Barb Marshall  00:02

One of the more interesting women I talked to had actually been given her Fitbit by her daughter and they were Fitbit friends. So she would make up little white lies about why her step count was down certain days. Oh, yeah, I forgot about it. I left it charging. Oh, I forgot to put it on after my shower.

Barb Marshall  00:26

She had legitimate concerns that her daughter was going to read into things that weren't there. She made a joke at one point about, oh, well, if I don't get enough steps, she's gonna put me in a home. But there was a real fear underlying that of the fact that she was being monitored and the numbers might indicate something that she did not feel was true, right? She was just having a slow day. We need to remind people that there are value decisions being made here. And there are different choices that can be made.

Sally Chivers  01:01

Welcome to Wrinkle Radio, where the stories we tell about aging matter. I'm your host, Sally Chivers, and I am so glad you're here. I'm joined by Barb Marshall for our second episode on sex tech and the meaning of aging. When you think about technology for older people, what comes to your mind,? A Walker, a call pendant, a medication dispenser, an airport login kiosk, an iPad with brain games, a programmable TV remote, a VCR, a laptop, a hearing aid, a bracelet alarm, a Fitbit, a care robot, a podcast microphone? In this episode, we talk about how what you just pictured says much about the world you live in and your attitude to growing older as it does about how technology might create better lives for all of us living in an aging world.

Barb Marshall  02:00

Some gerontechnologies or technologies that are developed specifically for older people were rejected as too limiting. Because, for example, the one that came up in one of our focus groups was the call pendants, you know, the "help, I've fallen and I can't get up" pendants that don't work outside the home. They don't work if they're too far from the base station in your house. It's like a tethering to your home. A couple of people who were talking about it in a focus group both gave examples of people in their building who had had falls in the parking garage and didn't get help, like, laid there for a long time because they couldn't communicate. So those were largely rejected in favor of just the kinds of apps that are available on cell phones that can do that kind of notification of a fall.

Sally Chivers  02:53

If you listened to the last episode of Wrinkle Radio, you'll recognize that voice. It's Barb Marshall, Professor Emeritus of Sociology at Trent University. If you haven't had a chance to listen to it yet, you're gonna want to listen to that episode on "Sex, Tech and Aging, mostly sex" after this one. Barb's latest research is in the new field of sociogerontechnology. She studies what technologies older people actually use, what they mean to them in their everyday lives, and how they affect what aging is, and could be. As I listened to Barb, I thought I'd take some time to offer a definition of technology. But that turned out to be way more complicated than I thought, and not super helpful. The one thing I kept coming back to as I looked into it, though, is that what we think of as technology changes with the times as much as tech innovation continues to happen. A pen, for example, is technology, technically speaking, but in the context of my conversation with Barb, an iPad pencil would count, but an old fashioned Bic pen or what some people call a biro, that wouldn't, even if that Bic pen or by biro would be a better tool for the task at hand. Why doesn't that Bic pen or Biro count? Because, well, it doesn't count. It doesn't track anything. It doesn't help surveil anything. It doesn't share data with anything besides the page. It doesn't help quantify things that can turn an aging population into a different kind of crisis than it might otherwise be. And into a target market. Barb's been studying technologies that do count and track and she explained to me why

Barb Marshall  04:49

There's this sense in which technologies are proposing themselves as ways to view things that we can't perceive yet as humans and identify patterns and identify risks, so we can intervene and circumvent. And that's a pretty big claim to make when you're talking about decisions being made about really important things in people's lives.

Sally Chivers  05:15

Yeah, like a call button that only keeps a person safe if they stay in their home. That's ageist by design: the people making it, the companies who sell it, maybe even the people who buy it, assume that an older person who for whatever reasons seems likely to fall or seems like they might really come to harm if they do fall. We assume that that older person doesn't want to or shouldn't go out. Even worse, that design might convince someone who buys it or wears it that they can't leave their home safely, even if they want to. And most older people, like most people, don't want to be stuck at home all day, every day. On the one hand, sure, help is nice if you fall. On the other hand, the risk of falling goes down anyway if you don't go anywhere. But we're living in a world where the ultimate sin is to cost society money. That's why most tech geared for an aging population aims to cut costs, simplify care, and free caregivers to have more time to get back to the grind, ahem, the workplace. Tech can save money. Tech can save lives. But not if we're ageist about who uses what and why. Or maybe it's just not worth it if we're ageist about who uses what and why. And definitely it can't do those things or shouldn't bother doing those things if we ignore older people's agency.

