10.6092/issn.2038-3460/17480
Ageing is not only a chronological matter. The following contributions at the crossroad of STS, material gerontology, design, and medical sociology offer alternative views on ageing and care. Ageing emerges as a boundary object through which authors explore the relationship with technologies and technology-based processes and practices. Authors point out that becoming older is a sociomaterial process and emphasize the importance of thinking with care when designing technology as well as the relevance of the socio-technical imaginary in conceptualizing older people.
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Tiago Moreira
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
frailty
Ageing as a Boundary Object. Thinking Differently of Ageing and Care
Text.Serial.Journal
https://tecnoscienza.unibo.it/
11
Crossing Boundaries
2021-03-09
2023-06-27
2021-03-09
2023-10-16
117-138
TS
Tiago Moreira
2020
10.6092/issn.2038-3460/17480
117
Durham University
2038-3460
2
frailty
en
138
Ageing as a Boundary Object. Thinking Differently of Ageing and Care
https://tecnoscienza.unibo.it/article/download/17480/16329
11
                                                                   Crossing Boundaries
                                                                                         117




Ageing as a Boundary Object
Thinking Differently of Ageing and Care

            Michela Cozza                                      Vera Gallistl
         Mälardalen University, SE                         University of Vienna, AU

          Anna Wanka                                       Helen Manchester
  Goethe University of Frankfurt, DE                       University of Bristol, UK

                                          Tiago Moreira
                                        Durham University, UK


     Abstract: Ageing is not only a chronological matter. The following con-
     tributions at the crossroad of STS, material gerontology, design, and me-
     dical sociology offer alternative views on ageing and care. Ageing emerges
     as a boundary object through which authors explore the relationship with
     technologies and technology-based processes and practices. Authors
     point out that becoming older is a sociomaterial process and emphasize
     the importance of thinking with care when designing technology as well as
     the relevance of the socio-technical imaginary in conceptualizing older
     people.

     Keywords: age studies; material gerontology; care; co-design; frailty.

     Submitted: 29 October, 2020 – Accepted: 30 November, 2020

     Corresponding author: Michela Cozza, Mälardalen University, School of
     Business, Society and Engineering (EST), Västerås, Sweden. Email:
     michela.cozza@mdh.se




Introduction

Michela Cozza

In one of her foundational articles, Susan Leigh Star (2010, 604) says: “I
am invariably asked the question, ‘well, but what is NOT a boundary ob-
ject?’ (or, along the same lines, ‘Couldn’t anything be a boundary ob-

TECNOSCIENZA
Italian Journal of Science and Technology Studies
11 (2) pp. 117-138 - ISSN 2038-3460
www.tecnoscienza.net                                2020                               117
118                                                         Tecnoscienza – 11 (2)

