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In oduc ion
© 2022 he con ibu o s
Published e sion
Hi onen, Helena; Tammelin, Mia; Wou e s, E eline J.M.; Hänninen, Rii a
Hi onen, H., Tammelin, M., Wou e s, E. J., & Hänninen, R. (2022). In oduc ion. In H. Hi onen,
M. Tammelin, R. Hänninen, & E. J. Wou e s (Eds.), Digi al T ans o ma ions in Ca e o Olde
People : C i ical Pe spec i es (pp. 3-14). Rou ledge. Rou ledge S udies in he Sociology o Heal h
and Illness. h ps://doi.o g/10.4324/9781003155317-2
2022
Digi al T ans o ma ions
in Ca e o Olde People:
C i ical Pe spec i es
Edi ed by
Helena Hi onen, Mia Tammelin, Rii a Hänninen
and E eline J.M. Wou e s
Fi s published in 2022
ISBN: 978-0-367-72557-0 (hbk)
ISBN: 978-0-367-72559-4 (pbk)
ISBN: 978-1-003-15531-7 (ebk)
Chap e 1
In oduc ion
Helena Hi onen, Mia Tammelin, E eline J.M. Wou e s,
and Rii a Hänninen
(CC BY-NC-ND 4.0)
DOI: 10.4324/9781003155317-2
This OA chap e is unded by Uni e si y o Jy askyla, Finland.
Chap e 1
In oduc ion
Helena Hi onen, Mia Tammelin, E eline J.M. Wou e s,
and Rii a Hänninen
In oduc ion
The wo key d i e s o socie al change in he 21s cen u y a e he signi ican and
apid changes in echnology and he demog aphic changes associa ed wi h age-
ing socie ies (Peine e al., 2021). Digi al echnologies shape ou embodied li es
and a ec ou knowledge o he sel and he wo ld in a ious ways. Phenomena
such as he accele a ion in compu a ional powe ha e b ough apid g ow h in he
use o in o ma ion and communica ion echnologies (ICTs) in di e en domains,
including se ices o olde people, whe e an a ay o de ices and in o ma ion
sys ems a e cu en ly used. A apid digi alisa ion is also e lec ed in he policy
le el h ough he ac i e p omo ion o e-inclusion o all ci izens in he knowl-
edge-based economy by he EU, among o he s (Eu opean En i onmen al Agency,
2020, p. 28). This is elling o he weigh and hopes pu on echnologies o esol e
complex p oblems aced by ageing socie ies (Man o ani and Tu nheim, 2016).
The digi al ansi ion in he ca e o olde people is d i en by policies ha
aim o p o ide se ices o a g owing p opo ion o popula ion h ough digi al-
ised se ice pla o ms, and as (cos )e icien ly as possible. The Wes e n wel a e
s a es a e ageing as , and he ela i e sha e o he o al popula ion o people aged
65 and o e in Eu ope is p ojec ed o each 29.4% in 2050. This is likely o ha e
p o ound implica ions, no only o he li es o indi iduals, bu also o go e n-
men s, business, and ci il socie y. Ageing impac s heal h and social ca e sys ems,
labou ma ke s, public inances, and pension en i lemen s (Eu os a , 2020). In an
e o o inc ease se ice e iciency, s a es a e becoming inc easingly elian on
digi al pla o ms, ools, and applica ions. A he ime o w i ing o his book, he
COVID-19 pandemic, wi h i s ecommenda ions on social dis ancing, has u he
accele a ed he digi al ans o ma ion and use o digi al echnology in ca e se -
ice p o ision, o one by la ge-scale in oduc ion o he p ac ices o eleca e and
elemoni o ing in se ices o olde people.
Digi alisa ion has consequences on how ageing is depic ed a he policy le el.
