Doing it my way: old women, technology and wellbeing

Authors


Address for correspondence: Meika Loe, Department of Sociology and Anthropology, Colgate University, 13 Oak Drive, Hamilton, New York 13346, USA
e-mail: mloe@colgate.edu

Abstract

This article focuses on women in their nineties (nonagenarians) who are ageing in place – or ageing at home – in upstate New York. I analyse these old women’s use of everyday technological tools to care for themselves and construct meaning. I argue that despite what we may expect, nonagenarian women can be and are technogenarians in their active and creative uses of everyday technologies. Old women utilise lifelong care work repertoires to identify, adjust, use and reject old and new technologies for their own everyday mobility, communication, nourishment, and physiological health. Perhaps most importantly techno-savvy elders can maintain and achieve health and wellbeing, associated here with bodily comfort, social networks, self-efficacy and intellectual life, in and beyond their homes. In these ways, nonagenarians can teach us how household technologies can be health and ageing technologies; instruments of continuity and control; or just the opposite.

Introduction

Understanding how old women create support for themselves near the end of life is an important topic, and particularly pressing as the population ages, becomes feminised, and remains largely home-centred. In 2000, 4.2 million people in the United States were aged 85 and older; this number is projected to increase to almost 10 million by 2030 and to 21 million by 2050. The ratio of women to men in this category is roughly 2:1 (US Census Bureau 2005).

Currently 83 per cent of Americans aged 65 and over own their own homes, in comparison with four per cent who reside in long-term care facilities (Mann 2003). Given the growing population of elders likely to ‘age in place’ – or in their homes – in future generations, scholars of ageing (as well as commercial entities) have focused on the role of assistive technologies and design in home care. While ageing scholarship increasingly focuses on elders as technology users, a significant proportion of ageing scholarship also emphasises what is done for elders: how elders are cared for, how assistive technology and universal design products are made to assist elders, and caregivers, etc. (e.g. Charness and Schaie 2003). Scholarship emphasising the ‘impact’ of technology can reinforce ageist notions of elders as dependent passive receivers of care; this framing can miss how elders can be agents, and how ‘technologies can be used [by elders] as weapons to fight to remain independent and in maintaining contact with the outside world’ (Gutman 2003: 260). In other words, elders can be technology experts and negotiators. For example, while we know that household technologies such as telephones and eyeglasses are crucial to day-to-day lives (Mann 2003), we do not have a sense of how elders creatively utilise, reject, and make sense of a wide array of old and new technologies in their lives.

This article focuses on women in their nineties (nonagenarians) who are ageing in place in upstate New York. I analyse these old women’s use of everyday technological tools to care for themselves in old age and construct meaning. I argue that despite what we may expect, nonagenarian women can be and are technogenarians in their active use of everyday technologies to create meaningful lives and maintain health. Specifically, old women use and negotiate old and new technologies in the context of gendered repertoires to achieve goals such as self-efficacy, wellbeing, and connectedness.

This article explores how old women take responsibility for their own health and care through adapting everyday technologies – from slow cookers to gardening tools to televisions – to fit their needs and to age comfortably (Cruikshank 2003). I argue that health for elders includes being able to maintain social networks, intellectual growth and participation, and physical wellbeing; much of this is accomplished with the help of everyday technologies. Policy makers must take this into account, and address the cost of monthly telephone, television, and internet bills in ageing initiatives.

An emphasis on the everyday lives and meaning-making of elders reveals how (1) old women are agentic, actively identifying, adjusting and rejecting a range of technologies to enable self-care, (2) successful ageing for nonagenarians means ageing comfortably, and (3) everyday household technologies are assistive ageing technologies or health technologies; in other words, the line between health and non-health technologies, as well as low and high tech, are blurred when elders are put at the centre of analysis.

This research takes place in New York state, where ageing in place – or ageing at home – is a key policy initiative as well as the most common way to age. In upstate New York, roughly 80 per cent are already doing so (Humphreys 2007), and a significant proportion of these are women living alone, practising self-care and playing the role of ‘solo problem solvers’ with the help of technology (Charness 2003: 16). Ageing in place ideally demands a certain degree of wellbeing, and elders’ use of technologies can be crucial in maintaining their sense of cognitive, emotional, and physical abilities.

Ageing in place

As population numbers and healthcare costs grow, ‘ageing in place’ has become a buzzword for a variety of stakeholders in the United States. State and federal entities as well as health management corporations are invested in reducing costly institutional care for elders. Increasingly, Medicare funding subsidises home-based healthcare in the United States. Medical research teams in Canada and the US are currently exploring and assessing costs and health outcomes associated with ‘home hospitalisation’ in relation to traditional inpatient hospital care.1 In this changing medico-political context, Gitlin (2003) points out that ‘home is quickly becoming the context for a widening array of health and human services’ with expanded Medicare coverage for care at home, decreased hospital stays and increases in outpatient services. Particularly for the physically frail, the boundaries of hospital and home have blended (2003: 190).

