Ageing and ambient assisted living: new landscapes of dwelling

DOI: 10.4324/9781003144441-7 This chapter has been made available under a CC-BY license. Introduction In his well-known Gulliver’s Travels, Jonathan Swift said that every man desires to live long, but no man wishes to age. However, getting older is still the only way we have found to live long, as stated by Sainte-Beuve (Deschavanne & Tavoillot, 2007). Longevity can be understood as the period by which a living being manages to survive longer than other individuals of the same species. Pascal Bruckner (2019) maintains that the possibility of extending life is one of humanity’s most extraordinary collective achievements. It is the most palpable reflection of the advances achieved in the health field. Longevity in human beings is a mirror of the success of the fight against some infectious diseases, mortality resulting from childhood illnesses, and childbirth complications, or those related to more advanced age groups. Hence, health has become an issue of social concern through ageing. Extended life prolongs age but not youth. Ageing is a biological process by which living beings become old, which involves a series of structural and functional changes that appear over time and are not the result of diseases or accidents. In recent decades, old age has tended to be stigmatised, as it implies the deterioration of the body. The tyranny of youth is, par excellence, the utopia of an unhappily old society. However, until recently, in many societies, old age was a synonym for wisdom. What age teaches us is the meaning and importance of nuances, learning to distinguish what is trivial from what is fundamental, for instance, love, beauty, poetry, art, and so on. Therefore, old age is not a synonym for resignation (Bruckner, 2019). Today, the gap between the biological life of people and the age of work and social retirement is increasing. This circumstance provides an opportunity to rethink how to live and how to plan for the important period in human existence that is entailed by ageing, which can span 20 or 30 years. In this light, old age becomes a precious resource. An older adult needs to continue to be eager in his or her desire to enjoy the world and to undertake new goals. Bruckner (2019) argues that in the third and fourth ages, one must persist in being, loving, working, and learning without ever abdicating to age. This idea means that old age should be as active and healthy as possible. However, the current social structures are based 5 Ageing and ambient assisted living New landscapes of dwelling Santiago Quesada-García 102 Ageing and Urban Planning on the life expectancies that were common after World War II, when 50 was the threshold for what was considered the beginning of old age. Currently, men and women over 50 are in a similar condition to those over 30. On the other hand, our society is immersed in a silent digital revolution based on communication, which is changing the manner of social interaction, participation, residential solutions, and even city models (Applebaum, 2021). Today, it is unnecessary to go out to the street to shop, work or debate a political issue; it can be done online (Echevarría, 1999). The current society is undergoing a rapid transformation in the way in which people transmit and receive information. It is a new communication revolution that is having significant consequences. Information and communication technologies (ICTs) have emerged as the application of scientific knowledge for practical purposes and have acquired particular importance. In this context, the notion of Ambient or Active Assisted Living (AAL) appears in domestic spaces to introduce technology-based services and assistance that enable older people to have a healthier, safer, and more comfortable life in their home environment for as long as possible. Ageing in the cities of the fourth digital decade According to the report on the ageing of the world’s population by the Population Division of the Department of Economic and Social Affairs of the United Nations (UN, 2019), in 2050, one in five people will be older than 60. The number in this age bracket will reach 2.1 billion, exceeding the number of youths between 15 and 24 years old. In addition, almost 80% of older adults in the whole world belong to developing countries, thus indicating that agedness is not exclusive to First World countries but rather is a general phenomenon (UN, 2019). The accelerated rhythm of ageing of the world’s population will impact the demand for goods and services, as well as social protection, health, housing, education, transportation, information, and communications. It will also influence the work and financial markets, family structures, intergenerational relationships, and, undoubtedly, the development of multi-level governance. Such a general impact will create a need for policies and significant urban transformations since, by the middle of the 21st century, 70% of the world’s population will live in cities, and this population will be substantially aged, as indicated above. By 2070, one in three Europeans will be older than 65 (European Commission, 2021). The active-to-inactive population ratio will reach one active to four inactive persons; this proportion is currently one to two. With this assessment, in recent