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Design and elders: The Presence project

Imagine a world where every second European adult is over fifty years old. And where two-thirds of disposable consumer income is held by this age-group. By 2020 this will be a reality. There will be huge demand for services that enable older people to live independently in their own communities as they age. But although it is potentially huge – health care alone represents nearly eight per cent of Europe’s GDP – few people or companies understand this emerging market. There is no category in the DOW index for services in which elderly people communicate and care for each other using new information tools and services; investors and entrepreneurs seem blind to the potential of new markets fuelled by the changing lifestyles and considerable financial resources of many elderly people. (I wrote this chapter for an American Centre for Design book, but I do not recall ever seeing a copy).

Imagine a world where every second European adult is over fifty years old. And where two-thirds of disposable consumer income is held by this age-group. By 2020 this will be a reality. There will be huge demand for services that enable older people to live independently in their own communities as they age. But although it is potentially huge – health care alone represents nearly eight per cent of Europe’s GDP – few people or companies understand this emerging market. There is no category in the DOW index for services in which elderly people communicate and care for each other using new information tools and services; investors and entrepreneurs seem blind to the potential of new markets fuelled by the changing lifestyles and considerable financial resources of many elderly people.
Governments, too, are stuck in a negative mind-set: they fear that social, welfare, and health-care costs are going to escalate alarmingly, and are uncertain how best to react. As a result, perhaps the greatest of human achievements – the addition of 25 or more years to the average European lifespan in the space of three generations – is all too often see as a problem, and not an opportunity. Presence (www.presencweb.org)is a two-year programme that brings together an international group of researchers to begin to fill this gap.
Social computing
These design and business issues converge in the concept of ‘social computing’ – a theme which informs an important European Union programme called i3 (it stands for Intelligent Information Interfaces www.i3net.org) – of which Presence is a part. i3confronts the question: ‘how may we use design to develop new forms of public and personal media in order to meet new social needs?’. Twenty five i3 projects, with an aggregare value by now of 100 million euro (about $100 million) involve industrial companies, design groups, social research and human factors specialists, and real communities, all over Europe. Presence is a two-year programme that brings together an international group of researchers designers and industrial partners from Norway, Italy, The Netherlands and the United Kingdom. There are eight partner organisations, and more than 25 people are actively involved with this project.
Beginning in 1997, the project team set out to challenge stereotypes of older people as a predominantly frail, needy and disabled; their investigations focussed instead on the positive possibilities of ageing – even to see elders as knowledge assets. To reinforce this positive bias, the team decided on day one to work with groups of real people in their own communities, instead of taking the more conventional approach of generating ‘user profiles’ based on statistical and therefore abstract information.
Three ‘test-sites’ were chosen, each with its own individual characteristics and cultural roots. One was in Oslo, an affluent neighbourhood of more highly educated people who work with computers and are learning to get onto the Internet. A second community was an inner city area in Amsterdam called the Bijlmer; people from over 92 different countries live there. The Bijlmer is perceived by many Dutch people to be a ghetto, a really bad neighbourhood although, s we shall see, the people who live there see it differently. The third test-site was Peccioli in Italy, a small rural village. Between them the three communities cover the European spectrum – from North to South, urban to rural, from native to immigrant, from rich to poor, and from the extended family to fragmented family structures. The diversity to be found in just three test-sites was almost literally infinite.
Mapping communication flows
Combining traditional research techniques with new design and user-driven methods, which I describe below, the Presence team set out first to map the way communications flowed in the three communities. These ’maps’ did not just focus on so-called ‘purposive’ communication – letters to the bank, calling a taxi, a town-hall meeting – but also embraced all kinds of social and cultural communications – the many ways people build relationships, articulate their needs and fears, and interact informally with friends, family, carers, officials and so on. The dynamic of the project was top focus on the people themselves, their needs, their habits, their frustrations, their daily life. Information was also collected on demographics, how many people lived in the communities, how much money they had, and so on; but the soft, qualitative stuff proved more inspirational for the designers, when their turn came.