Given the blurring of home and healthcare, elders themselves state a preference for ageing at home. Forty years of national survey research, including that of the American Association of Retired Persons (AARP), reveals that the vast majority of elders prefer to age at home. Elders cite normalcy, continuity in self-identity, autonomy, and control as reasons for this preference (Gitlin 2003: 198). Many prefer to die in their own homes. However, critics argue that ageing at home can be extremely isolating, and that home-based healthcare and transport can be expensive and difficult to access. Importantly, informal caregivers like family members still provide 80 per cent of care to dependent old persons living at home (Binstock and Chuff 2000, Burke 2009).

Given this context, elders and state entities may attach different meanings to ageing in place. Many elders associate ageing in place with staying at home and in being in control of their day-to-day lives; avoiding institutionalisation can help to preserve autonomy and dignity. State entities support these initiatives primarily as a cost-saving measure; to cut back on healthcare and hospitalisation costs.

Technology plays a key role in ageing in place initiatives and in the day-to-day support of elders. While most technologies are not devised with an elder user in mind, many research centres and private businesses are now emerging to fill this niche (Joyce et al. 2007). For example, an increasing number of US housing developers are integrating universal design by creating living environments that are accessible and effective for all ages and abilities, including ramps instead of stairs, kitchen counters at a variety of heights and cabinets with pull-out shelves. And Japan’s private sector leads the way in communications technology innovations for an ageing populace (Joyce et al. 2007).2

Elder tech users

This article attempts to bridge several bodies of work: science and technology literature on technology users; feminist research on gender and technology; and social gerontology research on place, ageing and technology. Most centrally, this work contributes to a growing body of literature on users and technology (e.g. Cowan 1983, Woolgar 1991, Kline and Pinch 1996, Oudshoorn and Pinch 2005). This literature focuses on technology and users as mutually constructed (Oudshoorn and Pinch 2005), both embedded and made meaningful in their social worlds where each reciprocally acts upon and influences the other. This body of work has not fully explored tech users across the age spectrum, and how ageing and technology use intersect. This ‘context of use’ is crucial when analysing ‘gerontechnologies’ and how these are utilised and appropriated in everyday lives.

Feminist scholars remind us that technology means different things to differently situated people. Users inscribe technologies with their own scripts for appropriate use (Akrich 1992), and these scripts can be gender and age based. Cowan (1983) brought the fields of history of technology and women’s history together, emphasising women as users of technology, and how their social position in gendered (domestic) worlds contributes to the meanings they attach to technologies. The discussion of gender and technology is a robust field, but discussion of elders is relatively absent (e.g. Moore 2007, Wajcman 1991).

Over the past several decades a growing body of work emphasises young and middle-aged women’s active role in appropriating technology, from reproductive technologies, to household technologies, to computer technologies, and women’s resistance to exclusion in this and other technological arenas. However, very few scholars are exploring how contemporary elders utilise and ascribe meaning to technologies into their day-to-day lives.3 This is particularly true in the gerontology literature which tends to be more evaluative than ethnographic, emphasising, for example, how technology may be used to accomplish goals, rather than exploring the meanings elders attach to technology in their everyday lives.

This article begins from the premise that technology structures women’s lives and at the same time is utilised in the expression of womanhood, even in old age. Lifelong gender roles and expectations – including housework, care work, appearance work, relationship work, and health work – continue to organise elders’ lives and technology use in old age. Women learn to use technology to meet this range of gendered work expectations throughout their lives. Thus, to borrow a key theoretical device from gender studies, it follows that in the process of ‘doing gender’ (West and Zimmerman 1987), women display expertise in technology modification, creation, and use, across the lifecourse.

This work responds to a call for scholarship (Joyce and Mamo 2006) that merges feminist ageing studies with science and technology studies, and in the process, work that reclaims old men and women as technologically literate, rather than as victims of technology and design. Specifically, this paper examines how old women actively and creatively appropriate a wide range of technologies to achieve specific ends.

Methods

Gubrium and Holstein (2000) argue that knowledge of old age should come from the aged themselves. This research was conducted with this in mind, using in-depth interviews coupled with both lifecourse and symbolic interactionist approaches. A lifecourse approach emphasises common themes, continuity and change across one’s lifespan, and how these biographical aspects can shape contemporary realities, such as technology use. A symbolic interactionist framework focuses on how individuals actively participate in their environments and create social realities and meanings through these interactions. My focus here is to use both of these approaches to understand how biography, place, and social context shape elders’ active technology use and concurrent meaning making.

Because all informants for this study were born before 1930, their gendered scripts as well as approaches to ageing, health and technology probably differ from those women born in later birth cohorts (Hardy 2003). For example, many nonagenarians have learned to live in moderation, and to appreciate and use technologies as they became available, including radios, sewing machines, kettles and slow cookers. Today, few own or regularly use microwaves, dishwashers, or computers. Some are ambivalent about new biotechnologies like prescription drugs and medical devices (especially those not utilised by their parents), but may also defer to their doctors when it comes to unfamiliar health issues. While there may be notable exceptions, this cohort effect is a crucial part of understanding their common social contexts and familiarity with particular technologies.

