Design for Agency, Adaptivity and Reciprocity: re-imagining AAL and telecare agendas

It goes without saying that the developed world is facing significant challenges in dealing with the increasing demands of an ageing population, especially around health and care. It is also easy to understand why technology is seen as a key enabler for meeting this challenge. Application areas such as Ambient Assisted Living (AAL) and telecare are receiving increasing governmental, industry and research attention, taking advantage of maturing and increasingly ubiquitous wireless, mobile and sensor-based technologies. However, to date, many of these advances have been largely driven by technology-utopian visions without real understanding for how such technologies come to be situated in everyday life and healthcare practice and what their potential is for enhancing new ways of living into older age. Further, there is limited evidence of their effectiveness to date, and the problems with adoption from the patients’ perspectives suggest it is timely to reflect on these experiences and reimagine new ways of approaching AAL/telecare from a broader socio-technical perspective. To this end, we propose AAL/telecare as modular infrastructures for the home that can be adapted and repurposed, starting with personal ‘quality of life’ and social needs (supporting peer care) and progressing to monitoring, physical and medical needs (supporting formal care) as relevant for a person and as needs evolve. This extends the adoption path to supporting healthy ageing, taking notions of agency, adaptivity and social reciprocity as core principles. We illustrate this with some examples and identify some of the associated technical and methodological challenges.