years, the European Commission has developed a line of action that combines the uncertainty of the cost of old age due to disease, dependency, and other factors with the appreciation of the added value that older people bring with their knowledge, experience, and so on. The EU4Health Programme of the European Union (EU) 2021–2027 underlines that, to adequately face old age and achieve the best well-being in European societies, the systems must incorporate policies that promote health and prevent illness in order to decrease the impact on the economy, assistance, and social development (Figure 5.1). Ageing and ambient assisted living 103 Thus, the growing paradigm of healthy ageing arises based on developing and maintaining functional, physical, and cognitive capacities in a way that enables the well-being of people during their ageing process. This is achieved if they can perform, fully and autonomously, the Instrumental Activities of Daily Living (IADL) (Graf, 2008) while fulfilling their needs and vital aspirations. People’s functional, physical, and cognitive skills are influenced by both physiological and psychological changes and by aspects related to health or the presence or absence of illness. These capacities are determined by two factors that interact with one another. The first is the intrinsic faculty of each person, that is, the combination of their physical and mental skills. The second is the physical environment and social ambiance in which they live (Proulx et al., 2016). Physical spaces and environments, as well as the technology integrated within them, can be planned and designed to adapt to people’s attitudes and capacities. One of the most important actions to promote healthy old age is, therefore, the planning of adapted and adaptable environments. It is necessary to build a habitat – both individual and collective – that promotes the maximum quality of life over Figure 5.1 Trends in healthcare and their impact on a healthier architecture. Source: Prepared by the author, adapted from a design by Hyojung Kim and Barcelona Global Design in Lleó et al. (2015). 104 Ageing and Urban Planning the course of the constant evolution of human needs throughout childhood, youth, maturity and, especially, in the context of ageing (Robinson & Pallasmaa, 2015). This means thinking about architecture and the cities of the future with a view to meeting the individual and social demands generated by this growing demographic trend and giving priority to essential aspects for older adults such as experience and memory, accessibility and adaptation, functionality and diversity, integration and social interaction, as well as the meaning and use of habitable spaces and environments. These intangible values must be added to the growing technological influence caused by the gradual and unstoppable digital transformation that has surrounded contemporary society over the last three decades and is still far from complete (Quesada-García et al., 2023b). This transformation is a new kind of revolution – dizzying and silent – that is leading to changing attitudes in regard to the ways in which people and environments interact, habits of living, and the production of a definite change of mentality in the current society (Echevarría, 1999). Every day, people are more intensely and proactively seeking or demanding constant improvements to their quality of life by means of efficient environmental, health, and intelligent solutions that must be as sustainable, affordable, and integral as possible. The digital revolution incorporates innovative forms of communication that promote new methods of interaction through mobile devices, cell phones, television, and the internet, and entail a radical mutation in the relationships between people and between people and domestic objects. The common element in the majority of everyday devices is their technological essence. They are devices that are capable of gathering and processing data, which, thanks to the possibility of communicating with each other, makes them intelligent. This new interaction is characterised by three factors: a ubiquitous experience in high definition; the connection of electronic and home appliance devices with a range of services; and interactive communication between computers, telephones, tablets, or visual and touch recognition devices (Quesada-García & Pulido, 2012). Technology has become another component in the landscape of everyday life. The catalyst for this digital revolution has been the internet, which is a decentralised set of interconnected communication networks that enable and build a fluid information transmission network. The concept of the internet of things (IoT), coined by Kevin Ashton, first appeared in 1999 at the Massachusetts Institute of Technology (MIT) Auto-ID Center (Ashton, 2009). The IoT is a network of physical objects with embedded technology, such as sensors or software, capable of communicating and interacting with each other or the external environment. In a home, they are typically household appliances or technical items, including devices (such as thermostats, home security cameras, systems, lighting fixtures, etc.) that support one or several ecosystems and that can be controlled through devices such as smartphones or speakers. The connectivity of these products allows them to have some