Meet the Solutionists, with Mark Scott

Would you want a robot to look after you in your later years? What if it treated you like a child?

That’s exactly what’s happening to some older people subject to an influx of high-tech solutions to a struggling aged care system in Australia. Our population is ageing and staff are burning out, so tech companies are trying to enter the space with their own 'fixes.’

But what if these technologies are just solutions looking for a problem?

Associate Professor Barbara Barbosa Neves is a sociologist of technology who says this is all too common. When older people are excluded from tech design, the technology simply doesn’t work for them. It might be difficult to use, but it can also have adverse effects, like furthering stereotypes and deepening loneliness. She explains how inclusive design – as well looking at the bigger picture – can make a real difference. 

Mark Scott  00:01

This podcast is recorded at the University of Sydney's Camperdown campus on the land of the Gadigal people of the Eora Nation. They've been discovering and sharing knowledge here for 10s of 1000s of years. I pay my respects to elders, past and present, and extend that respect to all Aboriginal and Torres Strait Islander people. Would you let a robot look after your grandmother? If she could no longer live in her own home, would you want her to live in an AI-powered aged care facility? According to a suite of AI companies, this is exactly the solution to Australia's crisis of aged care. As our population ages, a strained system will only struggle more, and simply adding more people to the workforce isn't an option. AI will predict falls before they happen, these companies say, and they'll cut down on the time-consuming and error-prone work of human staff. But AI, like most modern technology, tends to be designed without the input of older people. And we haven't even asked Grandma what she thinks. I'm Mark Scott. This is The Solutionists. Associate Professor Barbara Barbosa Navez is a sociologist of technology and ageing at the University of Sydney's Centre for Healthy Societies, and a Sydney Horizon Fellow in AI and Healthy Ageing. Barbara, welcome. When, when we say Australia has an ageing population, what exactly does that mean? And, and why does it matter?

Barbara Neves  01:47

We have an ageing population because we are seeing declining of birth rates, and we're seeing the increasing of people aged 65 and over. And so that will continue to eventuate for the next decades. And so we have these two interesting demographic factors together. So the decline of birth rates and the increase of life expectancy rates. So, for example, 200 years ago, life expectancy at birth was around 40 years old, and so now we can live up to our 80s. And so I think this is interesting because we tend to see an ageing population as a demographic problem, but it's one of our greatest achievements, one of our most successful stories in human history. That so many people now can live longer lives.

Mark Scott  02:38

But it presents a whole new series of challenges for us as a society as well. What are, what are the challenges that are obvious in terms of us being an ageing society?

Barbara Neves  02:47

So some of the issues are around, for example, how we distribute care. So an ageing population usually will demand different types of care, especially as we grow older. There's also challenges around labour market, for example, but also in terms of social health and social inclusion. How do we include an ageing population? And so a lot of those issues tend to be with how we think about care and how we distribute care in our societies.

Mark Scott  03:18

You're particularly concerned about loneliness among older Australians. How widespread is loneliness as a problem?

Barbara Neves  03:25

So loneliness among older Australians, so those aged 65 and over, is actually more common than we realise. If we had four older Australians here with us in the studio, chances are one of them would be experiencing loneliness. Some studies even suggest higher numbers. For example, in 2023, the Ending Loneliness Together survey shows that 39% of older Australians are reporting loneliness.

Mark Scott  03:53

Why are you worried about loneliness?

Barbara Neves  03:56

I'm worried about loneliness for many reasons. First of all, because it does entail a lot of emotional pain. When we speak to our participants, older people, especially living in aged care, who experience loneliness, they say that they feel abandoned, that they feel forgotten. Some of them say that they cry every night. Others say that they're just waiting to die. I'm worried not only because loneliness hurts us emotionally, but also because it has profound consequences for later life. For example, it increases the likelihood of physical and cognitive decline, it's associated with cardiovascular issues, with stroke and heart issues. It's associated with depression and other mental health issues, but it's also associated with an increased risk of dementia. It's around 40% regardless of background or genetics. So it's a real social issue that has real health consequences. And it's been reassuring to finally see that loneliness is now recognised as a global public issue across the world.

Marlene  05:15

Loneliness to me, a big question. There are times I feel lonely, particularly when I miss my husband. Missing the quality of the conversation makes me feel lonely for his presence.

