Ageing, Vision Impairment and Digital Inclusion in Ireland

Blaithin Anna Mary Gallagher, Emma Murphy, Antoinette Fennell
NCBI Working for People with Sight Loss
(National Council for the Blind of Ireland)

Changing demographics means our population is ageing. Over the next quarter century, Europe is projected to retain its title of the oldest region in the world. The population of people aged 60+ is increasing at least twice as fast as the population as a whole with the greatest growth in the oldest old, i.e. those aged 80+ (Giannakouris, 2008; UN Population Division, 2007; McGee, 2005) In the Republic of Ireland the population is 4.58 million (CSO, 2011). Fifteen percent of the population are aged over 60 (CSO, 2007). Irelands combined life expectancy at birth was 80 in 2006 with a HALE of 70 (WHO, 2008). Those aged over 60 in Northern Ireland comprise 18.7 % of the population (NISRA, 2008). By 2031 this will increase to 28 per cent while in the Republic of Ireland it will take a further 10 years to reach a similar level. (CARDI 2011).

There is a significant body of work in the field of ageing research in Ireland. Notably the first longitudinal Irish study on ageing has recently published its initial findings based on the participation of 8,000 Irish adults over the age of 50 (TILDA, 2011). The Technology Research for Independent Living (TRIL) project is investigating new technologies that may support older people to live independently based on an ethnographic approach to gathering user needs (Bailey and Sheehan, 2009). There is also ongoing research investigating the potential of embedding sensor systems to the homes of older adults to create aware homes that can detect information on a persons functional, cognitive, and social well being (Doyle et al., 2011).

As the population ages, sensory and cognitive impairments, and physical disabilities, will become more common and therefore issues of access and inclusion to ICT for older adults will become more pressing. The recently launched FUTURAGE Road Map for European Ageing Research has recommended prioritising ageing research to overcome the digital divide and promote social inclusion (Walker et al., 2011).

Population of people with vision impairment

According to WHO there are 285 million people with vision impairment worldwide, comprising 246 million with low vision and 39 million who are blind. Approximately 43% of vision impairment is due to uncorrected refractive error (WHO, 2011). Uncorrected Refractive Error (URE) has been found to be a leading cause of bilateral vision impairment in a number of studies (Weih et al., 2000; Evans et al., 2004). Vision impairment and vision loss increase dramatically with age. About 65 % of all people who are visually impaired are aged 50 and older, while this age group comprises about 20 % of the world's population (WHO, 2011).

In the sensory domain, many aspects of visual processing change with age: decline in visual acuity, increase in presbyopia (inability to change the eyes focal length), increased sensitivity to glare, and reduced perception of colour (Gallagher, 2008). In addition, diseases and conditions which affect vision such as macular degeneration, glaucoma and cataracts become more common. Approximately 80% of all people with severe vision impairments are over the age 65 (Tate et al, 2005) with women in this cohort outnumbering men by almost three to one (Charles, 2007).

A new study (2011) commissioned by NCBI shows that there are 224,000 people living with sight loss in Ireland. This includes those with mild and moderate vision impairment, as well as those who are blind. Age-related macular degeneration (AMD) is the primary cause for 23% of people registered blind in Ireland. The population of people with vision loss in Ireland is set to rise by 21% over the next 10 years to 271,996 people or 5% of the entire population. (Deloitte Access Economics, 2011) It is estimated that at least 30,000 people have URE in the ROI while a corresponding population based figure would estimate the figure in NI to be at least 12,000. (Jackson & O'Brien et al, 2008)

About NCBI Working for people with sight loss (National Council for the Blind of Ireland)

NCBI is a not for profit voluntary organisation and the primary service provider to people with vision loss in Ireland. It is partially funded by the state but also has to generate income via fundraising activities etc. While not an organisation dedicated to ageing issues, the vast majority of service users are aged over 60. NCBI's work includes the provision of and training in aids & appliances, both high & low tech, to maximise the independence of service users. NCBI's technology service provides IT equipment as well as assistive technology and offers a regionalised technical support service to people with vision impairment on a national basis. The Centre for Inclusive Technology (CFIT) at NCBI works to ensure that ICT-based products and services in Ireland are designed to be accessible to the widest audience, including older people and people with disabilities.

ICT, Older People, & Risk of Social Exclusion

It is important to understand the degree of awareness of IT benefits and opportunities among older people and to identify their needs in relation to accessing IT and achieving computer literacy. Government and EU policies on making Information Technology accessible to older people and people with disabilities has been progressive, incorporating principles of inclusion and mainstreaming. In many cases however, there is still a long way to go before such policies are fully implemented and their aims fully realised. Computer literacy is today almost as essential as ordinary literacy and numeracy skills and due to the speed of the advances in ICT there is a high risk of older people and people with disabilities being left behind. Back in 1999 the possibilities of this exclusion were forewarned in a project report which warned that we must "ensure that the older community is not isolated through the development of the Information Society" (Gilligan et al, 1998; 42). Another report in 2000 warned that without basic accessibility rules there is a danger that the information revolution will result in a new and more disabling barrier to full integration and contribution to society" (European Disability Forum, 2005).