capabilities that are external to the physical device itself. These include the collection of data that can be analysed to inform decision-making, enable operational efficiency, and continually improve product performance. When these objects can change their Ageing and ambient assisted living 105 responses based on the data information and their own experience, they are called “smart objects” or “smart connected things” (SCoT). A smart object is not only a connected element but a product with effective interconnected management that improves its interaction with other objects and with people. It can be created as a manufactured product or by embedding electronic chips or sensors in non-smart physical objects. SCoTs are active products integrated by software and sensors, and they are connectivity that permits data to be exchanged between the product, maker, operator/user, and other systems. In buildings, the concept of IoT technology is applied to products used within a “SmartHome.” This type of home is made up of intelligent components, which are combined and reproducible in standardised models; smart objects that are designed to assist, in real-time, the domestic environment through the synergetic interaction of automation systems and technologies, materials, and innovative processes. To achieve that goal, an inhabited place must have a set of elements or subsystems that are interconnected with each other through mutual relations, with open, secure, and highly reliable software that acts as a whole according to general, pre-established rules. The response provided to the individual and collective needs of people by these assisted environments progressively transforms into demands for effective, sustainable, and affordable services, both for the open market and cities. As such, an osmotic and permeable process is generated between the offer of services and the implementation of technologies to enjoy them, in which the micro – the intimate home space – enriches the macro – the urban space – and vice versa. That is, there is an interaction between the domestic scale of the Smart House, the intermediate scale of the Smart Building, and the construction of a city that must become increasingly more intelligent each day (Mazziotta & Jenkins, 2016). The Smart City appears as a new urban model that is open in its definition; in it, the city is understood not as a physical, closed, and geographically defined element but as a network of a series of overlapping layers or grids which interact in order to improve their functioning and efficiency. The basic layer of a Smart City is the environment, on which other networks are superimposed, consisting of the following grids, layers, or systems: (a) information analysis and management; (b) water supply and purification; (c) waste and productive management; (d) energy generation and supply; and (e) urban mobility (Quesada-García & Pulido, 2012). Each one of these grids corresponds to an urban system that, in turn, consists of a multitude of interwoven nodes (Figure 5.2). These systems, which are equipped with sensors, communicate through a network that allows information management and decision-making. The purpose of this network organisation – multi-scale or fractal – is to facilitate the efficient response in real time to the constant flow of social demands. The Smart City is a network of networks that changes, mutates, and is in constant movement. Based on the persistent needs of society, it also adapts, incorporates new layers, modifies existing ones, builds new networks, and creates unsuspected landscapes (Quesada-García & Pulido, 2012). 106 Ageing and Urban Planning Figure 5.2 SmartGrids, layers, or networks that make up the Smart City. Source: Prepared by the author. In a few years, the services necessary to satisfy the demands and needs of the increasingly ageing population will constitute a new layer of the Smart City that must be designed and planned. Ambient and active assisted living: emergence of a new concept The application of new technological paradigms and means of management to the field of healthcare and older adults stemmed from the concept of ambient intelligence (AmI) at the end of the 1990s. The concept of AmI was originally developed by Eli Zelkha and Brian Epstein and their team at Palo Alto Ventures (Zelkha & Epstein, 1998) and was presented at the Digital Living Room conference, organised by Philips, and developed during the following decade (Figure 5.3). AmI refers to the use of intelligent assistance systems, embodied and integrated in different habitable environments, which create an omnipresent technological layer capable of transparent interaction with the inhabitant, observation, and interpretation of their actions and intentions. The objects can proactively interact with people where they are needed and are sensitive to both the user and the context (situational, spatial, temporal). The communication between the system and user Ageing and ambient assisted living 107 Figure 5.3 A timeline of key events and publications on AmI. Source: Prepared by the author. 