Data were collected through interviews and participant observation with 10 women aged 90-96 who are actively ageing in place in upstate New York. Initial contacts were made through connections with senior services centres, senior activities programs, social clubs, and local newspaper coverage. The majority of women interviewed are also participating in the author's longitudinal research project on ageing in New York, and have taken part in a series of interviews from 2006 to 2009. Interviews took place in their homes (apartment, condo or house), located in two counties in upstate New York, one rural and one an urban and suburban mix. All took part in at least one in-depth semi-structured digitally-recorded interview during this period. Interviews included open-ended questions across the lifecourse, focusing on each woman’s family, educational and work backgrounds as well as current daily routines and approaches to ageing and self-care. All interviews were taped, transcribed, and coded thematically.

In addition, I employed ethnographic methods to collect data about lived day-to-day experiences. Beyond regular visits to homes, between 2006 and 2009 I participated in informants’ lives and daily routines outside their homes, including intermittent doctor visits, grocery shopping trips, social club meetings, exercise classes, neighbourhood meals, funeral services and religious rituals. In addition, I logged approximately 150 hours observing a combination of regional ageing-related meetings and conferences, touring institutions dedicated to elder care, and conducting interviews with professionals in elder support and care.

The sample of ten women is largely representative of the national population in the 85 and over age group. According to the US Census (2005) category of the ‘oldest old’ (85+), 70 per cent lived in non-family one-person households and 79 per cent of the women in this category were widows. In terms of racial demographics, over 90 per cent of those over 85 years of age were White; six per cent were Black. Likewise, this sample includes eight widows and two married couples. Nine identify as White (with Polish, Danish, Irish, Italian, or Jewish ethnic backgrounds) and one as Black. Of the ten nonagenarians, eight live independently and two live with and care for spouses. In terms of housing, two rent apartments, two own condos, and six own houses.

These old women co-ordinate their own care in the context of a normal range of ageing-related sensory, cognitive, and physical difficulties. At the same time, most experience ageing-related strengths including domain-specific knowledge and daily task management skills (Morrow 2003). Notably, none of the women in the sample are wheelchair-bound; all are ambulatory in some way and this dramatically shapes their self-care regimens. Two women, Florence and Lillian, employ a home healthcare aid for a few hours each day. The rest of the sample depends on informal caregivers. Four have family members living within a 20-mile radius of their homes who help with transport and care on an intermittent basis.4 In general, most nonagenarians in this sample prefer to be totally independent, or to go beyond family assistance to utilise social networks, formal transport services (including paid drivers and public transport), or delivery services for day-to-day needs. The question, then, is how do nonagenarians independently manage self-care and daily routines?

Gutman (2003) states that there still exists ‘a dearth of research that explores elders' experiences with built environment and everyday task accomplishment’. The following sections aim to fill in these gaps, exploring how, for old women, constructing a self-care routine is technology work. In addition, caring for home and self is gendered work; women generally are socialised to co-ordinate their own care throughout their adult lives, as well as to construct and design home spaces that help them to meet their needs as well as that of their family. For old women who are their own primary caretakers, everyday mundane technologies can be significant in designing an ever-changing self-care repertoire to enable self-sufficiency, as well as control, independence and health.5

From tea bags to automobiles: nonagenarians get moving

Mobility is a central component of creating and maintaining wellbeing (Carp 1998). The spectrum of technologies that enable mobility for elders is much broader than walking sticks, walkers, wheelchairs and stair lifts – typically classified as ‘assistive devices’– and can include everything from automobiles, to public transport, to rock salt, security systems, special shoes, clothing, medication, heaters, and caffeinated beverages. Some elders prefer to be sedentary or home bound, and technologies like reclining chairs and walkers (used mostly as tables) can be used to support this goal as well. Most importantly, nonagenarians creatively utilise a broad range of mobility tools (not always as designers imagine they would be used) to achieve a variety of goals.

For example, Ruth has a self-designed mobility system that includes a variety of technologies, including walkers, a scooter, countertops, rock salt, and a home security system, each with a particular purpose. Her electric scooter is for use outside on the sidewalks, in nice weather. However, Ruth needs someone to bring it outside (down a few stairs) for her to use it, so it typically sits in her dark sitting room, covered. Her indoor walker moves with her, but not everywhere. Because she inhabits a compact area on the ground floor of her home, she relies on counters and walls for leverage when navigating halls and the kitchen. However, when she needs to leave the house, she must walk a distance to the back door, and relies on walker #1 to get there. She leaves one walker at the top of the back staircase, and at the bottom stands her walker #2, waiting for her. Walker #2 goes with Ruth when she must leave the house for doctor’s appointments. In the winter, Ruth keeps a bucket of rock salt near her back door and scatters the salt on the icy concrete before stepping outside. A few steps (on the salt) with the help of the walker and she can reach the door of the car waiting to drive her to her appointment. Together her walkers are ‘absolutely necessary’ as ‘another pair of legs’ without which Ruth believes she would fall. Finally, Ruth says she would never leave the house without operating her home security system, including a variety of locks and a security alarm; these assuage her fears and assure her that everything will be the same when she returns.