A he same ime, policy o ma ion en ails assump ions on how he ac o s in ol ed
in ca e o olde people a e pe cei ed in he socie y – including bo h hose deli e -
ing and hose ecei ing ca e se ices. In go e nmen al policies on ageing, digi al
DOI: 10.4324/9781003155317-2
4 H. Hi onen e al.
echnologies a e o en depic ed as a ool o suppo and secu e he li es o olde
people in hei p i a e homes and ins i u ional ca e acili ies. Technologies a e
designed o suppo e e yday unc ions and social ela ions and o p o ide se -
ices and en e ainmen in a digi alised o m o hose li ing in p i a e house-
holds. Howe e , he he e ogeneousness o olde people as a popula ion g oup and
he digi al compe ence expec ed o ca e wo ke s a e o en los in hese isions.
This c ea es a isk o deepening he exis ing inequali ies among he g oups o
olde people and ca e wo ke s as ac o s in he heal h and social ca e se ice sys-
em. In he case o ca e o olde people, he key ques ion o en seems o be how o
deli e high-quali y ye cos -e ec i e and equally accessible se ices o he age-
ing popula ion. The p emise o he chap e s in his book is ha his a ionalisa ion
is na ow and based on s e eo ypes and insu icien unde s anding o olde people
and ca e wo ke s as echnology use s. As a consequence, policies can dis ega d
he s uc u al and social complexi ies in ol ed in he p ac ical implemen a ion o
digi al echnologies in ca e o olde people. The pu pose o his book is o gi e
deepe insigh in o he cu en deba es on he opic.
Digi al echnologies and ca e o olde people
In his book, ou unde s anding and de ini ion o digi al echnologies is b oad. In
line wi h Peine e al. (2021), he aim is o a oid de e minis ic no ions o echnol-
ogy ha igno e sociocul u al powe ela ions and s e eo ypes o hei expec ed
use s. To do his, we sugges ha he s udy o echnology and ageing should no be
educed o echnologies explici ly dedica ed o ca e bu o also include e e yday
echnologies ha a e used o suppo ca e ela ionships and ca e wo k. The o -
me , he design o ge on echnologies, ha is, echnologies speci ically designed
o olde people, has al eady been s udied o some ex en . I has been c i ically
acknowledged o display an in e en ionis agenda, whe eas he la e , he use o
e e yday digi al echnologies in ca e o olde people, as Peine e al. (ibid.) sug-
ges , emains less explo ed and deba ed by academics and policymake s.
Ou ocus in his book is on digi al echnologies p esen in he e e yday li es
o ca e p o essionals and olde people ha ha e become inc easingly en angled
wi h digi al echnologies. This en anglemen conce ns de ices, applica ions, and
so wa e such as mobile phones, able compu e s and eleca e de ices, and eme -
gency esponse echnologies, bu also mo e a ge ed, assis i e (heal h) echnolo-
gies designed and p oduced o he pu pose o sel -moni o ing and medica ion,
among o he s. A majo i y o hese de ices and esou ces gene a e, s o e, o p o-
cess da a, and can hus be unde s ood as digi al echnologies. Today, hese ech-
nologies a e pa o he li es o olde people and ca e p o essionals, especially in
he p o ision o long- e m ca e o olde people in bo h ins i u ional se ings and
p i a e homes, bo h o which a e con ex s ha he chap e s in his book add ess.
Rega ding he use o he e m ‘olde people’, he scope o his book is also pu -
pose ully wide. While he ch onological age o 65+ is he mos common denomi-
na o o de ining ‘olde people’ in social sciences, as i is o he majo i y o
In oduc ion 5
he chap e s in his book, i is impo an o emphasise ha as a concep , ‘olde
people’ in ol es a a ie y o g oups anging om ac i e e i ees li ing he ‘ hi d
age’ o ail indi iduals in need o ound- he-clock ca e. To a oid language ha
has conno a ions o disc imina o y and nega i e s e eo ypes o olde people, he
e ms such as ‘elde ly’ and ‘senio s’ ha e been omi ed om he book apa om
e e ences o, e.g., legisla ion o p ope names o ins i u ions whe e hey appea .
