Open University – Written evidence (INQ0061)

Executive Summary

1. The Open University’s response to this inquiry focuses on the questions around the use of technologies for physical and mental wellbeing in later life and for supporting online social interactions to alleviate loneliness and social isolation in old age (Q5-7 in the Call for Evidence).

2. Based on the evidence from our research programmes, gaining digital skills and being online are paramount for healthy and happy ageing. Our policy recommendations include:
• Support health literacy programmes, involving local charities, GP practices and community groups, to engage people in their area to communicate the benefits of physical activity in later life and facilitate groups aimed at supporting healthy activity and socialisation.
• Support digital literacy and digital health literacy programmes to unlock the benefits on health and wellbeing outcomes from allowing people to access digital health wearables and other related digital health technologies.
• Raise awareness of the role of activity monitors in active and healthy ageing, for keeping fit, and as a preventative measure for some medical conditions, for socialisation and as a possible way to alleviate social isolation and loneliness, in self-management of health, in self-monitoring of health, for monitoring the person being cared for, and in social prescribing.
• Encourage older people to use the internet including through improving their digital skills and providing the technical support they need. There are substantial benefits of social connectivity through the internet in alleviating social isolation and loneliness. Drawing on our research, we make several detailed recommendations later in the submission about how digital skills programmes for older people can be effectively designed to deliver such a sustainable increase in internet use.
• Digital skills can help older people access online learning opportunities. Such opportunities can support older people to improve their skills and remain economically active for longer with associated wellbeing benefits, as well as contributing to better mental health and wellbeing more broadly.

Background on The Open University

3. The author of this submission, Professor Shailey Minocha, is Emerita Professor of Learning Technologies and Social Computing at The Open University. The focus of her research is understanding users’ interactions with technology and investigating the factors that affect usability, user experience and user adoption of technology-enabled systems. Her research projects have involved evaluating emerging online domains such as social networking tools, three-dimensional virtual worlds and virtual reality for online learning, and wearable technologies for digital health.

Question 5 – What technologies will be needed to facilitate treatments for ageing and aging-related diseases and what is the current state of readiness?

4. Given the UK’s ageing population, and as part of the agendas around Active and Healthy Ageing[1] and the creation of NHS Digital[2], there is an increasing focus on maintaining health in later life and encouraging physical activity to preserve mobility and motor skills, and self-monitoring of health and medical conditions.

5. The benefits of regular physical activity for older adults and those with chronic disease or mobility limitations are indisputable. Regular physical activity attenuates many of the health risks associated with obesity, cardiovascular disease, diabetes, depression and anxiety, and cognitive decline. As physical activity levels among older adults (both with and without chronic disease) are low, facilitating an increase in activity levels is an important public health priority. Walking has been shown to improve cognitive performance in older people. Our previous research has shown that walking with others can help reduce social isolation and loneliness among people aged 55 and over.[3]

6. National priorities related to an ageing population include helping older people retain their independence, supporting carers, and using internet-enabled technologies to transform healthcare services. We have been conducting a research programme, in collaboration with Age UK Milton Keynes, Carers Milton Keynes and Oxford University, to investigate whether and how wearable activity-tracking technologies can contribute towards monitoring of physical activity and health by people aged over 55, carers and people they care for, and be accepted by medical professionals.[4] Example technologies include off-the-shelf activity trackers such as from Fitbit, Garmin and Samsung, and smart watches. Typically, these devices record steps walked, sleep patterns, calories expended, and heart rate.

7. Our empirical mixed-methods research involving surveys, workshops and interviews with older people, carers, people being cared for, medical professionals, and manufacturers has shown the role that activity-tracking technologies can play in supporting the health and wellbeing of older people.

8. There are two ways in which activity trackers can play a role:

• for maintaining fitness - to support users to become and stay fit; in our survey for people aged 55 years or more (n=516), the two key motivations of using activity trackers were to monitor their physical activity and wanting to be fit.
• for monitoring a specific medical condition, such as with the heart, or extent of mobility while undergoing physiotherapy or recuperation after a hip or knee replacement.