Walkers can serve a variety of purposes. After losing her balance while walking in her neighbourhood this past year, Alice relies on her walker to navigate her home and beyond. She calls her red walker her ‘saviour’ because it allows her to continue to ‘get out and around’. This device is primarily used for mobility assurance, balance and movement, but it also doubles as a key piece of furniture and storage space. Whether the walker is being actively used or not, it is always nearby and Alice’s purse is always draped over the side. Florence is even better prepared, storing her flashlight, a chequebook, and pocketbook on the walker shelf. She also hangs her life support remote health monitoring device over the side. Since Florence spends most of the day in her recliner resting her sore back with the walker at her side, the walker is more table space than mobility device. In this way the walker ironically enables Florence to (primarily) avoid ambulatory discomfort, and support her sedentary lifestyle.

Mary lives with her husband on the second floor of a ‘walkup’ (an apartment building with no elevator) downtown. They use walking canes to steady themselves on the outside stairs and then once inside, her husband uses a stair lift to get up to the floor they inhabit. Together these assistive devices enable them to continue to live downtown, in the same building where Mary’s husband housed his dental practice 40 years ago. Mary says she dislikes anything that makes her dependent, but she uses a walking cane to prevent falls. ‘It gives me the feeling that maybe I’ll be okay.’ Likewise, she says she uses the stair lift when she has morning stiffness and when she has to carry groceries up, but prefers to walk most of the time. Mary is able to approach these mobility technologies as an option for comfort, security, and health. Interestingly, when grandchildren and neighbours visit, these technologies take on new meanings: the stair lift becomes a fun ride for all ages and the cane becomes a toy walking stick.

Mary, Shana, and Julia drive their own cars, mostly during the day and on short familiar routes. For Julia the car is a crucial component in her life that allows her to remain engaged in activities; a way to ‘get with people’ at church, with her book group, and over meals. It is a way to access the social networks that sustain her. However, she fears driving at night, admitting that she gets scared, and lost, and ‘driveways get confused with streets’. Shana, a committed gardener, says she must continue to drive her station wagon to pick up new plants at the nursery. Alice, who does not drive, keeps her 1970s era car in the garage, available to anyone who will drive it, including a driver she hires to take her shopping, on picnics, and to medical appointments. She holds out hope that someday, when her vision improves, she will be back driving. For her and Mary access to a car symbolises years of independence and self-sufficiency. This can still be achieved, in part, with a hired driver who operates the women's cars on their terms.

Anna and Dorothy depend on walking to get to most places they need to visit. Each highly values her active lifestyle, and depends on various technologies to stay consistent with her exercise routines. Neither is interested in elder-specific mobility devices, nor do they need them. Instead, they depend on transport options, hot beverages, and special fabrics and materials to stay warm, comfortable, and confident. Taking the bus and then walking to the community swimming pool enables Anna to ‘see sides of my city I have never seen before’. Anna then relies on her swimsuit and shower cap for regular exercise in the indoor pool (in all seasons). Similarly, Dorothy swears by her ‘beloved Yaktrax’, special shoes that grip the ice, as well as a full-length insulated coat, to feel secure on a winter day’s walk.

Several nonagenarians mentioned the importance of heaters, medication and hot caffeinated beverages to help them to get moving and participate in healthy activities. For Anna, a hot cup of coffee warms and energises her before her pool exercise class. Similarly, Ruth depends on a routine that combines strong hot tea, over-the-counter pain relievers, and a heated bathroom to loosen her joints and get moving in the mornings. These technologies then facilitate their mobility as they intend it.

Many of these elders’ daily routines might be summed up as ‘preventative medicine’ using a medicalisation model. However, while some technologies associated with these routines may have been prescribed by medical professionals, the context and meanings surrounding their use are much broader. These routines are extensions of lifelong self-care approaches that have less to do with a medical model, and much more to do with lifelong patterns of ‘doing gender’ in combination with self-soothing rituals and social networks, to promote wellbeing, comfort, and confidence.

Tools like the telephone, discussed in more detail in the next section, can also be seen as accessories to doing gender and mobility, as they enable elders to stay connected and co-ordinate rides and driving services. In sum, the list of mobility technologies that nonagenarians utilise goes beyond the expected to include a number of tools that can extend comfort zones beyond elders’ homes and enhance comfort, confidence, mobility and ambulatory control.

‘My collection of handy gadgets’: staying in touch, feeling alive

The telephone is the top technology that elders rely on, particularly women who are taught to value social connection (Mann 2003). However, few scholars have explored how elders use the telephone and communications technologies as tools for health and self-care, further blurring the boundaries between home and hospital.

For the nonagenarians with whom I spoke, the telephone holds instrumental and symbolic meanings associated with mortality, overcoming loneliness, co-ordinating care, and staying in touch with family and friends. Everyone agrees about the importance of this technology. Nonagenarians talked about the telephone being a primary tool in case of a personal emergency; yet they also referred to it as a reminder of one’s own mortality as well as that of one’s friends and loved ones. Many associate a ringing phone with the possibility of news of another friend or family member who is gone. All of these women come from an era when telephone use was rare; it was utilised primarily to convey important news. After receiving a call about the death of a dear friend, Alice commented that when it comes to her ‘collection of handy gadgets’, including calculators, timers, a CD-player, a walker, a television, and a computer, ‘[T]he telephone… is probably the most important thing because it means life and death’.

