Ambient Assisted Living: Identifying New Challenges and Needs for Digital Technologies and Service Innovation
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Published online: 2021-04-21
141
© 2021 IMIA and Georg Thieme Verlag KG
Ambient Assisted Living: Identifying
New Challenges and Needs for Digital
Technologies and Service Innovation
Vivian Vimarlund1, Elizabeth M. Borycki2, Andre W. Kushniruk3, Kerstin Avenberg4
1
Professor School of Engineering, Department of Computer and Information Science, Linköping
University, Sweden, Co-Chair WG Ambient Assisted Living
2
Professor, School of Health Information Science, University of Victoria, Canada, Chair WG Ambient
Assisted Living
3
Professor and Director, School of Health Information Science, University of Victoria, Canada
4
On behalf of the Swedish interest organizations for Elderly, Stockholm, Sweden. Member of
SeniorNet and Active Seniors non-profit organizations
Currently, the global AAL market is
Summary Such research is critical to the development of guidance for policy
expected to reach up to 13.74 billion USD
Background: The ambient assisted living (AAL) market is rapidly makers, suppliers and service providers.
by 2027 [3]. Therefore, there has emerged
becoming fundamental to the delivery of health and social care Discussion: Older adults are asking for intelligent, assistive living
a global interest in how older adults’ (i.e.,
services for the elderly. Worldwide many different steps have been solutions that help them to continue to live independent lives
the elderly) use Internet and information
taken to increase the engagement of older adults with these technol- and remain socially included in their networks, associations, and
and communication technology (ICT) in the
ogies. Much of this work has focused on the development of novel communities. The elderly need services that stimulate and main-
home. With increased pressures arising from
digital services that increase wellbeing or tackle social challenges. tain their physical and intellectual capital. The development of
the need to deliver virtual services, while at
Aim: The aim of the study was to identify and describe the de- innovative AAL environments is, however, a complex social pro-
the same time increasing social distancing
mands for AAL-services from the perspective of older adults. We cess that involves the use and delivery of innovative ICT–based
between individuals (in response to the
also examine the challenges and needs of the ambient assisted services. The implementation and use of AAL to support older
emergence of COVID-19), AAL technol-
living market using a needs based approach. adults involve service providers and elderly consumers.
ogies are being considered as a long-term
Method: An exploratory case study was conducted with an aim to Conclusions: The results of the study may be of interest to policy
solution to providing health and social care
capture information about older adults’ demands for AAL services. makers, entrepreneurs, technology suppliers, service providers
services during the current pandemic and
A survey was used to collect the data. The survey study respon- and health and social care organizations, who are willing to
into the future1.
dents validated the results. innovate and influence the development of the AAL market
In AAL and smart home environments,
Results: The results of the study indicate that the area of AAL needs through their choices and decisions.
research, and development (R & D) proj-
be studied from a multiple-sided market perspective. Our research ects and business ventures often focus on
suggests there is a need to describe and understand the factors that Keywords the importance of technology as a way of
facilitate or constrain the implementation of services with focus on Ambient assisted living, assistive technology, older adults, improving quality of life and/or supporting
health and social care. There is also a need to describe and analyze elderly, two-sided market, demand for services, challenges, user individuals with cognitive impairments, with
the relationship between policy and practice and its effects on the needs, business models
AAL market. It is necessary to capture expressed demand, to identify 1
The effective integration of health and social care
market challenges at the macro level and to be able to understand Yearb Med Inform 2021:141-9
services is expected to improve the care people
how services should operate and serve older adults in practice. http://dx.doi.org/10.1055/s-0041-1726492 receive. The term health care is usually related to
the treatment, control or prevention of a disease,
illness, injury or disability, and the care or aftercare
of a person with these needs. The term social care
focuses on providing assistance with activities of
daily living, maintaining independence, social
1 Introduction connected, and live independently into old
age” [1]. AAL includes the implementation
interaction, enabling the individual to play a fuller
part in the society, protecting them in vulnerable
An Ambient Assisted Living (AAL) en-
vironment can be defined as “the use of and use of intelligent technology to enable situations, helping them to manage complex rela-
the elderly to tackle the problems in the tionships and in some circumstances accessing a
information and communication technolo- care home. Social care services can reduce
gies (ICT) in a person’s daily life to enable domain of assisted living and to live in their the need for health care services because
them to stay active longer, remain socially preferred environment longer [2]. of the effects of the pandemic.