9. The benefits of using activity trackers that our study found include:

• Increased awareness and interest in one’s own health and the health of partners and other family members; taking up healthy activity routines by monitoring sleep and diet;
• An increase in physical activity, such as walking or gardening, which users link to increased motivation and improved mental wellbeing;
• Adoption of a healthier lifestyle and lifestyle changes such as reduced usage of car for local errands, attitude change towards food/diet; and
• Sharing of data with GPs to diagnose non-optimal sleep patterns.

10. There is also a role for digital health wearables in caring and incident reporting, for monitoring movement and locations in conditions such as dementia and Alzheimer’s Disease, and use of the long-term recorded data for diagnosis and medical interventions. One benefit of monitoring during and after treatment and facilitating early hospital-discharge is that it would help address long-term occupation of hospital beds and the negative impact this has both on patients’ wellbeing and on the cost of treatment.

11. The design and use of activity trackers that can effectively achieve these positive outcomes requires close collaboration between manufacturers, health care services and end-users so that the solutions developed can be easily adopted and used by older people to monitor their physical and mental wellbeing.

12. Our policy recommendations regarding technologies to support healthy living in old age and to facilitate treatment for aging-related diseases are:

• Support health literacy programmes. Encourage local charities, local GP practices and community groups to: set up meetings and talks to promote active and healthy living that support people in understanding how physical activity can have positive impacts on health in later life, such as slowing down the onset of frailty and cognitive decline, and reducing the risks of diseases such as diabetes and obesity; facilitate establishment of walking groups that support physical wellbeing and encourage socialisation; and target unpaid (informal) family/friends’ carers who are themselves an ageing population in need of respite and strategies for self-management of their health.
• Support digital literacy and digital health literacy programmes. If people develop digital skills to access online information and services and to use digital health wearables, it will have a significant impact on improving health outcomes as people will feel more in control of their health and care. The digital skills will enable them to better manage their conditions as well as helping to relieve the burden on NHS services.
• Raise awareness of the role of activity monitors in active and healthy ageing. This would have another benefits, which include: keeping fit; as a preventative measure for some medical conditions; for socialisation and as a possible way to alleviate social isolation and loneliness; in self-management and self-monitoring of health; for monitoring the people they care for; and in social prescribing. This awareness-raising could be carried out by local charities such as Age UK, through local GP practices, “show and tell” sessions of people sharing their experiences, and through Q&A sessions.

Question 6 - What technologies will be needed to help people to live independently for longer, with better health and wellbeing? What is the current state of readiness of these technologies, and what should be done to help older people to engage with them?

Question 7 - How can technology be used to improve mental health and reduce loneliness for older people?

13. Recent research from Age UK’s has found that if we don’t tackle loneliness in later life, there will be 2 million people aged over 50 in England by 2026 who will often feel lonely (Age UK, 2018[5]). Loneliness has a serious adverse impact on their wellbeing and quality of people’s lives with some studies suggesting it can be as harmful to health as obesity or smoking 15 cigarettes a day[6]. Loneliness also causes people to increased risks of cognitive decline and developing clinical dementia. There is also evidence that lonely people are more likely to visit a GP or A&E and are more likely to enter local authority funded residential care. 

14. Tackling loneliness in later life is therefore an important way of improving people’s health and wellbeing. The UK government published a Loneliness Strategy in 2018 and set out an agenda for reducing loneliness[7]. A key aspect of this strategy was the roll-out of social prescribing schemes across England. The aim of social prescribing is that link workers will help reduce the workload of GPs. A link worker helps patients find suitable community activities to improve their health and wellbeing and to support individuals in taking control of their mental and physical health. A person who is lonely may not have a medical condition and may just need encouragement to link up with activities in their neighbourhood and local community (e.g. a local walking group, or a Pilates class).