ject?’).”. In this article as well as in other contributions, Star has always
refrained from normative statements about the true and proper meaning
and use of boundary objects despite she has provided a definition that
reminds us of their plasticity and robustness (Star 2015).
In the same article, she continues by pointing out one dimension that we
deem relevant to this special issue on ageing and technology and, all the
more, in this Crossing Boundaries section of Tecnoscienza. Star thinks of
standards and boundary objects as inextricably related, especially over
time, in so far as what was a boundary object at one time may become
standardized later on. When this movement happens, as Star highlights,
the standard as such throws off or generates residual categories. Such a
deep interconnection between boundary objects and standards, and the
relationship(s) between standards and residual categories are key to the
study of ageing and technology, in particular by noticing that “[c]ertainly,
our society makes age – precise chronological age – something that no
one should be without (…) chronological age became a privileged stand-
ard for classifying individuals” (Treas 2009, 65).
By referring back to Star where she clarifies that the term ‘boundary ob-
ject’ embodies both a pragmatist sense and a material one – so that we
should go beyond the common idea of object as (exclusively) a thing – it
seems quite reasonable to assume ‘age’ as a boundary object, “something
people (...) act toward and with. Its materiality derives from action, not
from a sense of prefabricated stuff or ‘thing’ -ness” (Star 2010, 603) as
material gerontology has recently foregrounded with regard to how tech-
nologies and objects in general embody and foster a specific view of
age(ing) (Höppner 2017; Höppner and Urban 2018; Wanka and Gallistl
2018). Yet, age as boundary object turns out to be a problematic standard
depending on which actions are undertaken in relation to it and which
are the associated meanings, as well as material and symbolic implications
that many STS and other critical scholars have discussed in relation to
technology design in care settings (Maller 2015; Mol, Moser and Pols
2010; Buse, Martyn and Nettleton 2018).
Today, the chronological age is remarkably wide in the scope of its cover-
age and classifications relying on this standard are as many as the related
organizing purposes. On the basis of chronological age (among other rel-
evant standards), individuals are referred for medical tests, children are
admitted to different grades, and seniors qualify for dining discounts or
are entitled to get specific welfare services (Cozza et al. 2019). So far it
does not seem that the effects of taking age as an ‘ordering principle’ is
producing the dramatic effects that the above-mentioned relation be-
tween standards and categorisation was heralding. However, by crossing
several boundaries like, for example, that between medical sociology and
Cozza et al.                                                              119
STS we discover that ageing is quite often associated with a sociotechnical
imaginary of vulnerability and frailty that – at least in the countries of the
Global North – leaves very little space to a romanticised idea of the later
life as the age of wisdom and inactivity. On one hand, there is an idea of
older people as ‘people in need’ whose being and doing is marked by age-
associated decline as a condition that homogeneously concerns all elderly
(WHO 2017); on the other, and in sharp contrast with the previous
frame, there is a huge emphasis on activity in later life as proved by an in-
credible amount of scientific and business initiatives falling under the
concept of “active ageing” (Katz 2000).
In this section of the special issue, ageing is the boundary object through
which authors explore the relationship with technologies and technology-
based processes and practices by crossing multiple disciplinary bounda-
ries and pointing us towards alternative views of later life, older people,
age and ageing.



                                     ***
Connecting the Dots of New Materialist Approaches in the
Study of Age(ing): The Landscape of Material Gerontology

Vera Gallistl and Anna Wanka

    Gerontology – the discipline concerned with questions surrounding
age and ageing in the broadest sense – has increasingly turned to technol-
ogy use in later life as a topic of research. Whereas many gerontological
studies on ageing and technologies are rather applied and techno-
optimist, asking how technology can improve older adults’ lives, more
critical and cultural approaches have developed rather recently (Kolland
et al. 2019). They voice two types of critique: First, they criticize Geron-
tology’s blindness when it comes to the discourses and imaginaries of age
and ageing that shape technological development and design. This criti-
cism, often elaborated by researchers working at the intersection of Sci-
ence and Technology Studies (STS) and Gerontology, targets, on the one
hand, ageist stereotypes about technology use in later life in design pro-
cesses and the paternalist stance towards older adults resulting from it
(Peine and Neven 2019), and, on the other, the techno-optimism of ger-
ontological research itself (Neven and Peine 2017; Peine 2019). Second,
critique from new materialist approaches in Gerontology questions the
underdeveloped role materialities play in researching ageing and technol-
120                                                        Tecnoscienza – 11 (2)