This first phase strongly reinforced our team’s intuition that older people want to be more ‘present’ in their communities, to sustain active fulfilling and independent lives; to develop new communication skills; to increase their involvement in the local community; and thereby to develop a fresh sense of purpose, self-esteem and belonging. Apart from this emerging insight into what it is like to be old in Europe today, the early Presence investigations into communication patterns identified blockages and dysfunctions into the communication contexts of elderly people: these blockages or gaps became a list of service and product opportunities for people of all ages.
Researchers also used maps to explore the psycho geography of each territory – what designer Bill Gaver called the “emotional typology” of the local sites. On a map of the Bijlmer people were asked people to put red yellow and green stickers to indicate where they felt afraid, cautious or safe in, respectively. On another map people in Oslo were asked to mark where in the library they go daydream, where they go and be comfortable, or where they would like to go and can’t. In Peccioli the citizens were asked, where would the landmarks be? – and thy were given stickers of New York, everything from the statue of Liberty to a junkie on the street shooting drugs. And they had to ‘map’ these images onto a small Tuscan village.
This was a complex, messy, interactive process. Presence researchers worked in short cycles: talked with people, developed some ideas, showed these ideas to the people, got feedback, changed ideas, talked with the people again. They used conventional research methods, such as focus groups and questionnaires, but also developed new methods: maps that were annotated; postcards with questions on them were people wrote stories about themselves; photo albums of their own lives with hand-written stories about that.
Sidsel Bjornby, a social scientist who worked with the elderly people in Oslo, organised a series of so-called ‘dreams and dreads’ workshops. Recalls Bjornby: “we wanted to go deeply into how they felt for themselves in the future. At first we went through technology trends, discussing research from Norwegian Telecom; right then we found they were very
eager listeners to these trends and were not at all as afraid of the subject (technology) as we thought they might be”. A second workshop on social trends was also surprising. Here you had a group of elderly people who live in the most affluent part of Oslo, all professional people, and fairly well off, and they regretted the social consequences of economic developments in Norway: people had become more remote from each other, and were not so concerned about each other as they used to be. There was talk of it being a (socially) colder society. and people were afraid technology might exacerbate these negative trends.
After each discussion, the participants in the discussions were asked to go home and write postcards from ‘ten years in the future to somebody living now’. Some sent text, others drew images. Sidsel Bjornby recalls one imaginary postcard to a grandchild that said: “I enjoyed so much being present at your birthday party even though could not be present in person because I was sick at home. I could hear you play the piano and I could see everybody sitting around the table and all my relatives being happy. Thankyou”. This same lady also wrote postcards expressing concern about the future. ” She was worried that she would go into a nursing home and would have nobody to talk to because all the ones with any brain would be sitting in the Internet room and nobody would come and visit her”, recalls Bjornby.
” This simple device (postcards) taught us that elderly people can be a lot more open and creative in expressing their concerns and dreams about the future than we give them credit for”. Sidsel Bjorneby is ruefully aware now that the role of researcher and researchee are fluid: “one of our people said how interesting it had been to learn how young designers think!”.
Researchers at the other sites also used story-telling to get deeper into the social context. Danielle van Diemen, who led research in Amsterdam’s Bijlmer district, organised three-weekly sessions for a group of 25 people from Dutch, Caribbean and Indonesian descent. “We tried role playing and acting-out as a way to help people make a step from what is, to what could be”, recalls van Diemen, “and in particular to to communicate a part of their lives
which are hard to express in language”. The group therefore used visual tools, too, to express images, ideas, and memories; these in turn stimulated further role
playing and acting out – with or without designers being present. They formulated slogans which expressed their opinions, fears and thoughts. As a result, Danielle was able to gather information about a community which many other researchers have found extremely difficult to engage with. She concludes: ” I have discovered just how hard it is just to
imagine yourself being old. Maybe you can’t imagine it – which in itself is a strong message for designers. Don’t ever assume you know what people want”.