15. Indeed, our previous research (Minocha et al., 2015[8]) has shown that people aged 55 and over engaged in community activity – for example, volunteering, or participating in local walking groups, or helping in the local church – felt less lonely than those who did not have a reason or motivation to venture out of their homes. In fact, there is a growing body of evidence that social prescription initiatives such as arts, creativity, physical activity, learning new skills, volunteering, mutual aid and befriending result in improved mental health and social connectedness.

Sharing photographs online

16. Over the last year, researchers at The Open University and Oxford Brookes University have been investigating how sharing photographs online can help alleviate loneliness in people aged 60 and over[9]. Sharing photographs online improves social connectedness both online and offline. People make new friends when they are out and about in the community to take photos and by posting photos online, they are building new connections and making friends.

17. There is a common perception that older people find it hard to make new friends and they get lonely as their friends pass away but our data has shown that it is possible to make new friends through sharing of an artefact such as a photograph on photo-sharing sites. In our research, we have spoken to several users of the Blipfoto site[10], an online photography journal where users post one photo every day.

Mo’s story

18. One of our participants in late 60s (Mo) has been posting on Blipfoto for 10 years. She explained some of the advantages of finding a photo every day to post on the site:

It becomes a bit of a habit. Just something that you do. It encourages me to walk, you know, to find a photo. It encourages me to talk to people that I wouldn’t normally talk to. I’ve made a lot of friends just out on the street.

Jen’s story

19. One of our other participants (Jen) shared the health-status of her husband (who was suffering from cancer and later succumbed to it) with family and friends on WhatsApp through text and pictures. The WhatsApp group was set up by her daughter. She continues to use this group and other WhatsApp groups (for example, one that involves only her daughters and sister) to receive and send photos. While Jen is recovering from a recent operation and is house-bound, the photographs that she receives from her daughters and the ones she sends to them encourage conversation, keep them informed about their welfare and for her close-family to know that she is well.

I suppose it’s about connections, connections with them. …. I think it’s [photograph] an added dimension to keeping in touch, because I was thinking if there weren’t the photos, pre all this WhatsAppery, it was text messages, so it was words. “We’re off to the Anniversary Games. We’ll ring tomorrow,” or something, whereas now there might be a picture from the train. I don’t know. It’s about making connections. It is about feeling less isolated. I’m learning to live on my own.

20. Jen explained how sharing of photos are keeping her connected with the immediate family (daughters and younger sister).

I suppose it’s reciprocal because they [Jen’s daughters] do like to see, if I go off for a weekend or go out somewhere, they will sometimes nudge me and say, “Hey, where are your pics?” because I expect pics from them. So I sometimes have to say to my friends, “I must take a picture. The girls [daughters] want to know that I’m doing something, I’m having a happy day, or I’m out and about. I’m not just lurking in the house.” No, that’s putting it a bit crudely. It’s hard to specify, quantify the value of it all. 

21. While we understand that taking photos and then sharing them online may not interest everybody, and particularly when it requires digital skills and when people may have concerns about privacy and security, it may be worth exploring how sharing creative artefacts such as old photos and arts/crafts activities (and so on) can stimulate connections, foster friendships and help alleviate loneliness.

22. Digital skills also enable older people to access online learning opportunities which can support them to improve their skills, remain economically active for longer with associated wellbeing benefits, as well as helping them remain socially engaged and intellectually stimulated with benefits to their mental health and wellbeing more broadly. Learning opportunities such as through Open Educational Resources such as OpenLearn[11] and Massive Open Online Courses (MOOCs[12]) FutureLearn[13] can increase workforce skills, improve employability, contribute to better mental health and wellbeing along with providing opportunities to communicate online with other learners (e.g. through discussion forums). Working longer helps to reinforce individual financial wellbeing and may also have a positive influence on overall wellbeing.

