A framework for the acceptance of gerontechnology in relation to smart living

Despite the wide availability of telecare devices, the economic pressures, and the claimed benefits, the uptake of telecare services by older people is disappointingly limited. Much research is spent on finding out why the telecare acceptance is so much less than expected. Ease of use, or rather lack of it-a seemingly likely cause-is difficult to assess since the traditional usability criteria do not apply well to the daily life of older people. Acceptance in the social environment plays an important role, sometimes in a positive sense, but mostly in a negative one; however, social environment is all but impossible to manipulate. What does delay acceptance is the lack of standardization, which, in turn is also due to the fact that the impressive technological progress of the past decades has largely bypassed the field of assistive technology and health care. Another negative factor is cost. Though the price of devices has come down appreciably in recent years, system architecture and installation are getting more expensive and increased functionality goes hand in hand with higher cost. Next, during the actual running of telecare systems, successful operation has to compete with inherent difficulties of decision making in a noisy context. Making correct diagnoses is necessarily connected with false alarms, which may render the telecare system unusable. This is exacerbated by sources of unreliability in the system as a whole, like falling sensors, disconnected leads, empty batteries, and erased memories. In the light of these difficulties, traditional Technology Acceptance Models (TAMs) are focusing on a very small part and then probably the wrong one of the whole complex multistage decision process in implementing a telecare system. As it is, the comparatively immature state of telecare systems is up to now a multisectoral issue, in which stakeholders of different economic sectors operate mostly independently. Early stakeholders take decisions which later ones have to accept, up to the client as the end user, who also has to accept, but often does not. In a confusing situation like this, where the client is confronted with a system he or she has not chosen, it is doubtful that models based on a theory of rational behavior like the TAMs or Innovation Theory are valid at all. What should be minimally done on the basis of these observations are three things. First, an effective business case should be developed to run a telecare system-currently absent. Second, in addition to regulation, there should be a strong effort in the area of standardization. Finally, telecare should become a product that older people want, not one they have to accept.