IMIA Yearbook of Medical Informatics 2021142
Vimarlund et al.
the real-time delivery of digital services [4]. isolation and loneliness in the time of the use of the Internet, social media, technical
ICTs have the potential to improve health COVID-19 pandemic. In this research we also devices, and platforms provides older adults
care while at the same time alleviating examine the challenges and needs of seniors with the opportunity to maintain an active
loneliness and social isolation among the who may use AAL using a needs approach. and independent life while maintaining
elderly. Such health and social impacts are The results of the study may be of interest their contacts and networks, creating new
significant. They help to improve, expand, to decision makers, policy makers, entrepre- conditions and development opportunities
and sustain the older adults’ social contacts, neurs, as well as health and social care orga- for the AAL market [4].
while at the same time improving the emo- nizations, who are willing to influence and Research related to the everyday use
tional well-being of the individual during contribute to the further development of AAL. of ICT among older adults has primarily
the pandemic. Social and emotional contact It is our hope consumers and stakeholders in focused on how the elderly make use of
are critical to psychological and physical the AAL living market will stimulate inno- or understand digital technologies and
health [5, 6]. vation through their choices and decisions applications in AAL living environments.
Recently published studies (i.e., in regarding technologies they purchase. Many of these studies have their origins in
2020) have shown that among older adults, the medical and health sciences literature,
who were worried about the effects that where the elderly are seen as patients, or
COVID-19 was having on their lives, the potential patients [16-18]. Very often these
main concerns of this population group
focused on being unable to make plans,
2 Background studies attempt to better understand how
specific digital applications or devices can
and to perform activities that affect their Digital technologies can improve social- be made and used to improve health or social
well-being. Staying in touch with family ization and they can facilitate older adults’ care service delivery, or to describe to what
and friends remotely was noted by older ability to maintain an independent, healthy extent older adults use these digital services
adults as a way to avoid isolation and lone- lifestyle in their homes. Many studies have to communicate [19] and access other digital
liness [7]. Wu (2020) suggested that social suggested that older adults (i.e., individ- devices so they can receive services in their
isolation and loneliness among older adults uals over the age of 65 years) do not use homes [20-22].
in the context of COVID-19 will be a global technology nor do they have the ability to These studies often reveal that the elderly
challenge [8]. Prior to the pandemic, most learn how to use new technologies [13]. are less likely to have access to and use ICT
community-dwelling older adults actively Older adults are generally considered “late in their daily activities. Therefore, these
participated in social activities, such as adopters” of most technologies in these researchers have concluded that older adults
attending senior centers, church activities, studies. In contrast, as a group the elderly stay out of the “information society”. These
traveling, and many other social events. have become increasingly more connected, studies have revealed important trends. Yet,
However, due to the lockdowns imposed as more Internet users age and become older the focus of these studies is often only on one
by governments in response to outbreaks of adults. In Sweden, 96 % of the population side of the AAL market (i.e., the providers
COVID-19, older adults can no longer under- actively uses the Internet every day. Since of the services or the users). Yet they do not
take these activities. These restrictions have 2010 the number of Internet users over the offer information regarding the preferences
led to increasing levels of social isolation and age of 75 has increased from 23% to 69 %, of customers (i.e. older adults). In the next
feelings of loneliness among older adults as and the number of Internet users who are section of our paper, we outline the study
well as placing the elderly individual at risk over the age of 66 represent 84 percent of methodology and findings.
of increased stress, anxiety, and depression Internet users [14]. In parallel, according to
[9]. There is a need to prevent the health Canadian data, older adults represent one
effects of loneliness and social isolation of the fastest growing segments of Internet
on the elderly population. For governments
and health care organizations, this has been
users in country. Older adults are mak-
ing substantive inroads into the digital
3 Method
a major focus of concern, due to the link world. As well, online activity among those An explorative case study [23] was con-
between poor physical and mental health aged 65 to 74 has risen 16 percent from 2013 ducted with the aim to capture older adults’
status. Low levels of physical activity led to 2016. In the US, Internet adoption among demands for ambient assisted living services
to increased blood pressure, heart disease, the elderly has steadily increased over the in times of restrictions due to the effects of
obesity, diminished immune system func- past 15 years. Today, 67% of adults aged 65 pandemics [24]. A case study methodology
tioning, depression, anxiety, poorer cognitive and older state they go online and use ICTs allowed us to examine this contemporary
functioning, an increased risk of Alzheimer’s daily [15]. Individuals who retired ten to issue which is now of worldwide interest.