As with many communities of older people, those with vision loss who are ageing, may be reluctant to engage with ICT. This is especially the case for those people who have acquired vision loss as a result of ageing and have no knowledge about how assistive technology such as screen readers or magnification software packages may help them. ICT may be used to assist people from vulnerable social groups and in marginal social contexts, in particular older people, in order to maintain their active participation in social and working life.

Social isolation has been shown to affect people with vision loss (Sloan et al., 2005; Caul, 2003 Conrod & Overbury, 1998; Fletcher et al., 1991), as has loneliness (Hinds et al., 2003; Smeeth & Iliffe, 1998; Kassa, 1998). With the current ageing of European society, technological assistance (both specialized assistive technologies and the use of mainstream technologies) will play an important role in maintaining independence and promoting social inclusion.

Older people have a growing interest in participating actively in work & social life today. To meet this need older people must be encouraged to participate in lifelong learning. ICT can be used to help provide this group with pathways to improving their knowledge and competences. Participation in online social networks is becoming increasingly common and the inability to participate can lead to social exclusion.

The following paper outlines four of the projects that NCBI is involved in related to older adults and digital inclusion. Many of the projects NCBI has been involved with over that past decade are concerned with identifying and responding to the needs of older adults. Equipping older adults with the tools and skills that they need in order to cope with emerging technologies is essential. Often the older population are not well versed in these skills and people with vision impairment are at a greater disadvantage.

Completed projects

EATT Equal Access to Technology Training (computer literacy project)

The overall aim of the EATT project was to increase computer literacy among older people with vision impairments. Many older people with vision impairments are unaware of the benefits and opportunities created by assistive technology. This lack of knowledge effectively prevents them from access to inexpensive and widespread information and communication tools such as e-mail and the Internet (EATT Project Consortium 2003). Those people with vision impairments who finished school prior to introduction of IT training to the national educational curriculum were, as a result, unable to use a computer. This placed limits on their participation in social, cultural, and economic life. (Gallagher et al, 2005).

Research was undertaken in five countries exploring the needs of older people with vision loss in relation to accessing IT and IT training. Research was also carried out with IT training providers both in the specialised and mainstream training environments. On the basis of this research, EATT designed, developed, and delivered a range of accessible products including an innovative introductory IT course with the main aim to show participants that they can communicate independently using a PC with assistive software, despite their vision impairment. Success, encouragement, and independence were key throughout the delivery of the course. The course was made available in English, French, Danish, and Italian reflecting the languages of the project partners who included. Synscentralen, in the County of Aarhus, Denmark, SIADV in France, I.Ri.Fo.R. from Italy and Royal National Institute for the Blind (RNIB), Scotland. The NCBI (National Council for the Blind of Ireland) managed the project.

Other products developed as part of this project included: a Good Practice Guide for IT trainers to enable them to facilitate the inclusion of people with vision impairment on their courses; an Introduction to Technology Brochure designed to provide basic information about the various assistive technology available for people with vision impairment, and to explain its function; and a website, where all material was available for free download. This website was decommissioned in 2011.

The EATT project was successful in that it advanced our understanding of the use of ICT by older people with vision impairment. In the years after the project EU funding phase ended it was further translated into Polish and German. The course developed was used by many organisations in Europe as an introduction to ICT. Participants in the project were very positive about their experience. EATT was one of the final 32 projects short-listed from approximately 4000 Leonardo da Vinci I and II projects for the 2004 Leonardo da Vinci Award, which highlights best practice and innovation in the area of Vocational Educational Training.

Evision 55+

This project was developed in light of the ageing population and the corresponding increase in the population of people with acquired vision loss. IT skills are essential today for participating in work & social environments as well as being increasingly used to enhance opportunities in communication and access to information. This project aimed to facilitate and encourage participants, people age over 55 with sight loss, to increase their participation in social and life opportunities by developing and providing online learning modules specifically designed to meet the needs of this group. The project wanted to widen participants knowledge on age-related eye conditions and to give information about maintaining independence and continuing much-loved activities after sight loss.

In order to achieve its core objectives, the project first identified the needs of potential project participants by conducting research in each of the partner countries with the target group. This was necessary to find out how best to equip participants with the knowledge and skills required to access the world of social communication via the use of accessible information technology. An interactive website was especially created for the target group (www.vision55plus.net). This website provides the following modules for participants: Information on age related sight loss and compensatory mechanisms; Daily Living Skills; Computer Skills; and Internet skills. All information and modules can be accessed freely via the website. Project partners included : Berufsfrderungswerk Halle (BFW Halle, Germany) as the co-coordinating organisation; Institut Montclair (France) ; NCBI - Working for People with Sight Loss, Ireland ; Royal National College for the Blind, United Kingdom ; and Visio, The Netherlands. This project ended on December 31, 2009. For more information about this project please see the projects main webpage (www.vision55plus.eu). The project was funded under the European Commission's Life Long Learning Programme.