So too in Peccioli, in Italy, where research co-ordinator Cecilia Laschi concludes that the experience of being old is itself changing rapidly. “Being elderly now is very different from the elderly just a few years ago; and so our results – you have catch them before they change”. And this was in Peccioli, a small rural village, 20 per cent of whose citizens are over 65. Overall educational levels in Peccioli are low. It is also rather isolated: it is a rural area with no public transportation to the village centre, which adversely affects the social connectedness of people living there. The dominant social relationships are within the families, or with neighbours, who also provide assistance when needed. Using the cultural probes developed by the designers, and more traditional techniques, Laschi’s group finally prioritised three areas of possible communication need: sociability; the maintenance of knowledge and experience; and the need for assistance.
Cecilia Laschi recalls her pleasure and surprise at the receptiveness of elders in Peccioli to new communication concepts – as long as they could be deemed to be useful, and usable. Laschi emphasies that elderly people interpreted ‘useful’ in broad ways. “Inspirational design concepts were as well received as those that were more narrowly functional” she recalls; “they were not especially motivated by scenarios about practical personal assistance in case of disability, or something like that; they were just as enthusiastic about ways to know what their relatives are doing at any time”. (Someone told Laschi proudly that a big proportion of mobile phone sales in Italy are by mothers for their sons….)
These processes generated an enormous amount of feedback. In the case of the cultural probes, designers Tony Dunne and Bill Gaver received 600 maps, postcards, photographs, and other items. The team distributed disposable cameras with the packages, repackaged to fit into the rest of the probe materials, with requests on the back ranging from “show us the picture of what you will wear today” or “what you will carry in your bag?” to “take a picture of something ugly, something beautiful, something interesting, something boring”. The designers asked people to use a final three shots for things they would like to show us to let us know more about. The postcards, the maps, all the items could be self addressed and stamped so they could be returned to the designers separately. Returning from field trips to the various sites Gaver’s postman was dismayed to find he had to deliver huge amounts of mail.
From feedback to feed forward
The next stage was to develop a new round design concepts in response to the most recentfeedback. One design team, led by Elena Pacenti at Domus Academy, Milan, developed design concepts based on the notion of emotional communication. Recalls Pacenti: “the elderly we met were mostly active people, socially engaged, and all of them with good relationships with their family and friends. Our main objective and the objective of our work was to reinforce such relationships with the elderly and the local communities and with their families and friends. We explored new communication languages, new social media and new collaboration spaces”.
The Domus team organised its next round of scenarios into three concept areas: sociability, knowledge and experience, and assistance. Among several sociability scenarios were a talking television which allows older people to find out who among their friends is watching the same programme as them, and to exchange audio, video and written messages about the programme in real time. An active portrait would help elderly people participate in their grandchildren’s’ lives, even if they do not see them often. (The portrait – some kind of display – shows still pictures of the child at school, playing with friends and so on. The child’s image superimposed on the screen changes in response to what he or she is feeling. The older person can use the device to exchange audio or video messages with the child). A related concept is called active cameo; similar to the active portrait idea, it is worn as a pin or a necklace, and becomes warm when the child wishes to send ‘warm feelings’ to the grandparent. An idea called hot house enables people to ‘decorate’ the house with traces of loved ones; coloured circles appear periodically on walls and surfaces to display messages sent by grandchildren – with graphic maps showing where they are at the time. A scenario called eye on the town allows older people to ‘sample’ – through a smart television interface – what is going on in the town’s busiest bars, streets and squares; one variation – talk about it – enables the elderly Epson to talk with a friend about what they have both seen or heard.
The knowledge and experience scenarios focussed on the idea of elderly people as valuable knowledge assets. In memory traces so-called ‘soul panels’ are attached to the noticeboards of public buildings such as churches or community centres. These panels display information about events that happened there in the past. Older people write, edit and maintain these information feeds. A related system called Can I help you? allows tourists to contact elderly people with specific local knowledge from a central information point via videophone and ask them questions directly.