disease, and higher rates of mortality among fifteen years ago have become accustomed Furthermore, the use of a case study meth-
the elderly [10-12]. to the use of the Internet in their workplaces. odology allowed us: (i) to perform the study
In this study we aim to identify services Today, these individuals have reached the age in a real-life setting, (ii) capture experiences
that older adults would like to include in of 76 or older and have taken those digital and expectations of older adults, and (iii)
AAL living environments to diminish social behaviors with them. The rapid spread of the to deliver study outcomes that can lead to
IMIA Yearbook of Medical Informatics 2021143
Ambient Assisted Living: Identifying New Challenges and Needs for Digital Technologies and Service Innovation
an in-depth understanding of the demands Aktiva Seniorer, is a non-profit asso- as those specific to age, gender, educational
and expectations older adults have of AAL ciation that is politically and religiously level, and organizations the respondents
contexts. Moreover, case study research independent of trade unions. The association were associated with.
methods have allowed us to achieve an aims to bring together retired adults, and Before the survey was sent to potential
in-depth understanding of the phenomena, to offer cultural and social activities. The respondents, we randomly selected four in-
when there are no related or established organization provides individuals with the dividuals that represented the two organiza-
theories to build on [23]. opportunity to avoid social isolation after re- tions to assess the reliability of the questions.
tirement from working life. The association’s We asked them, in a one-hour interview,
activities take place in collaboration with to comment on the questions and provide
3.1 The Context of the Study and the adult national educational organization alternative questions that could be asked.
“Medborgarskola”, a study association that All individuals commented on the need to
the Survey offers a broad range of courses and cultural see the AAL area as a more inclusive area,
The study participants were members of two programs, to people of all ages and back- that includes healthy elderly that can manage
non-profit senior organizations (i.e. older grounds all over Sweden. their own life, live independently and be able
adults who had retired from work-life who Both associations suspended all social to make their own decisions.
live in Stockholm Sweden). Both organiza- activities in the middle of March as conse- A letter was sent to introduce the objec-
tions (i.e. SeniorNet and Aktiva Seniorer) quence of and extension of the COVID-19 tive of the survey, data collection method, a
have members and are located throughout pandemic. Both organizations followed the description of how data should be handled,
Sweden. At the regional level there exists recommendations from the Public Health the deadline to send the answers, information
local associations that groups of individuals Agency, namely, to protect yourself and about privacy statements and confidential-
that have chosen to become members of the others (especially if you are a part of a high- ity. We also asked about the respondents’
regional organizations because geograph- risk group such as those 70 years of age and willingness to participate in the validation
ical proximity. The organizations, both at older), and to take personal responsibility to process. The name of the project leader
the national, and at the regional level, have maintain social distance from others both and the survey coordinator as well as their
the same goals, expectations, structure, indoors and outdoors. e-post and phone number were included in
internal and external relationship as well the introduction letter, in case some of the
as resources. respondents wanted to contact them. The
The associations are politically, religious- 3.2 Phase 1: The Survey, Data survey was designed to be completed in 30
ly and trade union independent. Members minutes on average. To achieve this, we made
of both regional associations have similar Collection and Data Analysis a tradeoff between collecting detailed data
interests. They organize, plan, and propose Data were collected through a survey for a specific, short time frame with collect-
activities of interest to members and strive conducted at the end of March 2020. The ing more general data about the respondents’
after to offer their members a network to survey took place over a three-week period. expectations.
avoid social distance and social isolation. The survey questions were based on the To collect the most information possible,
They offered the same types of activities and concept of performance expectancy (i.e. we chose to develop a list of alternatives the
programs, and they belong to the same “um- the degree to which technology provides respondents were asked to select from and
brella” or national, federative association. benefits to users in performing certain activ- prioritize. The questions also offered the
The organizations further have members ities, namely social and cultural activities to possibility to add comments, reflections or
with similar socio-economic backgrounds as remain included in the community), effort to add complementary information and/or
well as similar life conditions and interests. expectance (i.e. the use of the technology alternatives they considered of relevance
The respondents of the study are consequent- to remain connected and active), and social after each block of questions in a free text
ly representative of both the organizations influence (i.e. the extent to which users per- box. None of the respondents added new
and the organizations’ populations (i.e., ceive that important others as for instance questions or delivered complementary
membership population). family, friends, members of associations information.