At the same time, elders actively use the telephone as a tool for staying connected, to feel part of something larger than oneself, to feel needed, and to maintain friendships particularly in the context of limited mobility. Without the ability to interact with others, all these women would experience isolation in their own homes in magnified ways. Alice points out that social relationships and health motivations tend to underlie technology use. She says, ‘The only real necessity beyond food, drink and shelter is friendship, and if technology can enable this, it can be important’. She goes on to say that many of her friends are either deceased or unable to leave their homes. Staying in touch with friends who are housebound requires regular use of the telephone.

Alice and others find that cordless phones can be crucial for maintaining social networks as well as for co-ordinating self-care. Having a telephone nearby provides assurance that emergency service providers can be reached. Doctors’ offices, pharmacies, care providers, and drivers can be reached by phone. Alice jokes that if the phone rings a long time, this means she has left it in the bathroom again. Dorothy has a strategy to avoid this; she never lets her cordless telephone leave her side. Dorothy has a special purse for her telephone that she carries with her throughout the day. She developed this strategy after she learned the hard way, having fallen during the night far from the telephone.

Communications technologies are a key tool for those ageing in place, serving as medical assistive technology as well as a familiar communication tool. Old women's uses of technologies are in part informed by fears of being injured and left helpless. In addition to phones, remote communication tools may be purchased by elders, and these can be associated with very different social meanings. Alice tells of how she begins and ends her day by pressing the button on her Lifeline communication device ‘to let them know I’m OK’. This detached health monitoring is perfect for Alice, who prefers to keep most medical technology at bay, but also feels reassured that if she needed help, this device would dispatch it. The machine also helps to order her day. However, this technology can become intrusive. When Alice had to leave town unexpectedly, she left a note on her door explaining the situation in case anyone checked on her. When she returned she realised that an emergency unit had been dispatched, and had ransacked her home in the process of trying to locate her.

While Alice and Florence pay for a phone-based health monitoring program called Lifeline Medical Alert6 in their urban area, the majority of nonagenarians create their own grassroots health monitoring networks and avoid the monthly bills associated with remote monitoring. For example, every morning several neighbours in a rural village check in on one another. Joanne calls Carol at 8am. Carol then calls Dorothy. If for some reason someone does not answer, the next step is to make a visit. Dorothy admits that this calling network has saved her life several times. Recently, a friend helped her to install an amplified phone ringer to ensure that she hears the phone. Rose relies on an evening phone check-in with a friend who always asks if she needs anything. For Ruth, who is almost completely home-bound (with many days spent in bed), a ringing telephone is a reminder that she is alive. When a friend calls, she frequently tells him or her, ‘Your call reminds me that I am alive, that I am not forgotten’.

Phone communication offers a sense of continuity across the lifecourse for women like Ruth and Rose for whom friendship and motherhood have become synonymous with quality of life, and even life itself. Regular telephone calls offer countless benefits beyond this: a reminder that someone cares; a routine that helps to order a day; a sense of participation in the outside world; and a feeling of security. Most importantly, perhaps, communication technologies including amplifiers, cordless phones and lifeline devices, in combination with nonagenarians’ creative approaches to monitoring and staying in touch (e.g. phone trees and phone purses) have enabled ageing in place for most study participants.

‘Have you seen my apparatus?’ Using machines to foster intellectual growth

While the telephone is crucial for health, elders incorporate a range of other communications technologies, including computers, televisions, and radios, into self-care routines and meaning making. These tools not only help them stay connected and in control, but also help to foster intellectual growth and by association, the health benefits that scientists now associate with brain stimulation.

Despite her daily reliance on the telephone, Dorothy says the computer is the one machine she could not live without. She uses the computer not only for email correspondence, but also for typing and storing her memoirs, engaging in translation work (as a favour to academic friends), and for monitoring her finances. She explains:

I even write my checks on the computer. Nobody else in the village does this, I don’t think. They may not know about it. I think it is wonderful. It helps me because sometimes I don’t know if 2 and 2 is 4 or 22! So this way I can see what I’m working with (Dorothy).

Not only does the computer provide Dorothy with a steady hand and a clear budget, but it also reinforces her reputation as a technogenarian in her community, a reputation of which she is proud.

Ruth stares at a screen every day, but it is not a computer. Because her eyes are poor, she relies on a machine that helps her read. It magnifies the text of each book page and projects it onto a large screen, from which she reads. Ruth explains that she has been reading since age five, but now she cannot read normally. She lost a retina in the concentration camp, and so she has only one good eye. ‘Have you seen my apparatus?’ she asks. She walks me into her reading room, pointing out a small television-like machine on a desk. She points to the power cord, plugged into the wall, then carefully turns on the monitor and the mouse-like ‘reader’ and moves it on the page of a Jewish community newsletter to show me how she reads with the help of the machine. Nearby on the twin bed is a stack of reading material, including holiday cards, business cards, newspapers and hardbound books. Ruth’s reading machine helps her to be both involved in her community and in control of her life, as well as to escape. She uses this technology to keep up with a broad range of personal business. At the same time, she uses the machine to enable her to escape from her immediate life and pain, into her favourite fiction books. ‘I would be dead without the apparatus,’ she says.

