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Short abstract:

A qualitative study following the implementation of a digital tool for health self-monitoring targeting older adults shows a complex interplay between user agency and algorithmic decision-making.

Long abstract:

Older adults are a key target for the development of technologies that promise to offer solutions for autonomous “healthy aging” in a context of healthcare systems under intense pressure. Developing telehealth applications for older users that may be experiencing cognitive decline has many challenges. In this paper, we examine the development pilot implementation of an application designed for autonomous health monitoring for older adults, including those experiencing neurodegenerative disease and their caregivers. The application entails an interactive health questionnaire and relies on a decisional algorithm to provide a personalized health assessment and recommendations, through which users may discover “problems” related to mobility, cognition, social isolation or nutrition. We examine how aging was scripted into the development of the technology and analyze a series of focus groups and interviews undertaken with older target users. We argue that the rejection of health assessments and the challenge posed to its assumptions about aging reveals a complex interplay between user agency and algorithmic decision-making. Participants’ feedback also brings forth methodological reckonings for future designs and research on technology that aims to engage older users. It also highlights contradictions in the design and innovation process. In discussion with other literature, this case study presents issues of translations and representations found in scripted technology for so-called healthy aging. We discuss some of the sensitivities and suggestions of participants that shed light on the missed opportunities in such innovation.