Keywords

1 Introduction

Information and communications technologies (ICTs) is often used as an extended synonym for information technology (IT), but is a more specific term that stresses the role of unified communications and the integration of telecommunications (telephone lines and wireless signals), computers as well as necessary enterprise software, middleware, storage, and audio-visual systems, which enable users to access, store, transmit, and manipulate information. The increasing permeation of information communication technologies (ICTs) in our society leads to the challenge that everybody needs to interact with ICTs in daily life. Populations in many countries are aging at the same time, and the current cohort of older adults has experienced ICTs for a relatively short period in their late lives [1]. Older adults differ considerably from young users in Human Computer Interaction (HCI) and they often meet difficulties while trying to accept and use new technology products and services. There remains an age-related digital divide that older adults lag behind in using and benefiting from information and communication technologies [2]. Venkatesh concluded that older adults, like anyone else, accept and adopt technology when it meets their needs and expectations [3, 4]. However, Verdegem and De Marez [5] reported that technology innovations often fail to be fully utilized since less attention is given to user acceptance. Thus, to ensure that older adults are able to adapt to the new information environment, there were some studies that explore from different perspectives the factors that influence the acceptance of information and communication technologies among older adults. Increasing attention on the acceptance of ICTs-related innovations by older adults makes a review of the recent studies on this topic timely and meaningful.

This study reviewed the existing research from a multi-disciplinary and holistic view to identify the predictors and areas concerned in the acceptance and usage of ICTs by older adults, and attempted to provide directions for further technology acceptance research within this specific group. A systematic review of qualitative, quantitative, and mixed methods studies examined the following research questions: What is the relevance of ICTs to the daily lives of older adults? What are the common ICTs applications in older adults’ lives? Which factors influence the acceptance of different types of ICTs for aging in place by older adults with normal health status? What are older adults concerned with when using different innovations of ICTs? This review will try to shed light on all these issues.

2 Methods

2.1 Literature Search Strategy

Four multi-disciplinary databases (Scopus, ProQuest, EBSCOHOST, Science Direct) were searched using a combination of three groups of key-words regarding age, acceptance and ICTs respectively: (1) ‘older adults’ OR ‘older people’ OR ‘elderly’ OR ‘aging’, subjected to ‘Title’; (2) ‘acceptance’ OR ‘adoption’, subjected to ‘Title/Abstract/Keywords’; (3) ‘information technology’ OR ‘ICTs’ OR ‘digital’ OR ‘electronics’ OR ‘computer’ OR ‘mobile phone’ OR ‘internet’ OR ‘e-health care’ OR ‘online service’ OR ‘home monitoring’, subjected to ‘Title/Abstract/Keywords’. Since technologies and social life changed so fast in recent years, this review will only focus on the batch of relatively new studies in recent ten years from 2004–2014/2015. A scientific selection process was developed by different kinds of exclusive and inclusive principles as shown in Fig. 1.

Fig. 1.
figure 1

Flow diagram of articles selection process

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2.2 Article Extraction

In order to extract the appropriate and valid articles in this review, a set of inclusion principles regarding ‘Topic exclusion’ and ‘Abstract exclusion’ were developed as shown in Table 1.

Table 1. Criteria for inclusion in review
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Finally, 29 valid papers were retained in total including qualitative methods (e.g. interviews, focus groups, contextual observations, diaries), quantitative methods (e.g. surveys, experiments) and mixed method.

3 Results

3.1 Characteristics of Reviewed Articles

The 29 articles were examined for exploring the factors that influence the willingness of older adults to use ICTs for aging in place, as well as their perceptions and expectations of different types of technologies. It was noted that the studies focused on a broad range of applications in our daily lives. Further, these interventions can be reasonably assigned into four specific applicable domains: intelligent monitoring, health care delivery, online services and social communication. Besides, some studies worked on this topic from a general point of view without addressing to a specific category of technology. Among these articles there were 12 qualitative studies, 13 quantitative studies, and four mixed studies respectively. General instruments such as cross-sectional questionnaire survey, face-to-face interview, experimental study, focus group, scenario study, ethnographical study, etc. were employed. There were more developed countries and central cities than developing countries and frontier areas in exploring the issue of older adults’ acceptance towards ICTs. More studies appeared in recent five years from 2011 to 2015. The main characteristics of the 29 literatures are shown in Table 2.