108 Ageing and Urban Planning takes place in such a way that the device can act invisibly with the person and display a proactive behaviour by which it takes action in advance of a future situation rather than reacting. These assistance systems are designed to take control of a situation and make early changes, rather than adjusting to a situation or waiting for something to happen. The AmI approach implies that technology is designed by and for people rather than expecting the users to adapt to the technology, as has tended to be the case up until now (Losco et al., 2017). This is the main difference between IoT and AmI. AmI faces its application with a holistic view focused on the person. The concept of holistic (from the Greek holos, meaning whole or integral) refers to the notion that the whole is not the sum of the parts, nor can it be explained by analysing how its separate components function; rather, it is imperative to do so integrally, contemplating the reality of its complexity. A holistic perspective implies overcoming the prejudice of the incapable individual and replacing it with the notion of the real person (Mace, 1998). The solutions of AmI aim to fulfil seven of the foundational principles of Universal Design – Design for All in Europe – (Connell et al., 1997). This is a process of designing products (devices, environments, systems, and processes) that can be used by people with the broadest range of skills in the widest range of situations (environments, conditions, and circumstances). Also, AmI is not limited to a straightforward and unique and connected relationship between objects or between the product and user but rather extends to all of the components of the multidimensional space (ambient) surrounding the inhabitant – the floor, walls, ceiling, paths, spaces, clothes, and so on (Koolhaas, 2014). The ambient begins to be “intelligent” when it does not need to be calculated or programed. The environment can learn the preferences of the inhabitant, constantly adapting the parameters of the system and, therefore, improving the inhabitant’s comfort, well-being, and quality of life (Aarts et al., 2001). AmI offers a new paradigm in which people can use technology through an environment that is aware of the context and in which the technology is adaptive, responsive, acceptable, and useful to their needs, habits, gestures, and emotions. To achieve its objective, AmI first tries to identify the characteristics of the context of each inhabitant after recognising the specific tools used and the activities they performed by this person. With this data, the activity is broken down into several components, levels, and sublevels that are recomposed coherently in an adequate design capable of supporting a certain lifestyle. It is a method reminiscent of that presented in 1936 within the context of architectonic standardisation by the German architect Ernst Neufert in his well-known book Bauentwurfslehre (edition in English: Architects’ Data) (Figure 5.4). AmI can contribute to technological advances in the human habitat with particular reference to services for people with specific needs and who may require specific solutions and, therefore, are at several degrees in relation to technology (Figure 5.5). Since its introduction, AmI has become part of the core strategies of many of the world’s leading technology companies, such as Google, Amazon, and Microsoft. Ageing and ambient assisted living 115 the complexity greatly increases when several technologies must be combined. In a market controlled by companies with patented products – a market in which corporations aspire to be dominant providers – technological barriers are created by the devices’ interoperability (Wrede, 2012). In contrast, it is worth mentioning the home products available from large companies, such as Securitas Direct or Konica, and, most importantly, from the GAFA (Google, Apple, Facebook, Amazon) multinational telecommunication companies. These companies have managed to introduce personal assistants, such as Alexa and Google Home, into the population in a highly effective manner. In the near future, together with televisions and cell phones, these assistants will be the doorway to the services these firms will offer to older users. The capillarity that the GAFA has achieved in the market contrasts with the scarce implementation of the products arising from the EU’s AAL Programme. The AAL Programme was initiated with the purpose of creating a technological business tissue in the European environment that would be capable of producing ICT products and services aimed at improving the quality of life of older adults. However, technological innovation is necessary yet insufficient for a space to meet the vital needs of its users. Developing such spaces involves creating environments and surroundings where human beings can feel fulfilled with complete awareness, autonomy, and freedom. A house is not a machine for living, as Le Corbusier said, but a home to be inhabited that is able to promote personal fulfilment. People’s quality of life also depends on intangible factors and values that do not depend on technology. The identity, character, and quality of the physical environment are intimately related to the vital social and cultural experience of each individual. In other words, the cultural and symbolic components of spaces have a special impact on people’s emotional and cognitive stability. If an older person can inhabit a personal space and preserve a sense of belonging to a place with autonomy, he or she will have a better quality