Current projects

VICON

VICON is an EU funded project investigating the development of virtual testing of consumer products and user interfaces. The needs of people with sensory or dexterity impairments are generally not considered when designing user interfaces (UIs) for mainstream consumer products. In addition, existing interfaces and controls rarely fulfil the accessibility requirements of users with vision, hearing, and dexterity impairments. VICON will focus on older users (aged over 65) including those with mild to moderate age-related impairments such as hearing reduction, and macular degeneration.

In April and May 2010, an NCBI researcher interviewed 23 Dublin-based volunteers ranging from 65 to 91 years of age about their experiences both positive and negative of two every-day products: the washing machine and the mobile phone. Equivalent research was carried out by project partners in the UK and Germany, which generated feedback from approximately 60 people in three different countries. Each field trial consisted of a combination of interviewing and observation, using the volunteers own products (mobile phone and washing machine) in their home. The field trials identified common difficulties that users faced while interacting with the products relating to physical, sensory, and cognitive impairments (Fennell et al., 2011).

Using the information collected during the field interviews, and in particular focusing on the key issues that people reported with the products, VICON aims to develop a Virtual User Model: a set of computer-generated characters that simulate humans. The movement and behaviour of these virtual humans can be programmed in such a way to mimic varying levels of impairment in vision, hearing, and manual dexterity.

VICON is co-founded by the European Commission under the 7th Framework Programme for RTD. Industry and research organisations involved in VICON are: University of Bremen, Germany; FIT, Germany; DORO, Sweden; ARCELIK, Turkey; RNID (Royal National Institute for the Deaf), UK and NCBI, Ireland. Further information can be found on the project website at: www.vicon-project.eu

I2Web

The interactive and collaborative features that define Web 2.0 hold great potential to create inclusive networks and virtual communities for older adults who can be excluded in the real word due physical and social barriers. However older adults are more likely to experience difficulties related to physical, sensory, or cognitive impairments, which can impact their ability to carry out tasks online. While the original World Wide Web, Web 1.0, was largely about people receiving information: reading text, viewing images and watching videos, Web 2.0 involves more complex types of user interaction that would previously have been associated with desktop software applications (I2Web, 2011). Web technologies and standards are evolving quickly to enable such web-based interaction but tools and guidelines to help developers create accessible solutions are much slower to appear (Cooper, 2007).

NCBI, in collaboration with a consortium of researchers and user organizations from across Europe, is investigating the accessibility of Web 2.0 applications for disabled and older people as part of the I2Web project. Following an extensive requirements gathering phase the project aims to create new tools to help developers produce applications that are more accessible to these groups (I2Web, 2011). As part of this requirements gathering phase, the project has investigated the ways that disabled and older people currently use Web 2.0, through interviews and user evaluations. By identifying the way that older users and users with disabilities approach and react to defining features of Web 2.0, these approaches and reactions can be recorded as strategies. These user strategies can be encoded into user models, or form broad user requirements for future Internet applications and devices, to inform standards, developers, and designers. This work is allowing the project to develop a new approach to accessibility (I2Web, 2011). The traditional approach to accessibility can often involve retro-fitting new solutions to inaccessible technologies. The I2Web approach is novel in that it is based on the positive strategies that people use and building applications that adapt to the user rather than the other way around (I2Web, 2011).

The I2Web project is co-financed by the 7th Framework Programme of the European Commission under its ICT Programme. Industry and research organisations involved in I2Web are: FIT, Germany; FAST, UK; University of York, UK; Public-I, UK; NCBI, Ireland; MAC, Ireland, University of Ljubljana, Slovenia; HP, Italy, Polymedia, Italy. Further information can be found on the project website at: www.i2web.eu

Conclusion

To participate as a full citizen in today's society one must have a degree of computer literacy as well as the ability to access and use the internet. Digital competence is influenced by factors such as as age, gender, and socio- economic status, which can in turn influence income, literacy, and level of educational attainment. However, for older people and people with disabilities it is also influenced by accessibility issues whereby physical and sensory disability is not considered at the design process by the ICT industry. It behoves us all to ensure that older people are engaging with ICT. Projects such as those outlined above are one step in this process. As a caring society we should be striving to ensure that we reduce social exclusion. Older people have a vast amount of wisdom and skills to share with those who come behind. By being more inclusive we will maintain and build capacity within society. We will harness experience and expertise, which in the long run will be cost effective as we put that wisdom to work. Including older people in online social networks and devising intergenerational projects will also help bridge the generational divide that has widened since ICT emerged and permeated society. Improving access to ICT for older people with vision impairment will enhance their participation in social, cultural and economic life, which will benefit society as a whole.

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The Journal of Community Informatics. ISSN: 1712-4441