Among the many product concepts developed by the Italian team, one in particular – developed as part of as third group on the theme of ‘assistance’, an called Nonnogotchi – caught everyone’s imagination. This Tamagotchi-like system is based on two wireless but directly connected devices: the grandchild has Nonno, and the grandparent Gotchi. The system enables the grandchild to remind a grandparent when to take their pills or measure their blood pressure. The Nonno bleeps when it is time to take a pill; the child sends a message to a screen in the old person’s house, or activates a buzzer on the Gotchi, to remind them it is time to take the pill. Each devices monitors traffic between the two so that if, for example, Grandpa is silent for a while, the grandchild’s device will mention this – and the child can make contact to make sure grandpa is ok and, in one scenario, send a suggestion that he goes out for a walk. The Nonnogotchi has already been prototyped and tested among the Peccioli and Oslo communities and from the feed back received the concept is being refined further.
Beating the Bijlmer blues
Meanwhile in the Bijlmer, designers Tony Dunne and Bill Gaver – both tutors at the Royal College of Art in London – were discovering that although the place has a bad reputation in the Netherlands, people who live there are proud of the place and lead rich and fulfilling social lives. Having arrived to solve short term problems such as day-to-day security, the designers shifted focus to communication concepts that would challenge negative images of the Bijlmer held by people who pass by it every day.
Over the next few months there emerged uses of electronic technology to provide a new facade or interface with the Bijlmer that would engage car users and train passengers passing by the area. One idea was a roadside projection system with photographs developed in local photo shops in real time to provide glimpses of every day life. Another idea was to project a home-made (in the Bijlmer) soap opera. In another concept, image scanners are used at home by elders and other inhabitants to capture and project images and words on so-called ‘slogan furniture’ sited in outdoor areas.
On a parallel track, Dunne and Gaver developed a concept called ‘radioscapes’ in Peccioli, the small Tuscan village – sounds captured from different locations in the beautiful countryside and fed back into the community by radio. “We came up with the idea of ‘social transmitters’ that might allow a kind of chat space to develop”, recalls Dunne; “these transmitters might be distributed in the countryside – perhaps attached to animals to allow them to enjoy the sounds of the local countryside. The original idea was to hang these transmitters around the necks of cows – until it transpired that the cows of the designers’ fantasy were in Holland: they only had chickens in Peccioli. “The idea was that having been lost for days, everyone’s favourite chicken was broadcasting again” said Gaver defiantly, having scaled down the needed devices. Finally, one of the local people prompted the designers to make the radio feeds available to tourists passing through the area: they might be able to pull into a lay-by and hear – on their car radios – locally-broadcast birdsongs, half-audible chat in the village square, the sounds of someone making wine. Gaver and Dunne later came up with an extraordinary computer interface for their radioscape idea,
Design revolution
Presence is an example of a revolution that is transforming the way our products, systems and cities can be designed. Both public and private sector organisations are discovering ways to deliver more value in their services by involving user communities directly and early in their development. The concept of user involvement is not that new, of course: telecommunication and software companies routinely give prototype or ‘alpha’ products to thousands of users during the development process. Indeed, most large-scale computer or communication systems are never ‘finished’ – they are customised by their users continuously, working with the supplier’s engineers and designers. But this approach is normally only found in high-end, software-only services. Gillian Crampton Smith, professor of interaction design at the Royal College of Art, reflected later: “in traditional user research, you see what peoples’ problems are, then you propose ways to solve them. But this entails mapping solutions to whatever already exists. In Presence, we were looking for opportunities, rather than solutions”. The key element in the Presence: elderly people were actively involved – along with designers, social researchers, and companies – from the start. Recalls Bill Gaver: “from the very outset of the project we wanted to explore a design centred approach, different from the more usual system of user-centred or technology driven approaches. We wanted to direct the conversation towards ideas or concepts that the elderly people might not have expected. Part of our strategy was actually to embrace subjectivity, provocation, ambiguity – and it seemed to work”.