ogy. Such approaches argue to take the materialities that constitute hu-
man life worlds, like the ageing body, the spaces we are in, and the things
that surround us – including technologies – more seriously when we aim
to better understand age and ageing.
    For studying ageing and technologies this implies to grant those mate-
rialities their own agency - technologies are not just being used by but in-
teract with older adults.
    Following this strand of critique, several scholars within the study of
age(ing) have started to think about materialities in more depth (for ex-
ample: Calasanti 2003; Gubrium and Holstein 2008; Buse and Twigg
2016; Artner et al. 2017). One approach developed from these endeavors
is material gerontology (Höppner and Urban 2018). Material gerontology
has been heavily influenced by both cultural gerontology (cf. Twigg and
Martin 2015) and new materialism (cf. Barad, 2003). New materialism is
an umbrella term for a nexus of theories formulated mainly in gender
studies and feminist STS and bringing together concepts such as “agential
realism” of Karen Barad (2003), “Deleuzian materialism” of Rosi Braidot-
ti ([1994] 2011), or “posthumanism” of Donna Haraway (2007). These
approaches understand discourses and materialities as inextricably linked
within “material-discursive practices” (Barad 2003, 818). This implies
that we do no longer look at how older adults use or act with technologies
- how they inter-act with technologies -, but how ageing and technologies
intra-act: hence, how the constellations of discourses (like discourses and
imaginaries of ageing) and materialities (like ageing bodies) that consti-
tute ageing are linked to the discourses (like technological innovation dis-
courses) and materialities (like the devices themselves) that constitute
technological innovation in discursive-material practices and, accordingly,
form processes of entangled becoming.
    For the study of ageing and technologies, looking at these socio-
material processes of becoming can enable a fuller and more exciting pic-
ture of how age and ageing is socio-materially co-constituted and can also
enable a more nuanced discussion about the role diverse materialities
(from technologies to other objects) play in this process. For STS, such
approaches can enable a fuller and more differentiated understanding of
the particularities of age and ageing as a socio-material phenomenon. In
the following, we illustrate how material gerontology approaches ques-
tions around ageing and technologies and discuss which insights such a
perspective yields for STS.

Connecting the dots: material gerontology
Cozza et al.                                                             121
    In this section, we want to take a broader look at the concepts and
approaches within material gerontology by answering the following three
questions from a material gerontological perspective: (1) Who and what is
involved in ageing processes? (2) Where and when do ageing processes
take place? (3) Where are the boundaries of ageing processes located and
who defines them?
    From a material gerontology perspective, ageing processes are co-
constituted in a nexus of discursive-material practices. This then, first and
foremost, means acknowledging that (human) ageing itself is not a phe-
nomenon that takes place within or happens to a human being, but that
ageing emerges as a phenomenon through the entanglement of diverse
materialities, discourses and subjectivities. The process of ageing is there-
fore not only a biological, but a symbolic, discursive, cultural and – most
importantly - material phenomenon (Wanka and Gallistl 2018), in which
a variety of human and non-human actors, humans, things, technologies,
animals and much more are entangled (Höppner and Urban 2018). Mate-
rial gerontology therefore does not center ageing processes in one human
actor but acknowledges a variety of – human and non-human – actors of
ageing processes. Ageing is therefore understood as distributed (Höppner
2021). The processes of becoming old is therefore an assemblage of mate-
rialities – from human bodies, things, technologies, spaces and their rela-
tions. Studies within material gerontology have consequently analyzed the
role of things, objects and technologies in ageing processes (Kollewe
2020), and have significantly gone beyond viewing them as ‘passive’ par-
ticipants in research projects, but rather granted them agency in shaping
experiences and identities in later life (Lovatt 2018). However, material
gerontology does not only focus on technological innovation, but also en-
gages with more mundane and ordinary objects of later life, such as dress
(Buse and Twigg 2016) or furniture (Depner 2015), which enables mate-
rial gerontology to not only look for innovative or new technologies in
later life, but also to provide tools for making the ordinary, tacit and non-
verbal aspects of materialities of age and ageing more visible.
    Second, material gerontology approaches question where and when
ageing processes take place. While ageing processes have traditionally
been located within, or close to the ageing body, not only by medical or
psychological, but also by social gerontology (Öberg 1996; Martin and
Twigg 2018), material gerontology significantly expands thinking on
where ageing processes take place, making the ageing body no longer the
central place of ageing (Höppner and Urban 2018). Studies instead high-
light the close connection between the materiality of bodies, artefacts,
and aspects of space in the becoming of age and ageing (Buse et al. 2018),
hence considering bodies, technologies and spaces as interrelated parts of
122                                                         Tecnoscienza – 11 (2)