23. In conclusion, our research demonstrates that being online opens a number of possibilities for social connectivity and for alleviating social isolation and loneliness. The opportunities include restoring old friendships even if friends have moved to far-off places; making new friends; finding about activities in their local area; staying connected with family by overcoming geographical differences; fostering interests and developing new hobbies; and for lifelong learning.

24. To unlock these benefits, it is important to encourage older people to adopt the internet to unlock these potential benefits and help people live independently for longer. The most recent data[14] shows that, since 2011, the proportion of those aged 75 years and over who were recent internet users has increased from 20% to 47% and the proportion of those aged 65-74 who were recent internet users has increased from 52% to 83%. However, while these increases are very positive, this still means that over half of those aged 75 are lapsed internet users (defined as not having used the internet for three months or more).

25. Improving older people’s digital skills will be essential in enabling them to use and keep using the internet. The findings from our research lead to a number of policy recommendations for how programmes to achieve this should be designed:

• Building training around someone’s interests helps people learn faster and keep the momentum. For example, showing an older person how to look at genealogy sites, if they have interests in family history, or how to look at brass band performances on YouTube, if they are interested in brass bands but can’t travel to events due to mobility or other constraints.
• One-off training on using the computer and internet is not effective. Rather, relatives and trainers need to structure their help over a period of time, teaching one application at a time through task-scenarios related to the older user’s interests.
• Older people need repetitive strategies to aid retention. This need increases the older someone is, meaning that older people can easily be left behind at a pace that suits younger age groups. Learning materials aimed at younger age groups can also heighten their sense that courses are not for them.
• Older people need regular technical support to stay online and to feel safe. The technical support could relate to accepting software updates, or buying new equipment, or changing the privacy or security settings of social networking software. Neighbours, charities and businesses should be encouraged to support older people in their local area by giving them the confidence to learn to do new things on the internet, to protect themselves from scams and other cybersecurity threats, and to receive and install software updates.
• Older people prefer learning from one another by sharing knowledge and swapping tips. Existing community venues such as schools, pubs and shops in the local communities could be used as hubs where older users could help sort out problems and share tips in a relaxed atmosphere.
• Focus on Tablets and apps: As we have made progress in our research on the use of the internet by older people, we have found that older people prefer Tablets because of the ease that Tablets provide. Cognitive load can be a significant barrier in online interactions for people over 55. Tablets have an intuitive interface and so the number of actions needed to access an application such as Skype can be minimal: 'switch tablet on and tap on the App'.
• Focus on privacy and online safety: Participants in our research have expressed concerns over privacy settings in social networking software such as Facebook. They would like that by default that settings should be set to the maximum privacy possible so that they don’t have to ‘remember’ or ‘learn’ to change the settings. The older people have the fear of internet scams and their online safety, such as ‘strangers’ getting to know about where they live or whether they live alone, etc.

About The Open University

26.          The OU’s mission is to be Open to people, places, methods and ideas. For most of our undergraduate qualifications there are no academic entry requirements. We believe students should have the opportunity to succeed irrespective of their previous experiences of education.

27.          The OU operates across all four nations of the UK and has 175,000 students. We teach four in ten part-time UK undergraduates (41%).

28.          The OU is a world leader in distance learning. Our undergraduates do not attend a campus; they live in their own homes throughout the UK. One in five of our first-year undergraduates study at full-time intensity, a proportion that has almost doubled since 2012/13.

29.          In this year’s National Student Survey, overall satisfaction with the OU remains at 87%, keeping the OU in the top 20 of UK universities. The OU continues to rank first for assessment and feedback.

30.          There is no typical OU student. People of all ages and backgrounds study with us and for many reasons – to update their skills, get a qualification, boost their career, change direction, prove themselves or keep mentally active.
• 76% of our directly-registered students work full or part-time
• 23% of our undergraduates live in the 25% most deprived areas
• 24,709 students with disabilities studied with us in 2017/18
• 33% of our students begin their studies with 1 A Level or less.

20 September 2019