All the nonagenarians in my sample incorporate televisions and radios into their lives in various ways. For many, watching or listening to the news is a way to feel connected to community and history; many associate this technology with family tradition. Some emphasised particular programming that they choose to consume. Alice never misses listening to the city mayor discuss local issues on a weekly radio program. Ruth has always listened to music to lighten her mood. Others watch the local news to stay in touch with the world around them.

For Lillian and her husband, television (movie) time represents something they can look forward to in the evenings. Lillian associates this time and technology with romance and companionship. She says:

I am so in love with this man… Every night Bernie picks out something for us to watch. So we see a movie or something else – we have full cable. So that is great fun. We like the romances, they are so wonderful (Lillian).

Alice and Shana utilise public television programming to learn new things. This passive learning sometimes spurred active learning for each of them. Alice commented, ‘I saw the poet laureate on Charlie Rose [interview show] so I got this book out to get more information on her. Very interesting poetry!’ Similarly, Shana recalled, ‘I watched Julia Child on public television – she lived to age 93! She reinforced my love of cooking’. In these examples, we see how technology creates a sense of social engagement, ranging from a romantic evening to exposure to new written works or ways of ageing.

Similarly, Anna is always looking for a new project and television helps her with this. Because she has a particular interest in successful women in society, Anna has incorporated the evening news with Katie Couric into her routine:

I’m following the career of Katie Couric. She got the interview with the pilot, I saw. You know, the Hudson River landing – just a few weeks ago. A big triumph for Katie! And I appreciate her salary – five million a year. That’s a sizeable salary (Anna).

Florence’s recliner faces the television and a flashing photo frame with family pictures. She says she is content to watch television to pass the time. But she has grown tired of the repetition both on television and in her photo frame, commenting ‘I’ve seen it all on TV. They are all repeats. And the pictures, I’ve memorised them all.’ In contrast to the others, the imaging technologies that Florence depends upon for stimulation have failed to deliver what she desires.

In nonagenarians’ daily lives, communications technologies can provide a respite from loneliness and boredom, and/or or intensify these emotions. They can symbolise mortality and life, stimulation or stasis, isolation or connection, and continuity and change. Elders like Ruth, Dorothy, Anna, Alice, and Lillian use technologies like the radio, the computer, the reading machine, and the television to maintain lifelong continuity, control and connectedness, mental health and wellbeing. As with the telephone, each uses these devices to extend their participation with the outside world, particularly in the context of compromised health and mobility.

Fun with sauté pans and slow cookers: creatively nourishing oneself

For many nonagenarians, kitchen technologies such as kettles, slow cookers, stoves and ovens are key instruments for self-care. They are also tools that can elicit creativity, connection, expression, health and even exciting new challenges. Such tools, many of which existed in the kitchens they inhabited as children or newlyweds, provide continuity over the course of a day and a life.

Shana, who was deboning a chicken just as I arrived for an interview, pointed to her kitchen as one of her favourite spaces in her home, and the place in which she starts her day. Ruth also begins her day in the kitchen, and described how turning the kettle on in the morning helps to ‘psych [herself] up’ and face the day. She explains, ‘First thing I do is turn on the kettle and get two tea bags – I need a hot strong tea to start the day. Then I go and wash myself.’ For both of these women, preparing food and drink was akin to preparing oneself for what lay ahead. Kitchens and kitchen technologies can be extensions of self, family, and lifelong routines.

For Anna, a self-described ‘diet freak’ in response to being ‘robust’ as a child, a specific food preparation routine (involving a slow cooker) allows her to maintain her weight and figure. Dorothy, someone who is always looking for a new challenge, has recently discovered that stovetop food preparation can be a creative process that can be novel, suspenseful and rewarding:

Cooking is a completely creative thing. With fresh vegetables and chicken and fish, and there’s so much you can do with those things! In the summer I go to the farmers market and in the winter I go on Fridays with a friend to the store. And I always get too much! But it is the process, the fun, and looking forward to eating it. Sometimes [what I sauté in the pan] it turns out great, sometimes not (Dorothy).

Julia describes how kitchen technologies enable her and a homeless friend to eat together; each warming up frozen or canned foods in the microwave for dinner:

She brings food – she’s one of those who goes to the dumpster – you know that grocery stores have to throw out out-of-date things, so she gets good quality frozen meals and brings that with her. She eats with me and offers it, but I don’t take it. I just warm up canned soup or something. But I enjoy her company! (Julia).

Several nonagenarians mentioned the electric slow-cooker as their favourite kitchen technology, perhaps because of its ease of use; it is difficult to burn a meal or make a mistake using this technology. When I first met Alice she talked about the importance of her slow cooker in terms of ease when it comes to making hot healthy meals for herself. She had just replaced her ‘tired’ 35-year-old model with a new ‘beautiful’ one. With changes in economic markets as well as her energy level and eyesight, Alice now attaches slightly different meanings to this technology:

My new fun project is to create meals that are as cheap as possible, and healthy. Like rice and beans. I’d like to make large portions that I can freeze for the future as well. That way I can save money and time and work on other things, like taxes (Alice).