SeniorNet is a non-profit organization for influence them), use technology to maintain
old adults with needs and/or are interested their connection [25], as well as questions
in IT issues. SeniorNet offers data meetings related to the challenges and expectations Data Collection
and courses related to how to use and ac- the respondents consider the AAL area have The survey was distributed by e-mail to
cess to social media. Courses are arranged to adopted to actively access and use ser- a total of (n=118) individuals associated
in collaboration with the adult national vices. The survey was supplemented with with Senior.Net or Aktiva Seniorer. 58
educational organization “Vuxenskolan” a questions regarding use of eHealth services individuals, active members of the Senior-
study association that offers a broad range of (in which health and social care services are Net, and 60 individuals, active members of
courses and cultural program to people of all included) in times of pandemics. The survey Aktiva Seniorer received the survey. A total
ages and backgrounds throughout Sweden. also included demographic questions such of 26 individuals from SeniorNet and 30
IMIA Yearbook of Medical Informatics 2021144
Vimarlund et al.
individuals from Aktiva Seniorer answered Table 1 Age, level of education, and membership of the respondents
the survey. Of these, 15 responses were
recorded after sending a reminder e-mail
Senior Net (n=26) Aktiva Seniorer (n=30)
a week after the deadline. Answers from a Number Percentage Number Percentage
respondent, who could not open the form Male 18 69 4 13
and send them via regular mail, as well as Female 8 31 26 87
two answers that were coded as incomplete Age
(i.e., less than half of the questions were 65-70 6 23 3 10
answered) and were omitted in the presen- 70-75 4 15 20 66
tation of the study results. 75-80 14 53 3 10
80 or older 1 4 4 13
Education
Data Analysis Vocational oriented 2 7
Data were analyzed by the first author of this High School 4 15 3 10
article in close collaboration with the survey University degree 7 26 1 3
coordinator. All answers were registered in Academic degree 13 50 25 83
tabular form. The number of respondents
and the frequency of their answers for each
question and respective sub-questions were
recorded to facilitate an analysis of the re-
sults and to be able to list ICT services, as
menting on the outputs of the survey. Three
respondents immediately replied by e-mail
4 Results
prioritized by the respondents. indicating that the results were consistent In this section of the paper the authors report
Most of the respondents lived alone. with their survey responses as well as with on the results of the study. We list areas and
There were in general, more women that our analysis and interpretation of the survey types of services the respondents identified
were members of Active Seniors organiza- results. To ensure the accuracy of the outputs, as being important and that need to be
tions than of the SeniorNet organizations. we invited the respondents who expressed included in AAL environments of today.
Most of the members of both associations their interest in participating in the validation We also describe a series of challenges and
had some academic degree (see Table 1). process and in commenting on the results needs that the AAL community and the mar-
Although there are different ways to clas- of the survey (n=35) and participating in ket should consider when motivating older
sify the elderly population (i.e., following an interview. adults to use services (see Table 2).
geriatric principles), we classify the respon- The validation interview round was
dents in the following groups: Youngest old performed individually. Respondents were
(individuals between 65 and 70 years old), interviewed for one hour, outside their homes
middle-old individuals between 70 to 75 years in parks or public areas. Recommendations 4.1 Areas and Type of Services
old, and Old old individuals between 75 and to maintain social distance as recommended All respondents stated that they had volun-
80 years old. A few respondents were over 80 by the Public Health Agency were followed. tarily quarantined and used digital technol-
years old (n=5) they built their own group. During the interviews, the respondents were ogy to: (i) keep in touch or socialize with
The table above shows that most of the asked to verbally comment on the outcomes friends and family members; (ii) be able to
respondents belong to the group Old (75 to of the study. They were also asked to com- continue to be active in their networks and
80 years old). Most of the members of both ment on the study results regarding the use associations; (iii) stay up to date and follow
associations had academic education. While or the non-use of health and social services both national and international news, eco-
SeniorNet seems to attract more male indi- such as Net.Doctors, virtual consultations, nomic development and health-care infor-
viduals, more women than men are members and/or the national e-health portal. mation available from official portals (e.g.,
of Active Seniors. The manuscript was sent to our co-au- 1177 portals in Sweden) or published by
thors to identify (1) the level of literal healthcare authorities (iv) access to cultural
replication (i.e. the conditions under which performances; and (v) get involved in their
a particular phenomenon is likely to be own well-being through access to socio-cul-
found); (2) theoretical replication (i.e. the tural services that allow them to continue