Resea ch on ageing and (digi al) echnologies
A combined ocus on he phenomena o digi alisa ion, ageing, and ca e ( o olde
people) has been he opic o a numbe o edi ed scien i ic collec ions o e he pas
decade. Inc easingly, hese publica ions ha e aken a c i ical, in e disciplina y
app oach on ageing and echnology, b inging oge he schola s om social and
heal h sciences, ge on ology, social policy s udies, digi al sociology, an h opol-
ogy, and echnology and inno a ion s udies, among o he s. Consequen ly, many
o he publica ions ha e igh ly emphasised he need o in e p o essional and
in e disciplina y app oaches o inno a i e echnologies, some wi h he p ac ical
aim o helping ca e p o essionals o selec he app op ia e echnology o hei
needs (Chau and Osbo ne, 2018) o o deli e ca e in a mo e e icien manne ,
while o he s ha e aken o om a sociocul u al poin o iew wi h he aim o
widening he cu en cul u al and scien i ic unde s anding on he di e si y o olde
people as ‘a g oup’ o echnology use s (Ne es and Ve e e, 2019; P ende gas
and Ga a ini, 2015). Meanwhile, o he s ha e con ibu ed o he discussion on he
policymaking and discou ses ha ame public deba es on ageing and echnology
(Dominigues-Rue and Nie ling, 2016).
In e ms o heo e ical pe spec i es on ageing and echnology, science and
echnology s udies (STS) has been a pa icula ly ui ul s a ing poin o some
o he ecen publica ions (Henwood and Ma en , 2019). In sho , publica ions
eme ging om his backg ound ha e emphasised he need o unde s and he
use ’s ole in inno a ion p ocesses and o challenge de e minis ic unde s anding
o he domes ica ion o echnology in e e yday li e (Ös lund e al., 2015). Lup on
(2018), among o he s, has concep ualised digi al (heal h) echnologies as socio-
cul u al a e ac s and emphasised a need o in es iga e and iden i y he social,
cul u al, and poli ical unde pinnings o digi al heal h. Mos ecen ly, Peine e al.
(2021) ha e me ged he social scien i ic s udy o echnology and ageing unde he
concep o socio-ge on echnology by concep ualising ageing as a socio-ma e ial
phenomenon and d awing om STS and he s udy o ageing and echnology.
S udies eme ging om his exci ing line o heo isa ion emphasise ha he mean-
ings and uses we gi e o digi al echnologies a e always unde pinned by aci
assump ions, no ms, meanings, and alues. As a consequence, he design and use
o digi al echnologies a e subjec o human decision-making and in es ed wi h
hei make s’ es ablished ideas o hei use s – who may accep o ejec , esis o
igno e hese echnologies, wi hin he limi s o he a o dances o he echnology
in ques ion.

6 H. Hi onen e al.
This pe spec i e indica es ha he e is conside able scope o human in e -
p e a i e lexibili y in he use o echnologies. In e e yday li e, people a e, and
o en mus be, c ea i e wi h echnologies as hey come ac oss a numbe o digi al
de ices and applica ions ha ha e di e en unc ionali ies and a o dances. The
e e yday li es o olde people and ca e wo ke s a e hus cha ac e ised by g owing
ubiqui ousness and in e up ions, oppo uni ies, and obs acles in a se ice en i-
onmen ha is all oo o en cha ac e ised by sca ci y o ime and unp edic abili y.
As digi al echnologies become inc easingly embedded in he e e yday p ac ice
o ca e, ou book sugges s ha s udies on ca e o olde people should also ec-
ognise his embeddedness. Ca e wo k is a join accomplishmen be ween a ious
ac o s ha , as he chap e s in his book demons a e om di e en iewpoin s,
equi es con inuous o ganising, synch onisa ion, and a common o ien a ion om
hose in ol ed. Rega dless o he ype o echnology in ques ion, his book aims
o unde line how ca e a i s essence emains ecip ocal and ela ional, and how
he g owing embeddedness o digi al echnologies ewo ks and ( e)c ea es he
ela ionali y o ca e be ween human and non-human ac o s alike in ways ha a e
no sel -e iden ly posi i e o nega i e.