socio-material assemblages of ageing (Jarke 2020). Studies have, inter alia,
explored the architectures of care and health of later life, highlighted how
imaginaries of ageing bodies are (re)produced through architectural spac-
es (Nettleton, Buse and Martin 2018) or studied how understandings of a
central place of ageing – the home – is constituted through the entangle-
ment between objects, spaces and embodied practices in processual man-
ners (Lovatt 2018). This has also enabled material gerontology to see how
age and ageing are shaped through spaces in unusual and unexpected
ways, e.g. looking at constellations of ageing in mountains (Gallistl and
Parisot 2020; Höppner 2015), or at materializations of ageing in benches
in public spaces (Moulaert and Wanka 2019). Age(ing), from a perspec-
tive of material gerontology, therefore is not only shaped by and through
spaces, it itself emerges as a spatial phenomenon, as it “‘spatialises’, that
is, it produces its respective spares as three-dimensional arrangements
comprising artefacts and bodies” (Reckwitz 2012, 252).
    Such a perspective also enables material gerontology approaches to
question when ageing processes take place. Understanding ageing as a
distributed phenomenon with multiple actors (Höppner 2021) also means
acknowledging the multiplicity of intersecting temporalities that age and
ageing is built through. While ageing is often associated with a particular
kind of time, namely (scarce) life-course time (Kottmann 2008), research
in material gerontology has significantly expanded this view, and shown
how multiple temporalities of age and ageing can become conflicted or
stand in contrast to each other, e.g. in innovation discourses of the arts
(Gallistl 2020) or technological development (Peine and Neven 2020).
From a material gerontology perspective, ageing therefore not only spati-
alizes, it also temporalizes, as it produces diverse (and sometimes conflict-
ing) temporalities.
    Third and consequently, material gerontological enables a new per-
spective on how boundaries are drawn in the processes of becoming old:
boundaries between diverse actors of ageing – like ageing human bodies
and the things that ‘surround’ them -, boundaries between what is ‘old’
and what is ‘young’, or boundaries between what is ‘normal’ and ‘deviant’
ageing. One central discussion concerns the boundaries of the ageing
body, which, in gerontology, has often been conceptualized through a
medical gaze, as a distinct, rational and – most importantly – enclosed en-
tity (Martin and Twigg 2018; Höppner and Urban 2018). Despite the fact
that body boundaries have been remarkably expanded in the last years,
for example through the diffusion of new care technologies, implants and
mobile devices, the ‘ageing body-entity’ is still often perceived as the
foundation of gerontological knowledge (Martin and Twigg 2018). Mate-
rial gerontology, on the contrary, highlights that humans are aged in ac-
Cozza et al.                                                            123
tor-networks, entanglements, assemblages and that the boundaries be-
tween actors in these relationships are made in practice, rather than being
pre-defined. Drawing on Barad’s (2003) conceptualization of agential
cuts, research within material gerontology has, for example, asked how
the often taken-for-granted boundary between human and non-human
actors of ageing are made through processes of becoming with things
(Höppner 2015).