This section reveals how lifelong gender roles and expectations continue to organise elders’ lives and technology use in old age. Social scripts that nonagenarians attach to kitchen technologies go well beyond health and food preparation. Kitchen technologies are used here to aid in achieving a wide range of goals including saving money, building connections, achieving a particular diet, waking up, carrying on family traditions, and expressing and nourishing oneself. This list of daily goals conveys the multidimensionality of self-care and health in old age. Ironically, while kitchen, mobility, and communication technologies are central to daily meaning making for women nonagenarians focused on health and autonomy, medical technologies rarely enter into discussions about self-care.

‘Newfangled medical things’: monitoring one’s body and opting out

Pharmaceuticals and over-the-counter medications are generally associated with health and wellbeing. However, paying attention to the meanings nonagenarians attach to medical use and non-use can illuminate how these biotechnologies are positioned as an array of techniques elders use to practice self-care. When asked about their medications, nonagenarians tend to say very little, suggesting that biotechnology has limited symbolic importance in their daily routines. Lillian remarked on the sheer number of pills that she takes on a daily basis. Julia commented on the pretty colours, saying, ‘I take a mass of pills. eight pills a day. I have four in the morning and they are yellow, white, blue and pink. So pretty! And I take the ones that make me lightheaded at night. I guess I have a bad heart’. Others were not aware of exactly how many pills they took in a typical day, and what they were for.

Ruth and Lillian spoke of medications that are meaningful to them in large part because they are tied to their own history or family tradition. They spoke of these biomedical technologies as a way to neutralise the body, to balance things out. Interestingly, both utilised biomedical products that were widely available (over the counter and by prescription) with long histories of use in the United States:

In the morning, to get going I take two tea bags – very hot strong tea… I take my daily laxative – I have a weak stomach from the war, we all do, from not eating. And I take my extra strength Tylenol. I use this [Velcro wrist support] so that I will not move my wrist. I did not want the surgery. So I use these instead (Ruth).

Nitro… it is such a nothing pill, and I’ve been taking it forever. But [when I asked for it in the hospital] the doctor didn’t give it to me, and that’s when I had my heart attack. Why wouldn’t he do this? My grandmother took this. I still remember her sticking it under her tongue, and I’d ask what it was and she gave me the sign with her finger like ‘wait’ and then tell me, ‘That’s Nitroglycerin’. It makes me feel better. I always keep it by my bed at night (Lillian).

Pharmaceutical technologies that are linked to family and personal history, like Ruth’s laxatives, which she has taken since leaving the concentration camp at the end of WWII, and Lillian’s nitroglycerin tablets, which she witnessed being taken by her grandmother, can be added to the list of tools that help to provide continuity across the lifecourse. However, aspects of medical technology that are unfamiliar can be unwelcome. Lillian, Alice and Mary spoke critically about the medical profession and over-use of medical technologies in their own lives:

I talk with [a friend] about old age and what they do to old people – medically I mean – these newfangled medical things. She told me she saw someone in the hospital, 83, and she was in pain, and they were giving her something so she could live five months. We both agree, we don’t want any part of that. We’d rather be comfortable. To me, the eye [injections] are worth doing. I can try that again, and see if it works. So far not. But that other stuff – I won’t take it. It is for the doctors, not for us. Their pride. That’s why I’m not going to a nursing home. I need to be in control – that’s the big thing (Alice).

Recently I have been having TIAs [transient ischemic attacks]… they come on quickly and then disappear. Even though I feel fine afterwards, I go to the emergency room to be checked. Each time I am subjected to a full day of tests, and sometimes they keep me overnight to observe. This is frustrating, because I know I am fine and really I just want to be home. Then last week my gynecologist suggested a precautionary measure – a biopsy – to make sure I didn’t have ovarian cancer. Was this really necessary? I don’t know. I didn’t really want to go, but [my daughter] wouldn’t let me pass on it. Afterwards I was very uncomfortable and had heavy bleeding for weeks. It reminded me of the surgery I had -- that created more stress on my body, in new places. I just don’t know about all of this (Mary).

In this section, nonagenarians are negotiating medicine in their daily lives, making decisions about both use and non-use of medical technology, revealing a spectrum of meaning making around biotechnology. For these women it comes down to self-determination and control – are they able to make decisions about their own care, or is their care determined by others? For Alice, having a choice about a medical procedure for her eyes fits with her self-care ethic. In contrast, being ‘subjected’ to medical surveillance and care can be akin to being in a nursing home where a patient retains very little self-determination, a fate Alice and Mary both describe as ‘worse than death’.

Conclusion

This study contributes to research that explores how old women creatively utilise and adapt everyday technologies to construct meaningful lives. Nonagenarians can teach us how everyday technologies can become technologies of ageing; instruments of continuity, control and health; or just the opposite. As we have seen, creative use of technology underscores self-determination and nonagenarians’ ability to do self-care mostly on their own, even as some are thwarted by techno-solutions.

This research contributes to our understanding of health, ageing, and gender as agentic; as actively ‘done’ in day-to-day life (West and Zimmerman 1987) in combination with technology use. When Alice is engaged in her daily slow-cooker food preparation routine, she is accomplishing womanhood and wellbeing in her active use of technology, and in the context of a life of women’s work nourishing others (DeVault 1991). Nonagenarians in this sample push on scholarship in gender studies and science and technology studies to reveal how the active accomplishment of gender is technology-based just as it is age- and health-focused.