Besides ad ancing he cu en unde s anding o he human- echnology ela ion-
ship, p e ious esea ch on ageing and ca e unde lines ha he a ious and o en
con adic o y consequences o he embeddedness o digi al echnologies in ca e
o olde people should be no ed in policymaking and ac i e ageing p og ammes
(Gallis l and Wanka, 2019). All oo o en, ca e policies en ision solu ions o p ob-
lems, o e shadowed by echnological de e minism, and wi hou conside a ion o
he agency o hose in ol ed. In his book, we p opose ha he e is a need o
discuss digi alisa ion o ca e o olde people h ough e isi ing he exis ing heo-
isa ion and h ough o mula ing new amewo ks o s udy in e o s o c i ically
assess se ice p o ide s’, ca e p o essionals’, and olde people’s oppo uni ies
o digi al agency. In hei pa , he chap e s in his book demons a e how digi al
agency loca es a di e en le els, such as policy and cul u e, (wo k) communi y,
and he indi idual.
Digi al agency and ca e o olde people
Technologies and hei possible uses and implica ions a e o a la ge ex en cons i-
u ed when hey become used in p ac ice. The same echnologies may he e o e
cause e y di e en e ec s, depending on he con ex and he use (O likowski,
2007). Taking a c i ical pe spec i e on how digi al echnologies a e cu en ly
being implemen ed in ca e o olde people, his book pays close a en ion o
how echnology-based ca e in e en ions can limi o enable he agency o hose
in ol ed in ca e o olde people. This is no a ques ion o echnologies being bad,
good, use ul, o useless, bu a ques ion o how a speci ic echnology is imple-
men ed in a speci ic con ex om he poin o iew o hose in ol ed, as Nie ling
and Dominiguez-Rue (2016) also unde line. While we acknowledge ha in o mal
ca e emains he p ima y o m o ca e o olde people in mos Wes e n coun ies,
In oduc ion 7
he ocus o his book is on digi alisa ion om he pe spec i e o o mal a ange-
men s o ca e p o ision on he one hand, and om he pe spec i e o how dom-
inan discou ses and policies o ca e and echnology ame and posi ion olde
people as use s o co-p oduce s o digi al echnologies and se ices on he o he .
Embedding digi al echnologies wi hin p ac ices o ca e is ne e s aigh o -
wa d. To engage wi h echnologies in a meaning ul way in a digi al socie y, indi-
iduals need he abili y o con ol and adap o a digi al wo ld, ha is, hey need o
ha e digi al agency. The concep was coined by Passey e al. (2018) as a holis ic
and c i ical concep o o e policymake s, educa o s, and echnology leade s a
way o add ess social, ci ic, and economic well-being in a digi alised socie y. In
his book, he p oblems ha inno a ion, design, and echnology implemen a ion
ace a e aken as a e lexi e s a ing poin o assess he po en ial implica ions o
digi alisa ion in ca e o olde people. Mo e speci ically, he book akes he idea
o digi al agency as a pu pose ully loose, o e a ching concep ual s a ing poin
om which o add ess he ambi alences ha a ise when digi al echnologies a e
in oduced in ca e o olde people.
While he concep o digi al agency o iginally add esses ac o s in ol ed in
educa ion and lea ning, i can also help o o e come ins umen al pe spec i es on
digi al echnologies as ‘a solu ion’ o ‘ he p oblem’ o ageing when s udying digi-
al echnologies in ca e o olde people. Mo eo e , he concep o e s an oppo -
uni y o social scien i ic e lec ion on he de e minis ic no ions ha a e o en
a ached o echnologies and hei use s, especially as hey appea in inno a ion
and policy documen s on ca e and ageing. In his book, we unde s and he concep
o e e o heal h and social ca e p o essionals’ and se ice use s’ digi al compe-
ence, hei digi al con idence, and digi al accoun abili y. The goal o being able
o use echnologies o sel -iden i ied pu poses and o be able o modi y, de elop,
and he e o e con ol and manage hei use is a challenging one. Ye , his is wha
is inc easingly expec ed o indi iduals in con empo a y socie ies. In wha ol-
lows, we elabo a e on he possibili ies he concep can open o he s udy o digi-
alisa ion o ca e om he poin o iew o olde people and ca e p o essionals.