Table 2. Characteristics of reviewed articles
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3.2 Usage of ICTs by Older Adults

Older adults reported using a wide range of technology in their everyday lives and cited efficiency, making life easier, and communication as reasons for the use of technology. General ICT devices and services that are adopted by older users include mobile phone, desktop computer, Internet, electronic commerce, portable computer or mini-computer, and various kinds of computer/smartphone applications and internet applications. Apart from communicating with family members, friends, and health care providers, and dealing with daily routines, ICTs can be applied in various innovative fields in people’s daily life, such as e-services, smart-home, tele-medicine, ambient intelligence monitoring, robots, etc. Literatures in this review covered majority of ICTs innovations which were classified into intelligent monitoring, health care delivery, online services and social communications, as shown in Table 2. ICTs are now highly relevant with older adults’ daily life at home, work and health care environment [33]. Since work life is extending, to remain active, competitive, and useful in the workforce, older adults must use and learn to use basic digital technologies in the information era. Many older adults prefer to remain in their own home, the majority of their activities occur within the home environment. ICTs can support many home-based tasks, e.g., gathering information, safety and security monitoring of older adults at home, etc. More ICT applications will be brought into older adults’ home environment and it is a positive trend for older adults to use ICTs in home. Besides, ICTs have the potential to assist in monitoring and maintaining health as well as managing health conditions and diseases, especially in facilitating cost-effective care [34].

3.3 Determinants of ICTs Acceptance

Research around technology acceptance and usage among older adults has now received increasing attention over time, especially in the developed countries such as the United States, Japan, and The Netherlands. Majority of the studies towards technology acceptance factors for aging in place were in the pre-implementation stage. Various factors were explored by prior researchers in different contexts. These factors can be basically categorized into Perceived Benefits of Use (i.e., perceived impact on life, perceived usefulness, needs satisfaction, perceived benefits, perceived convenience), Subjective Norm (i.e., children/family’s influence, caregivers’ influence, social influence), Perceived Behavior Control (i.e., self-efficacy, anxiety, facilitating condition, support availability), Perceived Usability (i.e., perceived ease of use, age-centered interface, system reliability), Affections, and Socio-demographic mediators (i.e., gender, age, education, income, health and post experience), as shown in Table 3.

Table 3. Summary of acceptance factors regarding ICTs
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Different structural models based on Technology Acceptance Model (TAM) [35], Unified Theory of Acceptance and Use of Technology (UTAUT) [3], and the Theory of Planned Behavior (TPB) [36]) were built according to the causal dependencies among the potential factors. Chen and Chan [31] built a gerontechnology acceptance model called “STAM” among older Hong Kong Chinese. The results showed that individual attributes including age, gender, education, self-efficacy and anxiety, and health and ability characteristics, as well as facilitating conditions explicitly and directly affected technology acceptance. Besides, Heart & Kalderon [14] explored older adults’ adoption of health-related ICTs through examination of TPB in the context of computer use. The result indicated that perceived behavioral control could significantly affect intention to use information and communication technology. Whether older adults determine to use technology also depends on their perceived needs or benefits, it is the most frequently mentioned factor overall [16]. Non-use of computers can be attributed to their low relevance and ‘relative advantage’ to older adults [37] as older adults like to adopt and use technologies only if the value and personal relevance is clear [28]. Generally, older adults report that they care much more about the benefits they gain from ICTs than the costs on ICTs [22].