3.3 Survey Validation conditions when it is not likely to be found) with their interests at distance.
The results of the survey study were val- of the outputs of the study; (3) discuss con- It is interesting to note that health and
idated in two steps. In the first step the struct validity (i.e. if concepts being studied social care services (for example, telemed-
researchers sent the preliminary results by and operationalized are correctly); and (4) icine or homecare) were not particularly
e-mail to the respondents who had written external validity (i.e. establish the domain to demanded by this group of individuals. No
and expressed interest in reading and com- which a study’s findings can be generalized). respondent indicated that they applied, used,
IMIA Yearbook of Medical Informatics 2021145
Ambient Assisted Living: Identifying New Challenges and Needs for Digital Technologies and Service Innovation
or were interested in receiving telemedicine d) Information about producers or suppliers’ AAL community has to consider, such as
services at home. Only a few respondents participation in national or global market- described below.
(n=5) suggested the need to include interac- places;
tive online doctors as a prioritized service. e) Warning systems that inform about brand
However, the respondents declared that they or reputation of the producers and provid- I - Developing of Control Mechanisms
access and use the possibilities that My ers of services; The AAL market, to which providers,
Care Contacts offer (the official healthcare f) Recommender systems that select and suppliers, users, and stakeholders belong,
platform in which individuals can get access recommend services adapted to their life needs to develop control mechanisms that
to their EHR) to make appointments with situation; exclude providers or suppliers in case the
general practitioners, renew medicines, and g) Interactive platforms that enable interac- rules, guidelines and/or policies in the area
to access answers from COVID-19 tests tion between the two sides of the market; are not followed to increase trust and confi-
and laboratory results. Participants in the h) Rapid and easy access to services. dence in the services and providers. Warning
validation process expressed the opinion that systems, networks of peers that evaluate the
healthcare services in contrast to social care In Table 2, the areas, types of services and services as well as differences between the
services are “in person services” and as such activities as well as challenges the areas that networks and organizations that can be ac-
it is difficult to replace them totally by virtual need to be addressed are described. cessed are also of importance for continued
services. This outcome becomes even more and systematic use of the services available.
interesting if we consider all the initiatives Furthermore, it is imperative to develop
that have been made worldwide to increase innovative business models that go beyond
the use of eHealth services, and to stimulate 4.2 Comments and Interpretation pure reimbursement or revenue models, and,
the elderly population to take advantage of the Results to create a logical structure of how services
of the opportunities that digitalization of The results seem to indicate that it is neces- can be delivered or accessed, distributed and/
services offers. sary to capture expressed demand, to identify or sell, depending on national rules, policies
Awareness of security issues seems to market challenges, to be able to understand or social insurance systems.
be high among the respondents. They stated how services should operate and serve old-
that: (i) it is difficult to know if the informa- er adults in practice as well as to develop
tion they access is reliable; (ii) it is difficult guidance to policy makers and suppliers II - Customer Orientation as Key to Success
to review sources; and (iii) there is a risk of or providers of AAL services. Further, the In general, older adults search for services
being subjected to intrusion and misuse of results of the study seem to indicate that that allow them to maintain their habitus,
information and opinions to a greater extent the area of AAL needs be studied from a i.e., lifestyle, and routines stable and more or
when accessing virtual services, especially multiple-sided market perspective (i.e., older less unchanged over time [26, 27]. Services
if it is not possible to identify the legitimacy adults, providers of health and social care that allow individuals to virtually “meet”
of the providers. services, developers of devices etc.). and continue “to interact” with each other
The results further show that the respon- We learned in this study that older adults regularly are identified as important. Social
dents asked for access to multi-home service ask for an assisted living context that helps activities services that allow one to keep
alternatives (i.e. to access alternatives that them to continue to have an independent patterns of conduct are considered as effec-
are equivalent to each other) that guarantee life and remain socially included in their tive to maintain the social capital they have
quality, safety, and privacy. They also asked networks, associations, and communities, accumulated over their life [28, 29]. Healthy
for networks that diminish risks and for the primarily, as well as for services that stim- older adults prioritize services that help them
development of a trusted area where infor- ulate and maintain their physical and intel- to reduce social isolation and loneliness,
mation can be transferred from producers to lectual activities. especially through services that help them
consumers in a structured, well-defined com- to keep self-determination, autonomy, and
plete, easy, and undistorted manner. Further, to have fun and enjoy life even in pandemic
the respondents indicated that AAL environ- situations.