Years of care work involving technology may translate as a cumulative advantage for women at the end of the lifecourse (O’Rand 2002). Conversely, elders hoping to age in place may be disadvantaged if their life skills do not ‘fit’ with self-care (Moore and Stratton 2002). Many women nonagenarians have developed creative approaches to technology use and self-care, and utilise these daily in their final years of life. These techniques include designing purses for phones, staging walkers at key places, using reading machines to connect and escape, creating telephone monitoring networks among friends, sewing items to enable comfort at home, using computers to keep track of household finances, and utilising simple kitchen technologies to create affordable healthy meals. In these ways, nonagenerians further their lifelong expertise in using technologies that assist with care work and the co-ordination of routine mundane tasks. This expertise, now taken for granted after years of practice, comes in handy when it comes to food preparation, health monitoring, connecting with others, and creating and maintaining a home over many years. Such domain-specific knowledge can be a key advantage and safety net in the context of ageing, allowing elders the ability to prove self-efficacy and remain at home and healthy, late in life. However, there is a downside, as most women do not have the option to retire from this gendered work.

As communities include more individuals ageing in place, all elders must be able to meet their own health needs through access to care and technology. While much political rhetoric focuses on access to care issues, key technologies like telephone and television services, as well as other communications technologies, kitchen technologies, and mobility technologies can be ‘the difference between life and death’. And they can also be costly. Age-based technology discounts and coverage are crucial to ensuring access to these ‘health’ technologies. Policies aimed at assisting elders as they pursue health, community, and changing forms of independence need to address the escalating costs of communication technologies in the home.

These old women’s lives reveal that perhaps the answer to the question about an ageing populace, home support and health is not simply new biotechnologies, assistive technologies or design strategies, but a renewed emphasis on elder agency and an awareness of existing technology repertoires and daily strategies to emphasise continuity and autonomy. After all, despite all the emphasis on successful ageing, elders in this project ultimately aim to achieve something more akin to comfortable ageing that emphasises ease (Cruikshank 2003).

For these nonagenarians, a self-care ethic is about accomplishing and maintaining a broad sense of health that involves comfort, confidence, continuity, autonomy and social capital in the context of old age. The real power of technology, as many of these nonagenarian women reveal, is in the implicit social relationships and other manifestations of humanity that underlie our use of tools and devices. As we have seen, self-efficacy and ageing in place are realistic goals when technology can be used to reveal and reinforce social networks, ensure continuity across the lifecourse (when it comes to everyday routines and roles), and enable intellectual participation and physical wellbeing.

Footnotes

  • 1

     For a discussion of the hospitalisation at home movement in long-term care, see, for example, The American Journal of Managed Care 2009 Jan; 15 1, 49-56, and Canadian Medical Association Journal. 2009 January: 180, 2.

  • 2

     For example, US universities have started ageing centres to develop new technologies such as Cornell’s environmental geriatrics program, Georgia Institute for Technology’s Center for Research and Education on Ageing and Technology, and MIT’s age lab. Companies such as Life Solutions Plus sell products aimed to ensure independent living. For more on this, see Joyce et al., (2007).

  • 3

     In my research on the Viagra phenomenon (2004), I explore how women and men across the age spectrum configure and inscribe this biomedical product with a wide range of gendered meanings, social norms and values.

  • 4

     While this article focuses on elder self-care, it should be noted that most of these women are not necessarily always alone when it comes to problem-solving and personal care. Most are also cared for in a variety of ways by other women; this is the care work that family members, friends, housecleaners, nursing aides, healthcare workers, and others perform. These support players are primarily younger women, and in health and domestic work fields, these are increasingly women of colour, poor women, and women from developing countries. This group of caregivers is crucial to the success of ageing in place initiatives. Even the two married couples in this sample who proudly take care of each other when it comes to health monitoring and emotional support, depend on regular assistance from a driver as well as neighbours and family; one couple also depends on a daily nursing aid to prepare meals and perform housekeeping tasks.

  • 5

     I have found in my broader study on ageing in place that those who are unable to master self-care repertoires late in life may risk losing control over the living environment and care. For example, a male informant in his late eighties told me that his discomfort with communication technologies (such as the telephone) may be a problem when it comes to overall health and wellbeing. Another explained that after his wife died, he fell apart. He could not manage to take care of himself, and lost a great deal of weight. His ‘saving grace’ was moving to an assisted living environment where meals and cleaning are taken care of.

  • 6

     The Lifeline Medical Alert website says ‘[the program] costs little more than a dollar a day, but the specific amount may vary slightly depending on which Lifeline program is nearest to you and which equipment and services you choose’. A phone call to the centre estimates a monthly bill of $38 with a one-time installation fee of $55. In this case, the cost is not the only barrier to use for elders like Dorothy. The independent ethic that comes with living in a remote rural location also contributes to this decision, as well as longtime, hard-earned trust in friendship networks that may not be granted to unknown service providers.

Acknowledgements:

I am indebted to Jennifer Reich and Kelly Joyce for support and feedback on this paper.

Ancillary