Community Informatics and Older Persons: The Necessary Connection

Michael Gurstein, Ph.D.

As is well known, there is a looming demographic crisis in Developed Countries with a rapidly aging population (people are living longer) and a rapidly declining birth rate. The effect of this is to put significant strains on overall economic activity and particularly on health care and support systems, as the aging population results in an increasing need for health care and medical interventions and for support and care services.

These trends are emerging on top of broader long term processes towards the medicalizing and professionalizing of various natural or quite widely distributed physical and biological conditions such as pregnancy, menopause, and aging itself and away from family and community self-help and self-reliance in these areas. The result of this is to shift what had otherwise been practices and interventions done by relatives, friends, neighbours and so on in people's homes and informal facilities into the very high cost environments of professional actions and medicalized and technologically focused institutional care.  Not surprisingly these trends combined with the aging population are putting very severe strains on national (and private) health care systems and funding.

And yet, we know instinctively and research evidence itself is beginning to emerge that particularly in the case of older persons individualized, medicalized, institutionally focused care may be precisely what is not needed and may have the effect over the span of the final decades of life to not only reduce the quality of life but even the length of life itself.

We know that individuals including or even especially older persons are happiest and healthiest and thus less likely to need interventions from the formal medical system if they are living surrounded by family and friends and firmly embedded in communities where they have support, friendship and love. As well, we know that communities have traditionally had ways of giving respect to and supporting their elders seeing this as a necessary element for the effective conduct of life within the community.  As well we can observe that traditional communities and even their counterparts which have evolved as for example as ethnic enclaves in the midst of modern urban environments have developed means to facilitate aging in place and with dignity and companionship through the use of religious institutions and congregations, ethnic organizations, fraternal societies and so on.

Those with sufficient vision in the medical and health care systems recognize and value these parallel structures of support and act so as to reinforce these where ever possible even in the face of frequent bureaucratic resistance and inertia and the quite frequent attempts to shift the balance in these areas to fee for service and for profit organizations and interventions.

Of course, there are many causes for the breakdown of community processes for support of older persons including population mobility and family fragmentation, cultural change, and the physical geography of modern urban living.  However, one contributing element has to be seen as being the way in which care for the older person is understood as being something to be shifted to the medical system rather than as a responsibility (or opportunity) for the family or community. And one element of the medicalizing of aging is that the form that medical care takes and particularly technology-enabled medical care is to focus on the individual as a "patient" interacting as an individual with different elements of the medical and hospital system--with aging being treated as a "disease" for which somehow medical intervention and its technology supports can find a "cure".

Even in the response to our call for papers for JoCI's special issue on Community Informatics and Older Persons we found that bulk of the papers received were focused on "Informatics" as applied to the circumstance and condition of individual older persons in relation to the health care system rather than towards older persons in and with their communities.  But of course, our intention in developing this special issue of JoCI was precisely to focus attention among those concerned with the well-being of older persons on the role that ICTs can play, not simply as a support to individual older persons seeking to retain their independence and autonomy but rather as a support to communities supporting their older population or as a support to older persons living their lives in and with their communities.

In this way, the questions we wished to address with this issue went directly to the heart of the role that a Community Informatics can play in modern and developed societies. Thus we saw Community Informatics as having a role in providing support to and enabling communities to do what they had traditionally done with their older population -- providing social (and thus emotional) continuity and connectedness, providing increasing amounts of care and service as the capabilities of the older person declines over time, and overall providing for a respected role and place for the older person as part of community life, continuity and well-being -- but now enhanced by the use of ICTs.  In this way we were looking to identify ways to overcome some of the barriers which contemporary society seems to place in the way of communities being able to cost-effectively look after their own or alternatively of individuals finding ways of getting support from their communities rather than looking to the support and intervention of impersonal professionalized and institutional systems.

I am delighted with this special issue on CI and Older Persons precisely because it demonstrates in example after example how ICTs can be used as supports for communities supporting their elders--helping to provide medical assistance, supporting families supporting their seniors, giving older persons additional meaning and companionship in their daily lives, providing a means for delivering caring services in times of emergency and so on.  What the articles in this issue demonstrate effectively and forcefully is the supportive role that ICTs can play in enhancing the capacity of communities to support and provide service to their older persons.  As well, they demonstrate the manner in which ICTs provide an additional means for older persons to maintain and reinforce their connections with their families and communities.

As the body of evidence grows linking community embeddedness to individual health, longevity and well-being for older persons, the significance of tools such as ICTs which can contribute to providing linkages for this embeddedness and for cost-effective means for the provision of support services for older persons, will continue to grow apace.  There is increasing insight into these processes and connections from a community focussed/community informatics perspective. This in turn is leading to an enhanced  understanding, planning and implementing of these connections, thus providing Community Informatics with an area for practical, conceptual, research and not incidentally employment growth into the future.

Taking some of the lessons from the papers in this special issue -- lessons such as appropriate methods of ICT instruction for older persons, issues of hardware and software design, strategies for effective social insertion of ICTs into environments dominated by older persons and so on all can be noted and usefully translated into new product design and development, strategies for ICT enabled social engagement, and recommendations for service development and implementation.

As we in the "Developed World" move into a future where the ratio of those in retirement age as against those in the working ages becomes dangerously unbalanced, the need for vibrant, active, well-resourced communities as supports, enablers, service providers, caregivers will dramatically increase.  It should be evident from the articles in this special issue that ICTs as enablers of communities can assist in these efforts by increasing intra-community communication, by facilitating service at a distance, by supporting social inclusion among others. 

There are thus huge new challenges and opportunities for Community Informatics practitioners and researchers to take their broader insights in the inter-relationship of ICTs and communities and apply these as the bases for public programs and not for profit and private initiatives in response.

I would also like to thank and congratulate Dr. Gene Loeb, the special issue Editor and his contributors for making an outstanding special issue possible.  Gene, an "older person" himself is the model of how energy, creativity, a positive attitude, and involvement in a community (in his case the community of those researching technology and older persons), when enabled by ICTs can do marvellous things and have significant impacts in the world.