ments have to offer an area for interaction 4.3 Needs and Challenges Internationally, socializing is mentioned
that guarantees and supports the following: The development of AAL environments that as being important for mental health and
a) Knowledge around suppliers, services, include healthy and un-healthy older adults, overall wellbeing. Connecting with family
devices, systems, or products; is a challenge that involves innovative ICT– and friends, use of social media to stay con-
b) Policies and rules producers and providers based services and that involves providers nected, keeping hobby and cultural activities
of services had to follow according to and consumers. Independent of the kind online, learning a new skill and protecting
national social security regulations; of service delivered, it seems that the area mental health are issues all governments
c) Business transparency where institutions needs to approach complex changes that do recommend as being especially important
are scrutinized to ensure that they behave not occur simultaneously. The complexity for older adults during this challenging time
appropriately; of the changes raises new challenges the of the COVID-19 pandemic [30].
IMIA Yearbook of Medical Informatics 2021146
Vimarlund et al.
Table 2 Areas, activities challenges, and needs
Areas and Activities Senior % Aktiva % Challenges for the AAL Needs for the specific
type of Net Seniorer community areas
services (n) (n)
Social services Communicate with 26 100% 30 100% Provide innovative platforms Cooperation and mutual
that allow friends that enable producers and understanding between
older adults to consumers to benefit from stakeholders, consumers,
keep social Keep in touch with 24 92% 30 100% interacting with each other and suppliers
interaction and family members and when offering/demanding
diminish next of kind and transferring services Clear governance
isolation Legal clarity
Communicate with 23 88% 21 70% Offer easy instructions about
multiple people more how to rapid access the Innovative business models
often (more than once services
a day)
List accredited suppliers
E-commerce to order 25 96% 30 100%
foods and/or goods,
medicines, assistive
technology, etc.
Follow economic and 19 73% 20 67%
political developments
daily
Socio- cultural Theater, Movies and 19 73% 28 93% Accessibility to multi-home Data sets to support
and leisure Shows alternatives interoperability
services to Musicals and Opera
keep older Concerts Network of peers that follow Certification or accreditation
adults social Ballet up and evaluate services criteria to analyze and
active E-books compare the level of
E-trips consistency of multi-home
services
Health and Contact 1177 Health 12 46% 20 67% Warning systems and points Contracts that clearly state
social care Portal or similar of contact in case something the goals and objectives of
services applications goes wrong the relationship between a
to facilitate vendor and a customer
follow up or to My health care 9 1 Mechanisms that allow
predict health Pathway system exclusion of suppliers in
status cases where the rules are
Health apps and 1 7 not followed Legal clarity, policies and
Reliable systems regulations adapted to the
services and Official information about ambient assisted living
information Update information 25 96% 27 90% the presence of several market
about diseases, published by official providers and suppliers who
epidemics, authorities offer equivalent services Innovative business models
pandemics, etc. adapted to different life
situations
Secure and Control that available 10 38% 27 90% Networks or associations of Effective Contracts
safe services information is reliable individuals that have the
that diminish same life situation to Specific but reasonable
risks and fears Reviewing sources 10 38% 22 73% stimulate social connectivity penalties
Avoiding others being 12 46% 17 56% Legal differences between Vigilance and transparent
able to see different kinds of communication that
individual or personal organizations stimulates engagement
information
Avoiding contacts that 7 26% 16 53%
expose oneself to
intrusion and abuse of
data and opinions
IMIA Yearbook of Medical Informatics 2021147
Ambient Assisted Living: Identifying New Challenges and Needs for Digital Technologies and Service Innovation
III - Managing Digital Threats the extent to which approaches should be ac- tenants of the service-dominant logic [32]
An interesting observation that emerges in tively encouraged, and how such approaches to open new collaborations between private
this study is the trust in technology that the should be organized to ensure sustainability and public actors [33].