Barb Marshall  06:50

Technology has not solved the problems that it set out to solve because, in many cases, the problems it set out to solve were not the problems that older people wanted to be solved. They were somebody else's problems that they want it to solve. I think there's a real risk of exacerbating inequalities. And I think there's a real capacity for creating new exclusions while trying to solve problems. Air quotes. You can't see that but I'm air quoting.

Barb Marshall  07:25

I think one of the really interesting things about technology and aging, at least from what we found, is that older people aren't using technologies designed for older people. They're using the same technologies that you're using. They're using smartphones and digital cameras and voice activated assistants: the Alexa's and the Google homes and stuff. Video conferencing apps. They're using the same kinds of technologies we are, sometimes using them in different ways. I said we, right, as I'm in that demographic (laughs). We were actually really surprised at how many technologies people did use, how many apps. Some of our participants presented themselves as technophobic. Oh, yeah, no, I don't know anything about that. I mean, two minutes later, they would go into telling us what devices they had and what apps they use, and there is an incredible range.

Sally Chivers  08:20

If you ask me what devices and apps I use, I'd tell you I do not use a fitness tracker. I'd probably come across as a little defensive. But I'd also be super convincing about how I don't want some thing on my arm that dings at me, and I definitely don't want a way to check my email strapped to my body. But if you ask me the right question, you'd find out that's not quite true. Fitness trackers and me, we have a, let's say, on again off again relationship. Here's why. One winter vacation when I finally had time to get outside and exercise, my Apple Watch couldn't tell how much harder it was to cross country ski than to walk. It barely registered that I was snowshoeing on a vertical cliff and six foot snow drifts. That's partly because I wasn't, but it sure felt like I was. And my Apple Watch did not care how I felt. "You're walking more slowly than usual. Try picking up the pace." Siri chided. The next morning, so annoyed that she wasn't picking up what I was putting down, I left my Apple watch on the kitchen counter as we set off straight up an icy hill. We came back exhilarated from another frigid escapade. I stripped off my wool socks and long underwear. And then I saw the screen flashing. "You haven't moved in a while. Try standing up for a moment." I panicked. I frantically Googled how to retroactively add steps so I could keep up my streak and I figured it out too. Sweet victory! I could do what I wanted, record intact. Human 1, technology 0. But the next morning, I didn't even move my Apple Watch to the kitchen counter. I just left it on my bedside table. Now that I knew the data was so easily faked, the bloom was off the rose.

Barb Marshall  10:26

What drew me to wearables was there was a stream of promo coming out of the age tech industries about how aging populations were going to create a huge new market for self tracking. So claims being made about an aging population. And here's what they do. And here's what they want. So for example, the Consumer Electronics Show, the year I was starting to do this work, the big push was on wearables. For older people, this was going to be a huge market. They assumed that this is a demographic that's obsessed with its health and is going to, you know, leap at the chance to strap on a wearable to monitor that. At the same time, I was looking at the academic research on wearables, and a lot of the stuff, again, coming out of Science and Technology Studies. And there was a massive gap in the research between work on wearables worn by young people who were optimizing their fitness and part of the quantified self movement.

Sally Chivers  11:31

The quantified self movement refers to the ways we think we come into being by measuring our activities:  walking, balance, weight, sleep, cycles, you name it, using these different trackers and monitors, things like the Apple Watch that joined an embarrassing number of similar trackers in my junk drawer.

Barb Marshall  11:52

The only other stuff was on passive monitoring of older people by others, okay, so in ambient assisted living, technologies of various sorts.