of life. In the design of space, residences and homes for old people that succeed in creating a sense of belonging to an environment are very important because each individual’s history, memories, and experiences are interwoven with the spaces in which they reside and the spaces in which they have lived. Another, and perhaps the greatest, barrier to the complete implementation of AAL is the transformation of Ambient Assisted Living syntagma from the denomination of an EU research and funding programme into a conceptual paradigm for intervention in domestic and urban spaces beyond the one-way service-user relationship by means of a technological product or service. Under this new paradigm, the term extends to the multiple dimensions surrounding people, including their cognitive and knowledge aspects, such that the interactions are not only instrumental but, more importantly, meaningful (Figure 5.7). The notion of AAL needs to be updated, but above all, it requires a definition of the environment or surroundings in which people live, as well as the implications of the former for the latter. The theorisation and conceptualisation of AAL are needed not only in terms of technological assistance and services but also 116 Ageing and Urban Planning in considering all of the inherent aspects of inhabited space. In turn, the meaning of a new spatial design paradigm must be explored: what it consists of and how it may respond to the changing needs of a growing and constantly evolving ageing population. The lack of an articulated theory on what AAL means, as well as its impact on the architecture and planning of cities, is a major limitation that prevents it from being implemented in a sustainable, consistent, and ongoing way. Meaningful AAL: an open conclusion Despite the barriers (technological, institutional, economic, social, and theoretical) to the application of AAL, architects, urbanists, and engineers have begun to outline a new way of understanding and designing environments to be inhabited – in the mid-and long-term – by populations that change, evolve, and age. In due course, AAL will be implemented because of the efficiency, comfort, and well-being it entails. The evolution of the notion of assisted living in the next ten years will come about through significant advances in cloud-based service technologies and standard service platforms, the development of the IoT, and e-trade portals that will promote new business models that will serve to permeate this stratum of the older population. Services based on a web environment e-cloud will open a new way of incorporating each user’s experience in co-creating content. AAL will serve to improve the services of the providers, who, in turn, will respond to the specific demands of the users. This should also help public administrations better plan their services to quickly adapt to changing social needs. Figure 5.7 Meaningful AAL. Source: Prepared by the author and adapted from a design by Hernández Perdomo and Iseco Sistemas in Lleó et al. (2015). Ageing and ambient assisted living 117 With the correct AAL implementation, home users will be able to establish personalised solutions according to their needs, desires, and economic resources, as they would with decorating and equipping their homes. However, for this to occur, technological platforms are needed based on the standards that support the interoperability between the different manufacturing and provider services distributed in the network. These platforms still have a long way to go in order to reach this technological standard. Four technological requirements must also generally be met (Flórez, 2008): • Natural interfaces: Interaction systems between people and computers must be intuitive to use, sensitive to the context, and multi-modal, that is, multi-user, multilingual, multichannel, and multipurpose. They must be based on the most common methods of human interaction, such as voice and gestures. The most paradigmatic example is the Nintendo Wii, which revolutionised the console world due to the fact that it has a more natural command than other games. As a result, it enables greater immersion despite its narrative graphics and despite the fact that its quality is lower than that of the competition. • Dynamic networks of massively distributed devices: For multiple devices to work together efficiently, they must communicate through either wired or wireless networks. These networks must be able to adjust and reconfigure themselves based on devices’ presence, absence, or errors. An example of this is when someone travels to a new country and their device automatically connects to the network, allowing them to make calls and use other functions without needing to reconfigure their device manually. • Comfortable hardware is the integration of devices with processing capacity in everyday objects, such as vehicles, furniture, clothing, toys, home appliances, etc., that are not annoying to use and that are transparent. One of the basic lines of work is wearable computing, which is developed in accessories such as watches, cell phones, and clothing. These devices have sensors that measure vital signs and send data or alarms if necessary. • Security and reliability: the entire technological layer of intercommunicated and omnipresent devices must be secured against indiscriminate