Furthermore, more external factors such as family and social influence and product usability were identified as important determinants towards various kinds of technology acceptance. Older adults’ children, friends and professional caregivers may positively or negatively influence their acceptance [10, 11, 28]. The longer older adults have used the technology, the more they perceived those people who are important to them would want them to use it [12]. From a human factors and ergonomics view, most studies presented evidences for the common suggested physiological and psychological reasons behind older adults’ lower levels of use of ICTs (e.g., poorer vision, memory, and dexterity) [38]. Older adults seemed to tolerate some complexity, but it should not be more than they could handle after learning [39], perceived usability was found to be important to the adoption and long-term use of the technology- the technology should be reliable, controllable, simple to use and tailored to users [7, 16]. Other than those modeling-based determinants, another determinant that can be extracted from the emotional dimensions of older adults is affections. Anxious or emotional reactions are expressed by older adults when they use computers or money-related technological services. Moreover, it was found that there was generally a negative prejudice or some discrimination attached to the use of assistive health technology like emergency alarm services [40]. Socio-demographics were shown as better predictors of gerontechnology usage behavior than the conventionally used attitudinal factors (usefulness and ease of use) [31]. Key socio-demographic variables in technology adoption were extracted as gender, age, income, and education [2]. Socio-demographic variables can further increase the power of technology acceptance model to determine whether older adults ultimately adopt the ICTs and to what extent.

4 Discussions

4.1 Usefulness and Findings

This review’s strength lies in its literature set which includes most recent studies on older adults’ acceptance of ICTs innovations, and it is more holistic since it gathered articles from four different multi-disciplinary databases (Scopus, ProQuest, Science Direct, EBSCOhost databases), involving studies from fields of ergonomics, sociology, psychology, gerontology, health, etc. Besides, the review classified ICTs innovations adopted in older adults’ lives (home/work/health care) into several groups, thereby highlighted that the development of recent ICTs innovations for older adults is clearly focused on intelligent monitoring or assistive products/services/systems, and indicated that the trend of adopting home-based information technology innovations is inevitable among older adults. Acceptance determinants (including mediators) were clearly distinguished in this review. Since determinants may promote users’ acceptance, the identified determinants may contribute more on later academic studies.

From the review, word strings like ‘needs’, ‘benefits’, and ‘relevance’ were frequently referred in most literatures. It revealed that older adults cares most about the benefits they can gain from ICTs innovations instead of extended features. Besides, ‘cost’ or ‘finance’ were mentioned as concerns in most literatures, older adults do report a heavy concern on the monthly service cost of ICTs and they hope that someone or government can afford a part of the expense. However, several studies also indicated that older adults choose to adopt the technology product/service as long as they need it or the benefits they get are worth the costs. Another significant aspect is on the usability; older adults reported many complaints on the obstacles when learning to use technologies due to health and ability impairments compared with younger people. Finally, older adults reported that they need human assistance or some other kinds of facilitations when using ICTs innovations.

4.2 Limitations and Future Work

However, this review should be used under the premise that it has three critical limitations. First, the extraction criteria of literatures do not include some important personal attributes of participants such as older person’s past experiences and their living arrangements, the influences of these attributes should not be ignored sometimes. Second, the review has now classified several groups of ICTs innovations, it would be better if the study continued to review acceptance factors and concerns specific to each type of ICTs application respectively rather than just gave a general idea on all ICTs innovations. Third, as technology and people’s living style developed quickly, there should be a holistic comparison on the acceptance situation towards ICTs of older adults in recent ten years and past decades, it will be a promising way to enlighten researchers and practitioners studying this topic, and even predictions of the acceptance towards ICTs by older adults in future can be seen in advance.

Meanwhile, some gaps were identified for future research in this review. Most of prior studies identified various factors that influence the acceptance of information technology. However, few studies identified the interrelationship of these factors and few of them adapted these factors into established models such as TAM, UTAUT and TPB to measure the acceptance of ICTs (or one kind of ICT device or service) by older adults. Another important gap is that there are few studies focusing on the longitudinal usage or acceptance of ICTs innovations. From a quantitative view, the ICTs acceptance model of older adults should be a dynamic one instead of a static one along with usage period. More and more research attention is appealed to the understanding of reasons of non-use of ICT by older adults. Now, it is time to explore promising tools to facilitate older adults to adopt ICT devices and services more effectively. In addition to aging-centered design, both the traditional and computer training programs need further studies.