Establishing boundaries, making connections: material gerontol-
ogy and STS

    Finally, we discuss where and how a material gerontology perspective
overlaps with other approaches aimed to better understand ageing and
technology, especially with those at the intersection of Science and Tech-
nology Studies (STS) and gerontology, and which insights a material ger-
ontology perspective could bring to STS.
    At first sight, the similarities between the material gerontology and
other approaches towards ageing and technology within STS are striking:
Both understand ageing as a processual constellation of practices that is
distributed between humans and non-humans (Höppner 2021; Moreira
2016); and that these practices co-constitute both ageing and other actors
involved in it (Höppner and Urban 2018; Peine and Neven 2019). More-
over, both perspectives stress the importance of materialities and their
spatial distribution in this process of co-constitution (Wanka and Gallistl
2018), at the same time acknowledging that the boundaries between the
material and the non-material, the human and non-human, are themselves
drawn in the course of it (Höppner 2017; Irni 2010).
    However, a material gerontology perspective demarcates from tradi-
tional STS perspective in one crucial aspect: in how seriously it takes the
centrality of age and ageing. For STS, age tends to be treated as a social
phenomenon alike any other, and a STS perspective could be applied ap-
proach the co-constitution of age(ing) and technologies just as it could be
applied to approach the co-constitution of health/illness and technolo-
gies, or gender and technologies – all with quite a similar design and the-
oretical background. A material gerontology perspective, however, can-
not so easily be applied to other phenomena than age(ing) - despite its in-
fluences from gender studies and (feminist) new materialism. For STS,
age(ing) tends to be seen as a case, whereas for material gerontology, it is
a concept – as age is not a blank canvas to be ‘filled’ with empirical data,
but an analytical approach.
    Borrowing from Nicolini’s metaphor of “zooming in and zooming
out” (2009) makes this distinction more explicit: When STS and material
124                                                         Tecnoscienza – 11 (2)

gerontology ‘zoom in’ at their research phenomenon, both perspectives
‘meet’ at the ‘intersection’ of co-constitution of age(ing) and technologies,
where they are both concerned with practices, processes and materialities.
However, they ‘separate’ when they ‘zoom out’: Here, STS refers back to
and takes into account a broader ‘non-age related’ picture, comprising,
for example, technology design processes and the discourses, narratives
and images around age and ageing, but also technologies and innovation,
that are (re-)-produced in them. Material gerontology, on the other hand,
‘zooms out’ to consider and refer back to the life-worlds of age(ing), in-
cluding the situation of older adults in a political economy of ageing, their
structural and symbolic disadvantage in society, their generational sociali-
zation, their life-courses and biographies, and the range of materialities
and materialized temporalities that characterize their life worlds: from
fancy and ‘new’ to mundane and ‘old’ devices, artefacts and objects.


                                    ***




Careful Co-Design: Working with Feminist Accounts of
Care in Co-Design

Helen Manchester

    Technologies and their effects have become increasingly implicated in
our everyday lives, loves and caring practices (Matthewmann 2011), in-
cluding those of older people living in care facilities. To date mainstream
technologies designed for the ageing market have been less than success-
ful, often due to ageist stereotypes that perceive ageing as a ‘problem’ and
technologies as potential easy win solutions (Vines et al. 2015; Peine and
Neven 2019). In design processes the ‘problem’ has often been defined by
designers at the outset, echoing cultural tropes of older people as frail and
lacking agency (Boyle 2014).
    More recently there has been a growing focus on consideration of the
social and everyday lives of older people and the emergence of new
methods of co-designing alongside older adults (Vines et al. 2015; Rodg-
ers 2018). These methods have tended to foreground power relations be-
tween humans, in particular the dichotomous relationship between those
Cozza et al.                                                             125
with power (e.g. designers) and those without (e.g. older adults). Howev-
er, this approach has often had the effect of sidelining the material and
more than human actors participating in these processes and can fail to
account for the entanglement of social and material worlds. In order to
intervene in design practice, Science and Technology (STS) scholars have
suggested that problems should be worked on within human collectives
who gather around particular ‘matters of concern’ related to ageing
(Latour 2005). These matters of concern are considered to be entangled
in social and material processes and practices.