use. For this, robust systems must have built-in information encryption methods and authentication mechanisms that use, for example, biometry-based techniques (fingerprints, iris, voice, etc.). The intelligent environment must be capable of maintaining, extending, or adapting to the evolution and changing needs of ageing people in such a way as to ensure that they have healthier, safer, and more comfortable lives with more personal autonomy and that they maintain vital contact with their cultural and social environments for as long as possible. However, as mentioned above at the end of the previous section, AAL as a paradigm or concept of design must not be limited to providing technology-based services. The reason for this is that although technology is a catalytic tool for some of the material challenges that society faces, it is insufficient in and by itself to respond to human needs. 118 Ageing and Urban Planning The relationship between technological innovation and social or cultural references places the architectural project at the centre of the search for solutions that synthesise needs, behaviours, and interactions between the environment, technology, and people. Architectural design acts as a stimulus for a broad search for solutions that are not just the result of solving one technical problem. Architecture, as both an art and a technique, builds the daily scene of the habitat and gives meaning to the places and spaces that people inhabit. Through the meaning that architecture gives to spaces and environments, human beings can relate to the values that transcend them as individuals and connect them with their vital, social, and cultural realities (Quesada-García & Valero-Flores, 2017). Taking these considerations into account, with the progress of AAL, it will be possible to build assisted environments that can intelligently and emotionally interact with the users of those spaces as an exo-brain or at least enable them to build their own exo-brain. Architecture, as a technique, will integrate intelligent assistance systems into buildings embedded within environments in such a way that they may interact invisibly and proactively with the occupants (Figures 5.8 and 5.9). Figure 5.8 Design of rooms for an Alzheimer’s disease patient. Source: “Laboratorio Tematico: Margherita Bolgiani, Alessandro Radice, Jessica Rosino” workshop directed by S. Quesada-García at Politecnico di Milano (2019). Ageing and ambient assisted living 119 This will enable the creation of assisted spaces that promote a healthier, safer, and more comfortable life – one in which each person adequately manages and controls his or her everyday physical reality with more personal autonomy. However, architecture goes beyond a mere technique or the application of technological systems. Architecture, as a two-thousand-year-old art, also builds spaces with compositional and formal resources that provide them with a meaning that transcends their intended function. This makes the space comprehensible, and the occupant may find a narrative, a symbolic value, and a sense of belonging. Architecture reconstructs connections with highly codified and symbolic cultural circuits in such a way that the habitat, in addition to being a refuge and an aid, is, as Roger Bartra says (2014), a cognitive prosthesis of the human being. The challenge that AAL presents as a new paradigm of dwelling consists of knowing how to design spaces that can behave as a kind of collective and individual exo-brain – one that is capable of adapting to the gradual demands and needs related to the evolution of the ways of life associated with the increasing longevity of the population. This challenge also extends to other scales of use, which range from the collective spaces of buildings and facilities to the public spaces of cities. In the near future, cities will have the capacity to manage, share, and transfer data and information to facilitate governance decisions in real time. The confirmation of this new city-network model provides a glimpse into the solutions in response to the older population’s needs, which will play a primary and particularly Figure 5.9 House for six older adults. Source: “Laboratorio Tematico: Margherita Bolgiani, Alessandro Radice, Jessica Rosino” workshop directed by S. Quesada-García at Politecnico di Milano (2019). 120 Ageing and Urban Planning determinant role in city planning. Future intelligent cities will add layers or grids dedicated to healthy ageing to their configuration layers or grids. These cities will consist of adapted and adaptable housing, as well as facilities and services that can be used by a population that will constantly evolve and demand new residential solutions. Future urban models should continue to be developed with great care being taken in regard to the inclusion, in the city planning and housing design, of decisions that, under the apparent objectivity and neutrality associated with technological solutions, are closer to Orwellian control than to the scope of freewill cooperation: the polis. Acknowledgements This work has been possible thanks to the results obtained in an R&D&I research project and funding obtained from grant PID2020-115790RB-I00 funded by MICIU/AEI/ 10.13039/501100011033. References AALIANCE. (2009). 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