Sally Chivers  12:04

I was part of a research team that studied nursing home care in six countries over about 10 years. We went to one place in the UK, where the management was so excited to show off their brand spanking new medication distribution device. They were these handheld gizmos. They had a screen that could display the photo of the resident, although most of them didn't have that set up. The screen also flashed what meds the resident was supposed to take, when they were supposed to take them, and then it tracked whether it had happened. Our research team was super excited about this too. But I found them entirely creepy. And I said so. My colleagues were shocked. And they kind of dismissed me as ignoring the practical, living in a sci fi fantasy. Which is fair enough, because I come to that team as someone who studies Film and Literature, and more gradually does this kind of ethnographic work. They were focused on how these gizmos were reducing medication errors and tracking those errors. But I was noticing they tracked whether the poor staff who had another task to do entered the info right. It didn't actually know who swallowed what. And the staff better enter that info right because now the system would know and report on each and any variation to what the machine had been taught to say the right schedule for nursing home life was. So I was relieved to learn from Barb that researchers are studying these kinds of passive monitoring devices. But as Barb explained, there's an even more disheartening absence in studies of age tech.

Barb Marshall  13:50

There was nothing, and I mean nothing, about older people who were self monitoring for whatever reason, and what they were doing, what they were measuring, how they felt about the data, all those kinds of things. So when I started interviewing around Fitbits, that was my interest was, well, let's get a sense for what's happening in this big gap in the middle.

Sally Chivers  14:15

But why does it matter whether people were studying older people and wearables? As long as we know they're using them because they want to and leaving them on the bedside table or in the junk drawer when they want to? Is that not enough?

Barb Marshall  14:30

I'll tell you the big problem I had with that gap. And I'm fairly disappointed in my academic community for not seeing how that gap in the research just reinforced this dichotomy of fit/frail, young/old, active/passive. So I was prompted to talk to a set of older people who were using wearable trackers of various sorts, trying to get a sense of what their experiences were

Sally Chivers  15:04

It turns out that, predictably, the people Barb talked to, were much more self aware about their wearables than I was about my Apple watch. But they still felt responsible. They felt responsible for taking certain individual actions to contribute to their own health, and thereby hopefully contribute to the healthcare system, and help prevent that mythical collapse that is going to come from an aging population, that whole disaster story that I talked about in episode two of Wrinkle Radio on Age Panic. A quick refresher: it might be a good thing for you to take your 10,000 steps and track them. But it can become a bad thing when you start to think you're morally deficient if you don't do that. It's harmful for individual people to think it's possible and even obligatory to protect the healthcare system from their needs, when in fact, care, and how we set it up, is a collective choice and responsibility.

Barb Marshall  16:09

The intent of those devices is really to motivate people to do certain things. That's why they buzz and they prompt and you get badges. It's supposed to be motivating you to adopt this kind of healthy lifestyle. And all of my participants were aware of that. And all of them took on board a kind of responsibilization of themselves, but they did not do so uncritically. And that was the thing I found really interesting that none of them took them up on critically. They were interested in the numbers. They were interested in the quantification. But they didn't take it too seriously. I mean, they incorporated it into a lot of other kinds of knowledge that was less quantifiable. So things like their family histories, that people talked a lot about their family histories, about their own intimate knowledge of their bodies, and having lived in their body for 65 or 70 or 75 years, right? So those kinds of things and their priorities at particular points in time. So it was not as straightforward as I think the behavioral analysis of these devices... I did come across a few studies that were done from a behavioralist perspective, using this in a clinical sense to try and get people who are obese, clinically obese, to exercise more, and did they have an effect. Most of what was interesting here was not at all capturable in that stimulus response model that behaviorists work with.

Sally Chivers  17:47

On Wrinkle Radio, the stories we tell about aging matter. And we don't just say that. We are trying to show the ways that the stories we tell about aging have material consequences, like, really matter for the kinds of lives that people can lead. Barb offered one of the most memorable examples of that, from research on age and tech,

Barb Marshall  18:12

The interpretation of the data that gets produced by all of the devices that are geared to managing later life? All of those rely on interpretation through cultural narratives that are ageist and that assume decline. Let me give you an example of a cultural narrative that's incredibly ageist that has an impact. This comes from Monika Urban's work. She's a German sociologist who's done a lot of work on in-home technologies for aging in place. And she gives this example of one of her participants in her research who had a seizure disorder, and there was a device under her mattress that would detect if she was having a seizure at night. But that technology could not tell the difference between a seizure and an orgasm. She would end up having sex with her boyfriend on the floor, so that she didn't set off the you know, seizure... So maybe we need to design those devices with an off switch, So if you're planning to have someone stay over, maybe you don't need the seizure alarm on if you've got someone staying over because they could, you know, notify if you had a seizure, and it wouldn't call in the cavalry if you had an orgasm. So that's just one example of just an incredibly ageist cultural narrative that changes somebody's everyday life and existence.