respondents have. There was no respondent and innovation. Many questions remain to be answered,
who questioned the use of ICT as an enabling such as if the market will be reduced to
technology. However, there are issues regard- services for patients with chronic diseases
V - The Role of Entrepreneurial Collaboration only or if it will be an inclusive area that
ing the quality, security and reliability of the
Generic use of services available in AAL are offers services that aim to reduce social
information provided virtually. Although
influenced by the asymmetry of information isolation and support social connectivity,
no comments were made regarding how
that exists between the various stakeholders, even for the healthy elderly. To empower
these factors affect people’s propensity to
and entrepreneurs active in the market. The society as a whole demands a more ho-
use ICT, it is important to keep in mind that
area faces competition from firms and entre- listic view of this area. This is not only to
accuracy, simplicity, quality, and security
preneurs that render services for customer renew or remove regulations or to develop
should be factors that affect the behavior and
groups or market segments. The respon- devices to monitor elderly at a distance. It
acceptance of ICT technologies, devices, and
dents in this study pointed out an important is also about how to motivate individuals,
e-services in AAL environments.
issue that entrepreneurs should take into in general, to change and adapt behavior to
The necessity to protect users and digital
consideration. Namely the need to access changing environments. The importance of
content providers against cyber-attacks, vi-
to multi-home services through platforms customer orientation as an antecedent for
ruses and fraud has reached new levels with
that allow interaction between customers service delivery success is supported by ev-
the global shift of economic activity online
and suppliers. To match this challenge, it idence from many research studies [34, 35].
being further accelerated by the COVID-19
will be necessary to enable and stimulate Even when value expectations of customers
pandemic. Enabling older adults, providers,
entrepreneurial collaboration between the evolve over time [36, 37]. The results of this
or suppliers of services to have trust in online
different actors joining an AAL market. study show that AAL environments needs
environments is a crucial foundation for this
Many entrepreneurs must take over the role to deliver services that bring value added to
shift. While the frequency of cyber-attacks
as “switch tenders” in that they operate in a the elderly. Further, the results of the study
varies among countries, the stakes attached
flexible yet—to some extent—projectable also indicate the need to provide services
to maintaining secure networks are increas-
way. This ability, in turn, implies that actors that prevent social isolation and the feeling
ing everywhere. This is especially the case in
belonging public organizations in the AAL of loneliness among older adults, especially
a time of crisis where older adults’ ability to
market must radically change their organi- because of the risks for stress and depression
communicate online has become a necessity
zational culture and behavior patterns from [9] and their subsequent effects on physical
for maintaining and allowing them to remain
mainly being administration-oriented to and mental health [10-12].
active and independent.
more entrepreneurship-oriented institutions. In view of the importance of AAL envi-
ronments, especially in times of a pandemic,
IV - Empowering Society we need to have a strategic role in accelerat-
The digital inclusion of older adults in AAL ing the diffusion of services, in facilitating
in the future should consider distinct paths 5 Conclusions and interaction, and in becoming more inclusive
of communication, different preferences
regarding the type of services that are Implications for the Area and offering services even for healthy older
adults that search for services to maintain
demanded in different life situations and The AAL area is rapidly becoming funda- social interaction and diminish social isola-
differences in generational gaps that still mental for the delivery of health and social tion. It is not possible to predict the future,
exist in varying countries. care services for older adults. Worldwide however, the results of this study suggest that
Worldwide policies for AAL appear to be many different steps have been taken to older adults today search for information in-
in a state of constant reform. The immediate increase the engagement of older adults, tensive services, network structures, rapid or
goal of many recent policy reforms has been mainly focusing on the development of immediate communication and opportunities
to slow the growth of health spending by novel digital services that increase well- to reach individuals regardless of geograph-
offering services individuals can manage being or tackle some social challenges, ical boundaries [38].
by themselves or platforms that support the such as the lack of qualified personnel or To give older adults the opportunity to
interaction between consumers and providers dwindling resources. At the same time, “live normally” during voluntary quaran-
in order to move from physical to digital some effort is also spent for establishing tine, in times when their mobility is limited
infrastructures. By increasing the use of a market in which both sides—consumers due to pandemic effects, seems to be an
digital services in AAL and by stimulating and providers—can interact and benefit from important factor for avoiding social isola-
the growth of the market, a strong move to with each other [31]. Along these lines, there tion and loneliness. It is not known if this
reducing public expenditure is envisaged. has been a great push to introduce “service pandemic will change the interaction and
However, an important policy question is innovation”, “design thinking” and other communication patterns for a long time.
IMIA Yearbook of Medical Informatics 2021148
Vimarlund et al.
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