But turning consumers into producers is easier said than done. One lesson learned in Presence: approaching citizens in a patronising way will quickly turn them off. Unless a project team is motivated by the desire to empower people – not to ‘help’ them -these real-time, real-world’ interactions will not succeed. Designing with, rather than for, elderly people raises other difficult process issues. Project leaders have to run research, development, and interaction with citizens, in parallel, rather than in linear sequence — the equivalent of parallel processing in computer software and, for that matter, in the human brain. This approach to innovation also raises difficult questions about current business models: who pays whom, for what, when ‘consumers’ add value to a system by being part of its development? The lesson from Presence is that in the information age, innovation is about re-inventing value – not simply adding value to existing service or product concepts.
Hybrid worlds
Presence has also raises important issues to do with the design of so-called ‘hybrid worlds’. When new multimedia technologies and internet first appeared, there was excited talk of ‘parallel worlds’ and escape into a ‘virtual reality’. Now the fuss has died down and we are still here- in the same old bodies, on the same old planet. Except that things are changing – in subtle ways – as information and communication systems permeate more and more of our everyday lives. Technologies may be converging – but information devices are dispersing and embedding themselves in our environments. As computing migrates from those ugly boxes on our desks, and suffuses everything around us, a new relationship is emerging between the real and the virtual, the artificial and natural, the mental and material. Presence confronted designers with wholly new questions about the qualities we need to make the new hybridity work.
One of the over-arching themes in all i3 projects is ‘territory as interface’ -not just looking at interfaces based on personal computers, but also at much broader ways of interacting with information and networks of information. Most of the Presence scenarios turned out to be hybrids between real space and digital space. Scenarios for mediated conversations in Peccioli, for example, between grandparents and their grandchildren, were a hybrid type of space with physical devices (for example, the Nonnogotchi) and digital communications. Such scenarios are at first sight about designing physical places, physical products for people to use in their everyday lives. But these are all overlaid with information and networks of information – a mixture of hardware and software, multifaceted design of devices and services and new kinds of social interactions enabled by media. Roger Coleman, director of another UK partner in Presence, DesignAge, and co-ordinator of the European Design for Ageing Network, draws a parallel with architecture: “we know that the way you design buildings affects the relationships people have within them. The way they relate to each other, and the shape of physical space, affects the shape of relationships. And I think information has the same kind of potential in reverse. That’s why we didn’t just transfer qualities of the physical world into the digital world; we overlapped one with the other”. This opened up a new dimension of design, says Coleman, “the aesthetics of relationships. Relationships mediated by the things we design are really quite different; we knew that from our history of using telephones – but the internet adds another, rather strange, dimension that we are only beginning to understand”.
Strange relations
Another strange proposal was to stop treating elderly people like sick children and to start treating them as knowledge assets – to exploit systematically their experience and connections. Marco Susani, director of the Domus Academy research centre in Milan, was militantly opposed to sentimentalism about elders: “Old people know things, they have experience – we need that”, said Susani. “Looked at this way, projects to enhance the connectivity of elderly people via internet become an investment, not a welfare cost”. All designers need stimulation and feedback: Susani’s idea is that users can be ‘antennas’ to help designers understand what’s happening out there in the real world. “We developed a reciprocal fascination with each other, a kind of courtship”, reflects Susani of the Presence team’s interactions with the various elderly partners in the project “I am not allowed to say flirting, because they told me in English it is not so correct, but anyway a kind of seduction between two kinds of actors – one pulling on a certain side – that “what if?” side – and the other pulling on, not so much the other side, but being a contrary element. That created energy.”.
Gillian Crampton Smith, professor at the Royal College of Art in London, is excited by what she seeds as a new kind of design, “design that does not expect a brief, that has time to react and interact, a design that steers, that anticipates, that grabs opportunities, that has
dialogue with the people who are going to use it. It means design with different attitude, which is fast and visionary, design that doesn’t plan the future, but simulates possibilities, and delivers “what if?” more than the “what is that?”.
Future Presence
There’s a lot of money to be made in all this. The potential market is huge for systems and services to do with care and welfare, the memory of communities, the way that different ethnic or cultural groups might communicate with each other or with tourists or incoming businesses. But how to get the innovation and investment ball rolling?