Mark Scott  05:37

This is Marlene. She lives in residential aged care in Sydney and participates in Barbara's research. Like up to two thirds of aged care residents across Australia, Marlene experiences loneliness more often these days.

Marlene  05:55

There was a time I used to be very depressed on weekends. I couldn't wait for the weekend to end. I just could not find a niche where I was engaged in something. I was, I was feeling so depressed. I used to just sleep most of the time, not to be awake and think about things.

Mark Scott  06:18

Marlene is interviewed about how she uses technology on a regular basis, which has her thinking about the future of her own care.

Marlene  06:28

Something that worries me about robots is the expense involved to buy the ones that I particularly need, but may not be able to afford. And then the other difficulty that might be connected with robotic structures is the fact that I can't really have a close relationship with it, because it really is a machine that has no feelings, whereas a person is more personable and can feel my feelings and understand the way in which I operate.

Mark Scott  07:10

So there's clearly a wide range of changes we need to make in our society to support an ageing population. But one promising approach, it would appear to be is digital technology. Before we talk about design too much, talk about how digital technology can help older people with loneliness.

Barbara Neves  07:31

Digital technology can help when it is designed to support meaningful relationships. Again, loneliness is not the absence of social interaction, it's the absence of meaningful interactions, meaningful relationships. So it can help when it supports existing relationships. A lot of my research on communication apps, on robots, and virtual reality, shows that it can indeed support in particular contexts when it just enhances existing relationships, enhances people's interests, but also the kinds of activities that they want to be part of. But technology can also make loneliness worse. And so it is important to have in mind that it really depends on the context how we use it, and if technology is integrated in larger ecosystems of care, or if it's just something that we push in isolation as kind of a one size fits all or one quick tech fix.

Mark Scott  08:33

We're talking about technology as part of a suite of solutions and changes, but you're wary of something that you've described as techno solutionism. What is that, and why is it a problem?

Barbara Neves  08:45

So this concept was not coined by me. Techno solutionism is this idea that technology, in isolation, on its own, is going to solve all our social problems. And so, for example, in aged care, we are seeing chatbots and companion robots pushed as a promise to solve loneliness. But again, those technologies in isolation cannot fix loneliness or dignity or care or societies or communities. We need more than just technology. We need, as I said, a kind of ecosystem of care. The other problem with techno solutionism is that often times the technology is developed first, and then we're going to go and try to find the problem for it to solve. And that means that then complex social issues such as loneliness become defined in technological terms, and so the only possible answer is technological. So that is the problem. The other issue is that techno solutionism can also frame how we see later life. For example, a lot of AI companies are now promising to cure and solve ageing, but ageing is not a problem. If we are ageing, we are alive. So ageing for us is a privilege. It is a sign of social progress. And so techno solutionism has this effect of not only potentially providing very simplistic responses to complex social problems, but also frame and influence how we see then care and later life.

Mark Scott  10:25

I think many of us in in dealing with older people would say technology is a real challenge for them, in a way. They're, they're anything but digital natives. Have you seen the rollout of technology that you feel has been well designed for this user group, and that doesn't generate, you know, concern or apprehension, but, but is embraced by this desired audience?

Barbara Neves  10:51

Yes, when we co-design technologies with other people, diverse groups of other people, we are more likely to find technologies that are relevant and useful for them. Technologies that really respect older people's dignity and agency and capacity to choose, and I think that's really important. What we have so far is mostly technologies who, depart from very stereotypical ideas of older people. That they are all the same, they are all too frail, or they're all too incompetent, too technophobic, and so on. And that is not the reality. A lot of older people use technology and know how to use it well. Now, of course, they are not familiar with a lot of the new technologies that we see emerging. So there is a process that would entail them learning to experiment with different technologies. The problem is that not only ageism is kind of inbuilt into technologies, as people also internalise ageism. And so, for example, we are a society, Western societies, very obsessed with being and looking young. Everything that is ageing is in decline, and that kind of narrative is then internalised by older people. They feel that they are in decline, that they are expiring, but also they feel that they are losing the capacity to engage with technologies because they didn't use them in the workplace, they weren't born with some of the technologies. So it has to be more with narratives that unfortunately are then internalised by a lot of older people. But a lot of the technologies that we use today were invented by older people.