Digi al agency o olde people and ca e wo ke s
Digi al agency highligh s some o he c i ical, key aspec s o be conside ed when
implemen ing digi al echnologies wi h espec o he he e ogeneous na u e o
olde people as a g oup o echnology use s. The bene i s o digi alisa ion o he
olde popula ion a e ypically desc ibed h ough imp o emen o well-being, qual-
i y o li e, and h ough he suppo ha hey gi e o ageing in place independen ly
and, as Timonen (2016) would ph ase i , ageing success ully. As ecen wo ks by
Ne es e al. (2019) and Peine e al. (2021), among o he s, ha e poin ed ou , such
an o e ly op imis ic app oach o en elies on p oblema ic, ageis s e eo ypes con-
ce ning olde people as echnology use s – a ques ion widely discussed in social
sciences o e he pas 20 yea s (see Gillea d and Higgs, 2000; Chap e 5 in his
book). As hese s udies ha e shown, o e ly op imis ic assump ions on he bene i s
8 H. Hi onen e al.
o digi alisa ion o en ame olde people as ail and un-agen ic, while ailing o
conside he di e si y in la e li e in e ms o ace and e hnici y (see Chap e 4 in
his book), gende , educa ion, and ch onological age, no o men ion economic,
social, and cul u al esou ces ha a e c i ical o digi al agency bu une enly dis-
pe sed among olde people.
Digi al echnologies limi o enable agency o olde people – some imes in unex-
pec ed ways – as hey a e based on dominan discou ses and expec a ions de i ed
om inno a ion o ageing-in-place policies. Good in en ions do no always lead
o desi ed ou comes. Ins ead, he p ac ical implemen a ion o digi al echnologies
causes ea angemen o esponsibili ies and in e ac ions, and hus can nega i ely
a ec he agency o olde people as s akeholde s in ol ed in he p ocess. Fo one,
he solu ions o suppo indi iduals’ independence in la e li e o en come wi h he
p ice o g owing su eillance a home in consequence o ‘da a eillance’ echnolo-
gies ha blu he spa ial bounda ies be ween public and p i a e sphe es.
Whe he i is in ins i u ional se ings such as nu sing homes o in p i a e
homes, echnologies can wo k o objec i y hei use s. In e connec ions be ween
digi al and social exclusion among olde people can be mani old, as Buche and
W ede (Chap e 4) in his book demons a e. The same goes o he design and
de elopmen p ocess o new echnologies in which olde people a e in i ed o
join as co-c ea o s, as Lolich and Timonen (Chap e 3) poin ou . Mo eo e , hese
p ocesses can be biased and exclusi e, as hey end o be based on ageis p esump-
ions and emb ace he agency o hose in a p i ileged posi ion, as Mannheim e al.
(Chap e 5) sugges . Howe e , echnologies can also g an olde people mo e le -
e age as ac i e agen s, as he example o he use o senso loo in ca e homes,
o one, sugges s (see Chap e s 6 and 7). F om he poin o iew o agency, hese
examples all poin o he need o c i ical assessmen o he limi s o pu suing
olde people’s digi al compe ence, digi al con idence, and digi al accoun abili y
as de e minan s o ‘quali y o la e li e’ in digi al socie ies.
The same no ion o he need o unde s and si ua ional con ex and unde lying
bias owa ds echnology use s applies o hose wo king in he ca e o olde peo-
ple. In his con ex o wo k, digi al echnologies ha e been implemen ed, o one,
o a ionalise ca e asks h ough means such as igo ous use o ime managemen
applica ions ha help in segmen ing ca e asks and wo k p ocesses in o sepa-
a e ime uni s (Chap e 6). In hopes o s onge anspa ency o se ice p o i-
sion, wo ke s a e also held inc easingly accoun able h ough means o digi alised
eco ding (Hämäläinen and Hi onen, 2020). Heal h and social ca e wo ke s play
a c ucial ole in he implemen a ion o echnologies in o he e e yday p ac ice o
ca e. Ye , hei agency can be limi ed by nume ous ac o s a ising om unjus-
i iable p esump ions on hei digi al compe ence o insu icien guidance a he
wo kplace, and om changing o oles o di e ences in indi idual use p e e -
ences, no o men ion he e hical dilemmas ha digi alised ca e can aise in ela-
ion o he use s’ p o essional iden i ies.
