and modes of operation, the rhetoric of technology is employed. Therefore, the purpose of the study is to investigate the use of IT in processes of organisational adaptations to reform, which requires the examination of: a) specific meaning of IT as used in long-term care policies for older people since the last structural reform, b) the rationale behind the introduction of a new IT system into a residential care organisation, and c) the meaning of IT as articulated by care staff who have experienced a change in technology. The first paper represents a rhetorical analysis at the macro or policy level. There is a significant influence of a global political actor in developing proactive strategies on ageing, which results in a new, multi-organisational approach in delivering government-subsidised services, such as residential care. Three key institutional texts were selected to represent international to local policy development since the time ageing became a global concern. Since then, ageing is also viewed as a human rights issue. Using Burke's pentad, an analytic framework to analyse rhetoric in texts (Stillar, 1998), these institutional texts are seen to employ the rhetoric of 'technology for sustainability' to justify changes to policy approaches that seek long-term viability. Technology, in the name of sustainable development ensures support for economic growth, which balances the long-term effects of population ageing. The existence of a global force, such as population ageing, allows the intervening powers of the UN in mainstreaming ageing into development policies. Accordingly, it initiates corresponding actions at national (Australian Commonwealth Government) and state (Queensland Government) levels. IT is a medium of communication, knowledge transfer, and standard practice at these levels of actions. The second paper represents a qualitative analysis at the meso or organisational level. This paper explores the cogent rationale in the introduction of a computer-based, care documentation system in a large residential aged care organisation. Twenty two staff, from every level of the organisation, were interviewed to get an insight into the role of IT in substantive changes to organisational structure and modes of service provision. Responses from staff indicate external and internal influence that pressured the organisation to change. In the bid to sustain the future of aged care, the industry is changing through the introduction of new structure of service delivery. The Aged Care Structural Reform instigated a shift towards sustainable service provision that is consumer-driven, with a fixed cost compliance mechanism and performance criteria that are tied to funding. Facing the requirement for evidence to corroborate funding, a residential care organisation changed its structure of service delivery by introducing a new strategic direction. IT is part of this new strategic direction, planning, and operations of a changed service environment. The third paper represents a qualitative analysis at the micro or individual level to examine the impact of IT at frontline service delivery. This study is also based on interviews with twenty-two staff, across the organisational structure; however, this time the focus is more on staff who are involved in providing direct care to older residents at the organisation. The reason behind this is that IT has always been a management tool which handles management priorities such as financial planning and performance monitoring. The themes arising from the interviews indicate discord at the level of service delivery from the introduction of a new technical system. It also points to the idea that staff generally refer to ethical ideas and future promise of the new system. In summary, these three papers attached to this thesis support the notion that the meaning of technology is socially constructed. First, technology in the aged care sector has particular reference to improving or enhancing the well-being of older people, and in this case, the provision of high quality services that fulfil the needs of older people. Second, IT has an important role in meeting the evidence-based requirement, such as in the use of information in manipulating the use of resources required for the ageing population. Third, the meaning of IT is conceived from the context requiring its use such as the need to use resource efficiently to ensure long-term sustainability, which were emphasised in the last reform. Fourth, IT is used to enable structural changes in organisations to implement generic practices originated from the business sector, requiring the use of strong rhetoric such as balance and future. The limit of this case study is that these dimensions of technology can only be applied to the specific context of aged care and is not generalisable to other political contexts. However, the strength of the study rests on the macro-, meso- and micro-analysis of the meaning of technology. Therefore, future studies should investigate and compare the dimensions of technology in other contexts.