Sally Chivers  19:45

The ageist story that an older woman, especially a woman with a seizure disorder, wouldn't want to have sex led to her having to have sex on the floor. That might sound kind of fun, but it also sounds kind of painful, even to me, at only 50. At least that woman knew that the device was tracking her and misunderstanding her. I was more naive. Some time after I'd gotten rid of that Apple Watch, I was playing around with my phone and I found the health app. And it had a record of my steps. To my dismay, it had been tracking me unawares. It had tracked me back before when I had been using a Fitbit, prior to the Apple Watch. And the data that it had was startlingly similar to what the Fitbit had tracked. It had been tracking me as I scaled those icy hills, and it had been tracking whether I stand longer on one foot than another while I stroll. Given that I was so startlingly naive, I was curious to know whether the participants in Barb's study chose to share their data.

Barb Marshall  20:57

Ha, one of the more, interesting women I talked to had actually been given her Fitbit by her daughter, who lived out on the West Coast. And they were Fitbit friends because her daughter set the Fitbit up for her. And they were Fitbit friends. And she was constantly worried. She would make us little white lies about why her step count was down certain days. Oh, yeah, I forgot about it. I left it charging. oh, I forgot to put it on after my shower and stuff. She had legitimate concerns that her daughter was going to read into things that weren't there. So she made a joke at one point about, oh, well, if I don't get enough steps, she's gonna put me in a home. But there was a real fear underlying that of the fact that she was being monitored and the numbers might indicate something that she did not feel was true, right? She was having a slow day.

Barb Marshall  21:48

Most did not share their data with anybody. And in fact, they just weren't interested in it. They weren't interested in joining the Fitbit communities online. They weren't terribly concerned about the fact that their data was being harvested and aggregated. And in fact, I had one participant who thought that was a potentially important public service that they were offering up knowledge that might help someone else. A few years later, when we did the focus groups on a broader range of technologies and a kind of broader range of participants, there was more critical concern there about data sharing, surveillance, algorithmic harm, Shadow labor, people were more aware. And I think it's just because there has been more public awareness of these issues. So we had people tell us things like they would avoid using particular technologies like an ATM at a bank because they liked the teller that they've had a relationship with for a long time, and they didn't want to see them lose their job.

Sally Chivers  22:52

The same night that our research team learned about those medication tracking devices in that nursing home in the UK we ate out at a truly ginormous Jamie Oliver restaurant. There were multiple floors of tables full of people clamoring for pasta. Our waiter nervously eyed our loud, demanding group. He pleaded for us to wait until everybody was ready before we placed our order. Why? Well, he had to submit our orders using a handheld gizmo. If he hesitated between my penne and my colleague's risotto, another waiter might put an order in. And that could mean a half hour delay between the penne and the risotto because the kitchen just went in order that they were put in to the different gizmos. They couldn't tell the difference between one gizmo and another. Now this waiter could tell we were not a group who would be cool with that. Besides pleading with us to help him game the system, he had no way to humanize the process. He couldn't just pop down to the kitchen to explain this was all for one table of type A diners. If it wasn't pre programmed into the gizmo, it couldn't happen. I don't know why the gizmo didn't allow him to input the table, but it didn't. So it wouldn't work. I glanced hopefully at my colleagues. We did coordinate our orders like a well trained regiment. But no one else seemed to notice that the waiter's gizmo looked exactly eerily like that medication tracking device. Same size, same shape, same color, same bells and whistles--not all pre programmed yet, the same promise of efficiency leading to a super stressed waiter and a kind of collusion between us and him to make it all pan out. There's this hope and sometimes fear that technology will replace the need for human labor. As Barb explained, that's double edged when it comes to care technologies.

Barb Marshall  25:09

There's also the question too of the invisibilizing of all the labor that's involved in technologies: keeping them working, changing the batteries. Ambient assisted living technologies are pitched to families as a good way to look after their parents. And you know, you can equip their homes, you can, but then it also means that you need to be accessible to respond to the dings and alarms. Somebody's got to make sure they're all charged up. Somebody's got to, you know, make sure they're working. There's lots of really good research that's coming out from a more critical perspective that's tackling some of these questions. Clara Berridge's work is fantastic. She's got a great article that explores why parents are less enthusiastic than their children about some of these technologies because she interviews both the parents and kids.