Mark Scott  12:28

So, what does a good design process look like, if you're trying to develop technology that will help older people in a practical way? How do you use that potential user group in an effective design process?

Barbara Neves  12:44

So co-design involves including older people since the start of the process. Not at the end. Not when we already made decisions, we already have a product, and we just want to know if older people like the colour or the avatar. That's not good co-design. Good co-design is people are involved as partners in the process, not as subjects or users. Good co-design, that kind of design that involves older people as partners, also means that we are challenging this idea of the single older user. There's no such thing as a single older user. Good co-design allows for diversity, personalisation. So then we can actually match different needs of different populations within the age group, this particular age group.

Mark Scott  13:34

Can you talk about some technology you've been involved in designing that's been particularly useful for older people?

Barbara Neves  13:41

We co-designed an accessible app, communication app, with older people, and we focused again on a lot of those accessibility issues. One of them was our participants had mortar and dexterity issues, and so they couldn't type. We designed something that would allow them just to tap and to swipe, and that was a way of them engaging with different forms of multimedia communication with family and friends. The project had really positive outcomes on the levels of social connectedness, so meaningful social interaction with family and friends. We've also designed particular environments for virtual reality that include older people's ideas of the kind of the environments that they want to look at. Sometimes in the lab, we come up with those environments that we think are really exciting, oceans, mountains. And then we get to the aged care facility, and they just really wanted to go and see their home. The home that they lived in when they were little in Italy or Greece or China. And so we tended then to use other types of environments that actually respond to what they want and not what we think they would want.

Mark Scott  14:48

Can you talk a bit about how you've seen robots deployed in aged care. What are the opportunities that you see, and what have been the risks that you identified?

Barbara Neves  15:00

So far, a lot of the social robots that we've tested, we see that they are limiting in terms of the social activities that they can do. They are also developed based on stereotypical assumptions of older people. A lot of the robots were actually developed first for children.

Mark Scott  15:21

Right.

Barbara Neves  15:21

And then the companies realised, well, there's this,

Mark Scott  15:24

Other market.

Barbara Neves  15:24

Growing market with an ageing population, so let's just repurpose the robots. And so a lot of our participants find them infantilising because they are, it's by design. Older people are never involved in the design of those particular social robots. What we found so far is that from social robots to chatbots to even fall detection sensors, older people are absent from the datasets, that are used to train the models. But they are also absent then from the decision-making processes of how we implement these technologies. A lot of older participants who I work with, they are very open to the idea of a robot. They are extremely bored in aged care facilities. A nursing home, a care home, is what American sociologist Erving Goffman calls a total institution. Suddenly, everything is hyper standardised. So it's so hyper standardised that everybody has to have breakfast at the same time, lunch at, at the same time, dinner at the same time. Everybody has to be involved in the same,

Mark Scott  16:26

Activities. 

Barbara Neves  16:26

Activities. Bingo. A lot of people hate bingo. Bingo night. And so it's usually young people designing what they think older people want. It's the same with technology. We see a lot of younger people designing what they think older people want. And so the opportunity here is actually to engage older people in that process.

Marlene  16:49

I always wanted to give myself a chance to learn another language. I didn't actually feel from high school days that I was good at languages, at English. I also speak another language, Dutch. My teacher wasn't particularly good at teaching English, and so my grades were always low. And I thought, well, let me see in my later years, 50 years later, how I would travel, learning Spanish. And what motivated me to learn is this fact that I wanted to prove to myself that I could learn a language, and it actually was a delight to learn it all. So much so that I'm now teaching the residents Español, but at a very basic level, and their vocabulary has ballooned quite a fair, a fair bit. I speak to the staff when they come in. I say "Hola, buenos días”, and they say "What's that?” and I'd say "That's Halloween in Español”. And sometimes they have no idea what language it is, but then they now, nowadays they also respond to me. You know, “buenos días”, “buenos noches”, “hasta luego”, and I say “hasta mañana”, “muchas gracias”. You know, it's, it's really, it's good.

Mark Scott  18:14

One of the things I don't quite understand about it is that, that you know, as you said at the beginning, the, the older population is a massively increasing part of our population. You would have thought it would have been a very lucrative market. You would have thought if you were a tech company and say, if I can bring the answer to providing support in and around loneliness, or top quality fall protection, or using AI to be able to engage with an elderly person and help around medication needs and identification, that that would be a market that was worthy of significant investment. But you almost seem to be suggesting that it's an afterthought, and they're grafting other research on other demographics onto the elderly people. Why isn't it good enough in its own right and a big enough market in its own right to support that?

