FULL TITLE

Managing risk in the homes of the frail elderly

Keywords

Risk, older people, domestic technologies

SUMMARY

This page describes a framework for thinking about risk in the homes of the frail elderly. The framework is unusual in offering a systematic basis for selecting and evaluating technology for independent living that takes account of social and psychological concerns such as loneliness and dependency as well as the normal physical ones.

Older people living independently face many serious risks. For the very frail, even the simplest activity can be hazardous, and the risks of psychological and social harm such as loneliness and fear may be as important as those of physical harm (see "Socially Dependable Design").

Information and communication technology applications can help increase the independence and quality of life of older people, or people with disabilities who live in their own homes. A risk management framework is needed to assist in selecting applications that match the needs and wishes of particular individuals.

Methodology
Systematic approaches to risk identification are broadly classified as bottom-up, such as HAZOP or top-down, such as Fault Tree Analysis. Here we adopt a bottom-up approach, using Swain and Guttman’s (1983) error modes—error of omission, error of commission, and extraneous error—to generate a preliminary taxonomy of potential mishaps for different activities of daily living (see Table 1). The work was done iteratively over a two year period at Brunel and York Universities.

Table 1. Activities of Daily Living (ADLs) and events to be used in risk analysis

Movement

Mobility (movement involving walking more than a few steps)
Transferring (e.g., from bed to chair)
Dressing
Using steps and stairs
Entering and leaving the home
Letting visitors in and out of the home

Nutrition

Shopping
Meal preparation
Eating and drinking

Hygiene

Toileting
Grooming
Bathing
Housework

Socialising

Using the telephone and other communication technology
Socialising at home
Socialising outside of the home

Other

Entertainment (e.g., TV)
Self medication
Handling money

External Events

Fire
Flood
Infestation
Crime

The framework

Risk comprises two components: the likelihood of the occurrence of harm and the consequences of that harm. In the home, the social and psychological harms are as important as the physical ones. The importance of the harm (e.g., injury) is conditioned by its consequences (e.g., distress, costly medical treatment). We identify six generic types of harm (see Table 2) and four generic consequences (including distress and loss of confidence in ability to live independently). The resultant client-centred framework offers a systematic basis for selecting and evaluating technology for independent living.

Table 2. Generic types of harm (GTH) and the consequences that condition their seriousness.

Harm

Physical
injury (physical damage to the person occurring on a short time scale)
untreated medical condition (physical damage to the person occurring on a medium time scale due to a delay in receiving medical treatment)
physical deterioration (physical damage to the person occurring on a long time scale)
Psychological and social
dependency (reduction in perceived personal worth due to dependency on technology or carers)
loneliness (unwanted isolation from the community)
fear (of attack, robbery etc.)
debt (poverty)

Consequences

distress (pain, fear and worry)
loss of confidence in ability to live independently on the part of the older person or the people who care for them
costly medical treatment
death

Using the framework

The framework is designed to be used for assessing and managing risk for a specific individual in a specific context, that is, where they are living and the way that they live. The steps to be taken are:
• Define objectives of risk analysis and the scope of the system evaluated;
• Risk Analysis of current situation;
• Risk analysis of planned system;
• Risk analysis post-installation.
See an example of how the framework can support this last step.

PAPERS

Blythe, M., Monk, A.F. and Doughty, K. (in press) Socially Dependable Design: The Challenge of Ageing Populations for HCI, Interacting with Computers, accepted subject to revision.

Monk, A.F., Hone, K., Lines, L., Dowdall, A., Baxter, G., Blythe, M.B. and Wright, P. (in press) Towards a practical framework for managing the risks of selecting technology to support independent living, J. of Applied Ergonomics, accepted subject to revision.

Other references

Swain, A.D. & Guttman, H.E. (1983). Handbook of human reliability analysis with emphasis on nuclear power plant applications (NUREG CR-1278). Washington, DC: Nuclear Regulatory Commission.

Author

Gordon Baxter, G dot Baxter at psych dot york dot ac dot uk