P e ious esea ch (e.g. Hämäläinen, 2020; Pols, 2017) has demons a ed
o e and o e ha digi alisa ion does no sel -e iden ly suppo he p o essional,
In oduc ion 9
e hical goals o ca e. Ye , de e minis ic no ions o use s’ disposi ions, as well as
he a o dances o echnologies, p e ail. The chap e s in his book demons a e
how echnologies challenge ca e wo ke s’ possibili ies o manage and coo dina e
he wo k hey do. They o e a a ie y o iewpoin s on his, including how he
socio-ma e ial con ex s o digi alisa ion a ec he empo ali y and spa iali y o
ca e wo k (Chap e s 6 and 7), and how he adop ion o new echnologies equi es
u ning he use s’ aci and embodied knowledge in o codi ied and ans e able
aining and p o ocols (Chap e 9). The chap e s also show how echnology sup-
po a he wo kplace in luences he wo ke s’ in e es s and compe ence as echnol-
ogy use s (Chap e 10).
Digi al agency and ca e policy
The assump ions conce ning bo h ca e p o essionals’ and olde people’s com-
pe ence and capaci ies as echnology use s in he con ex o apidly digi alising
socie ies a e essen ially a ques ion o hei digi al agency. A ocus on agency in
his book b ings o h he e hical and p ac ical ques ions o ca e p o essionals’
and se ice use s’ digi al compe ence, hei digi al con idence, and accoun abil-
i y. The ac o s a ec ing use s’ compe ence and con idence as echnology use s
a e c ucial o c ea ing he condi ions in which indi iduals ha e con ol o e and
hei capaci y o adap o changes in hei social en i onmen (Passey e al., 2018).
The simul aneous p ocesses o apid ageing and digi alisa ion ha e esul ed in
heal h and social ca e policy e o ms ha do no sel -e iden ly suppo he goal
o imp o ing olde people’s possibili ies o meaning ul agency in a digi al soci-
e y. No ion on ‘inno a ions’, ‘co-c ea ion’, ‘accep ance’, and ‘ac i e ageing’ ha
policy ecommenda ions o en p opaga e can be p oblema ic when implemen ed,
as Lolich and Timonen (Chap e 3) and Mannheim e al. (Chap e 5), among o h-
e s, sugges . C i ical engagemen wi h policy de elopmen on digi alisa ion is
he e o e necessa y o unde s and he socie al ela ions o powe ha delinea e he
e i o y o employ ci izens’ digi al agency.
In gene al e ms, he book add esses c i ically he ques ion o digi alisa ion in
ca e o olde people by b inging abou bo h heo e ical and empi ical insigh s on
digi al agency om a a ie y o an age poin s ha can be use ul in assessing he
u u e di ec ions o ageing in a digi al socie y. This includes he in e es s and he
agency o se ice p o ide s, ca e wo ke s, olde people, comme cial ac o s, and
policymake s alike, and discussion on he co-cons uc ion o ageing and digi ali-
sa ion as social phenomena. The momen o do his could no be imelie , as he
COVID-19 pandemic has led o a pa ly o ced digi alisa ion o essen ial se ices
o all heal h and social se ice use s. O e all, howe e , he pandemic has had a
much g ea e impac on he li es o olde people han any o he age g oup. While
he isk o illness and dea h ypically inc eases wi h age, he lack o pe sonal
con ac wi h amily membe s, iends, and o he acquain ances due o he isk o
i us in ec ion has, in many cases, led o se e e social isola ion o olde people
(Eu os a , 2020).