One way is for governments to take the lead: they, after all, have most to gain. Recent studies (Diego) suggest showing that if you increase the connectivity of all people in a community – never mind just elderly people – so that they can help out and look after each other better, it reduces the cost burden on the health service, the welfare service, and all of the rest of
it, which are all very expensive. National governments are probably too slow and disconnected from local contexts to be pioneers here; a better vanguard group is probably among ambitious city managers for whom social quality is one of the assets they use in promoting themselves in world-wide city v city competition. A European network of ‘tele-cities’ is interested in taking Presence to a next stage.
Private companies are also beginning to see the potential of social computing. Kay Hofmeester, project manager of Presence, has been leading the search for new industrial partners. “When we show Nonnogotchi to drug companies, or to people running privatised welfare services, they usually are quick to come up with new scenarios of their own which we had not thought of. But it’s still not obvious to any of us exactly what kind of business model will pay for it – the development costs, the infrastructure, the running costs. Do the users pay, does the state pay, does the city pay or some combination of those?”. Hofmeester adds: ” if we had our life over again – or to put it another way, for the next stage of the project – we would like to bring in business people at the start along with service providers, technology developers, city managers and so on. Only two years down the track we have some great concepts here – but if we can take them one step further and make a business out of it, that’s when you accelerate the process”.
The process is the product
How can we make people the subject – not the object – of innovation? This was the key question in the Presence project. A consensus emerged that using multiple methodologies – in a tactical way, according to need and circumstance – is the right approach. Research results are relatively worthless until they are disseminated to – and acted upon by – third parties, preferably in a real-world context. This is literally new territory for most designers. The name ‘cultural probes’, for example, was chosen to suggest that they are despatched into an alien environment, returning hints and signs which must be interpreted from afar. Boys, boys, this is the city outside your door we’re talking about here!
Pro-active design scenarios can anticipate or discover ‘needs’ that people did not know they had, or were unable to articulate clearly on their own. And the role of a ‘cultural probe’ is to test either for gaps, or for patterns – to identify needs or functions that other forms of research had not unearthed; or to make connections between ideas that users had not themselves associated with each other. The aesthetic quality of research tools matters a lot: people are more likely to be engaged by a well-designed bag of tricks than by some endless questionnaire
Another success factor in research of this kind is time: time to understand a community; time to get to know individuals within it; time to conduct research at a speed that does not threaten people; and time to reflect on results
“It’s less important that a method is scientifically sound, than that it be effective” said Elena Pacenti. She recalls a story from another i3 project, Maypole, which is about children and intra-family communications. “At one point a group of children in Vienna were given instant cameras and asked to take photographs of their daily routines and media behaviours, and to make the photographs up into story boards. One of the children’s’ well-meaning teachers could not believe that designers would want such messy presentations, and re-arranged the photographs in neat straight lines, thereby destroying a lot of the meaning that had been given to them”. Someone else noted that hand-drawn pictures, however rough, usually have more immediacy and resonance than professionally executed artwork. Experts from other disciplines attending Presence often said how pleasantly surprised they were by the apparently chaotic arrays of snapshots, multiple views of communities, the mixture of paper, stickies, video screens. In working with ‘real people’ designers are going to have to overcome a reputation for obsessive tidiness and a preoccupation with straight lines. Now where could that idea have come from?
“Simulate to stimulate” summarises Marco Susani. “Observing and involving users in innovation is not a science, which has a pretence towards neutrality. On the contrary, in our approach, you need to have bias to provoke and stimulate a reaction and this start the conversation. Once that starts, we are often amazed by how creative people become”
Pleaded Tony Dunne towards the end of 1999: “involve users as soon as possible, but above all please let us always make the experience fun”.
Hard and soft – the dialectics of design research
user — person
consumer — producer
control — emerge
care — enable
author — character
facts — feelings
distance — presence
objective — immersive
inform — inspire
describe — simulate
suggest — discuss
gaps — patterns
record — reflect
understand — involve
feedback — feed forward
useful — desirable
normal — absurd
adaptive — generative
objects — events
form — context
think — do

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