Barbara Neves  19:06

I think it is changing. I think a lot of companies are realising with this longevity economy that they have to cater to diverse groups of other people and they have to market their products in different ways and design the products in different ways. But it's still, again we are still very ageist in how we see societies and how we see technologies. And so if ageing is something that we see in a negative lens as decline, it's something that we don't want to focus on, and so we see that happening across of different companies and technologies. When we interview AI developers, for example, working specifically on technologies for aged care, they are very passionate about the work that they are doing, and they really want to make a difference, but they see still older people as all the same. They are too many, or they are too frail, and they see ageing as a cost and as a form of decline. And that also then influences how they design their own technologies.

Mark Scott  20:07

You began your career, Barbara, on the technology side of this equation. What made you interested in researching for and, and working in support of older people in particular?

Barbara Neves  20:19

So it's quite a personal story. I, I was, I'm trained as a sociologist. I was attending a conference in Boston. I was a PhD student at the time, and I attended this conference by Sophie Freud, the granddaughter of Sigmund Freud. She was 83, 84 years old at the time, and she was very frail. She needed a walker. I still have this image of her in my head, and she delivered one of the most engaging talks that I've ever attended. But I kept thinking in my mind that she was so brilliant, but also so old and so frail. And as a sociologist trained in the science of interrogating social norms and social expectations, I couldn't quite reconcile my reaction not to her age, but to how I was reacting to her. And led, led me, it's a kind of a confronting moment that I realised I was being deeply ageist, and that changed the direction of my research. At the time, I was looking at internet use among young people, and I changed my topic to look at an age comparative perspective. I also then realised that a lot of the studies that I was involved in were showing that older people who used and knew how to use technology were more likely to be socially included. And so I became really interested in the interactions between technology, ageing, and inclusion. And I joined a computer science lab. I moved to, from social sciences to computer science. I was the social director of the Technologies for Ageing Gracefully Lab at the University of Toronto in Canada, I think I was the first sociologist hired by the department. And I worked alongside computer scientists and designers to really design and think about technologies with older people, rather than simply for older people. And now here in Australia, I continue to work across gerontology, computer science, and sociology to really ensure that older people's perspectives are at the centre of technology design and policy. Not just for them, but also for all of us who hope to grow old in societies that actually value care and inclusion.

Mark Scott  22:35

And if we can do that, if we can get the voice of experience, if we can research effectively, if we can design in partnership, are you finally an optimist on what technology can bring to bear in the support of older people?

Barbara Neves  22:49

Definitely. In actuality, sociologists look at, at technology as part of society. So for us, technologies are socio-technical systems. If those socio-technical systems are well developed, I can see a very bright and optimistic future that actually brings together human and technological care in ways that help everybody to flourish, not just a few.

Mark Scott  23:16

That's Associate Professor Barbara Barbosa Neves. You also heard from Marlene, one of Barbara's research participants. If you want to learn more about loneliness itself, listen to our podcast with Professor Melody Ding, who studies loneliness from a public health perspective.

Melody Ding  23:36

From the policy point of view, the interventions are more likely to be at structural level. For example, creating public open spaces, the so-called third place where people can go hang out with each other to increase that level of incidental interactions among each other. So that is addressing more of social isolation side of the problem.

Mark Scott  23:58

You can listen to that episode of The Solutionists right now, and make sure you're following the show so you don't miss an episode. The Solutionists is a podcast from the University of Sydney, produced by Deadset Studios.

The Solutionists is a podcast from the University of Sydney, produced by Deadset Studios. Keep up to date with The Solutionists by following @sydney_uni on Facebook and Instagram, and @sydney.edu.au on Bluesky.

This episode was produced by Liam Riordan with sound design by Jeremy Wilmot. Supervising producer is Sarah Dabro. Executive editors are Kellie Riordan, Sladjana Rstic, and Mark Scott. Strategist is Ann Chesterman.

This podcast was recorded on the land of the Gadigal people of the Eora nation. For thousands of years, across innumerable generations, knowledge has been taught, shared and exchanged here. We pay respect to elders past and present and extend that respect to all Aboriginal and Torres Strait Islander people.