Barb Marshall  25:59

But I think overall, we've got to locate this in the whole political economy of the surveillance of aging populations ... of austerity politics, data sharing, aggregation of data, I mean, all of this, again, that standard paragraph in the gerontechnological stuff is all about cost containment, and it's all about: populations are aging, they're going to swamp the public purse with all our needs and costs. And so here's a way we can contain those costs. And that I don't think has, well, for starters, I don't think it's been borne out. Certainly the kinds of technologies have not been scaled up. I mean, for one thing, they're expensive, there's a lot of cost and there's usually a monthly cost in monitoring as well. And it's not just a one time purchase, but it's still that's the standard introductory paragraph for most of those articles promoting them is solving the problems of an aging population and their insatiable appetite for sucking up public funds. And I'm not trying to minimize the fact that we do have a problem funding a health care system that's going to be increasingly burdened as populations age, they do consume more health care costs, although not in the scale that people think, right? Because people aging now are healthier and are more self sufficient. And a lot of that just has to go back to things like just better nutrition and all kinds of things. I don't want to minimize that. But why do we never ever see in those discussions, things like, well, maybe we need to rethink the tax structure to better support this, you know? That never gets mentioned. And so I think that austerity politics and the political economy questions really need to be reminded. We need to remind people that there are value decisions being made here. And there are different choices that can be made.

Sally Chivers  27:55

As listeners know, on Wrinkle Radio, we're serious that the questions we talk about affect us as Age Studies scholars. So I asked Barb to tell me about her relationship with technology, now that she's retired. And her answer really resonates with what she just said, about value decisions, and different choices that can be made.

Barb Marshall  28:19

One of the other things that came up in our focus groups, there were a number of the participants had quite a long experience working with computers in previous jobs, but made a conscious decision to not have a cell phone or not do things in their retirement because they wanted to be more present in their everyday world. And it was with their awareness of the finitude of life that they wanted to be present for what time they had. And I have to say I, I feel that even though I use technology extensively, it's allowed me to collaborate, and keep writing with people all over the place. I have watched great lectures by eminent scholars I would never otherwise get a chance to see, you know, I can get them on my screen, which is amazing. Most of what I read now I read electronically. I don't live close to university anymore. So physical books are kind of an issue for me to access. So I get a lot of stuff digitally. So those kinds of things I love. But I also find myself disconnecting way more from technology than I was able to before. So I think one of the things I enjoy most about retirement is I don't feel like I have to check my email constantly. You know, once a day is good. Sometimes not even once a day, if I'm not feeling up to it. I can get outside every day, which is really nice after how many years of sitting in an office at a desk in front of a screen most of the time trying to do things. It's just really nice to be able to go outside.

Sally Chivers  30:00

Even without an Apple Watch to chide me it's impossible to argue with Barb on that one. The weather's changing towards summer in my hemisphere. I'm going to take Barb's advice. Wrinkle radio is heading for summer break so I can get outside while the getting's good. Before I go, I want to thank Barb Marshall, Professor Emeritus of Sociology at Trent University for the beautiful reminder. And for all she taught me about aging and tech.

Sally Chivers  30:28

Before you get too critical of your relationship to your devices and decide to leave them on your bedside tables, I invite you to like, follow, subscribe and share this podcast with people you think would enjoy it. While you're at it, would you take a moment to give Wrinkle Radio a five star rating and write a review? That would really help us out and help other people learn more about why the stories we tell about aging matter.

Sally Chivers  31:02

This has been Wrinkle Radio. I'm your Host Sally Chivers. Thank you for listening. As Season One comes to a close I want to thank the Aging and Data research team for sponsoring and VoicEd radio for hosting. Thank you to our spectacular guests. Dana Capell, Andrea Charise, Ulla Kriebernegg, Albert Banerjee and Barb Marshall. A special thanks from the bottom of my heart to Doug Chivers-Story, my biggest fan and first listener always. And thank you again to all of you for listening, sending encouraging messages, spreading the word. It means more to me than you will ever know. This has been the biggest, most joyous learning curve of my career and life. I'm so glad you've been part of it. And I cannot wait to have you back listening in the fall. Until then, remember: don't panic! It's just aging.