STS and feminist materialist thinking in co-design

    In my own co-design work in care settings for older people I bring an
approach that draws on some of these ideas from STS but also combining
them with feminist materialist thinking concerning the relationality be-
tween care and technology (Mol, Moser and Pols 2010). These scholars
argue of the ‘absurdity of disentangling human and non-human relations
of care’ (Bellacasa 2017, 2; Mol, Moser and Pols 2010) suggesting that
paying attention to the relational, affective and interdependent effects of
technologies, alongside other care practices, is vital in technological de-
sign processes. Taking this stance into processes of co-design in care set-
tings involves rejecting more instrumental, economic accounts of the
world and increasing awareness and visibility of the networks of actors
that are taken for granted in everyday practices of care (Mol, Moser and
Pols 2010; Barad 2007; Bellacasa 2011). The co-design process here in-
volves making visible, and tangible, sociomaterial relations of care and
how they contribute to social well-being. The process of technology de-
sign proceeds as an open-ended innovation process where technologies
are considered unfinished projects which are open to adjustment or tink-
ering (Akrich 1992; Mol, Moser and Pols 2010).
    Bringing feminist materialist ideas of care to the practice of co-
designing technologies means engaging with care in all its sociomaterial
complexity. To simplify some complex historical arguments, feminist
scholars ask us to reconsider care in four key respects: firstly, seeing care
as an everyday, messy, material practice; secondly, seeing care as political
(and often overlooked); thirdly, understanding care as going beyond lan-
guage to encompass embodied materialities of care including touch and
bodies and finally care as a dynamic process being about diligent atten-
tion to detail, involving repair and maintenance (Tronto 1993; Bellacasa
2017).

Careful co-design
126                                                              Tecnoscienza – 11 (2)


    Drawing on these ideas of care Bellacasa (2011; 2017) has suggested
that STS scholars might consider moving beyond the Latourian call to
gather around matters of concern to consider intervening in ‘matters of
care’. In my own work I have been interested in bringing Bellacasa’s ra-
ther theoretical ideas to the practice of co-design. I have begun to think
about co-design as a matter of care or as a care practice which, I believe,
supports more ethical, sustainable design in the ageing sector. Below I
will outline how taking this approach might change practices of co-design
and will argue that this approach is of particular value when working in
settings where questions of care are predominant.
    Firstly, moving from ‘I am concerned’ to ‘I care’ draws attention to af-
fective aspects of technology design practices that have often been ig-
nored. It involves paying attention to the networks of actors that are often
taken for granted in technology design processes, including making visi-
ble how bodies, space, aesthetics and intangible concerns come together
as we co-design technologies. For instance, noticing how the touch of a
hand or the view out of window, might be important elements to consider
in both the design practice and in relation to the object of the design.
    Working with co-design as a care practice also highlights co-design as
a material, vital doing. It suggests the need for diligent attention to detail,
for constant repair and maintenance and attention to humans but also
things and materialities as we co-design together and with the material
world around us. I have always found the below quote from Miriam
Winance particularly helpful in thinking about good co-design practices –
if we substituted the word ‘care’ with ‘design’ the quote gets to the heart
of how careful co-design processes work in practice:

       to care is to meticulously explore, quibble, test, touch, adapt, adjust,
       pay attention to details and change them, until a suitable arrange-
       ment (material, emotional, relational) is achieved. (Winance 2010,
       111)

    So matters of care are doings, they cannot help but therefore involve
the social and the material world and the more than human.
    Careful co-design also involves a critical approach that questions why
certain practices of care have been invisible and de-valued and looks to
enable new actors and tools to align in trying out a more democratic and
holistic future making approach to the design of technologies. The con-
tention here is that open ended, careful design projects are necessary in
order to make ‘good’ care practices, exemplified by approaches that
acknowledge the ethical/political, the affective and the material/ mainte-
Cozza et al.                                                             127
nance of care (involving our bodies, ourselves, and our environment)
more viable and present in new technological designs and approaches to
care.
    So what does this mean for co-design practices and outcomes? It in-
volves us attending to sociomaterial arrangements as matters of care in
co-design processes. For instance, recognising the role of material culture,
such as aspects of the built environment and everyday objects, in care set-
tings in order to illuminate and develop their role in caring practices
(Maller 2015; Buse, Martyn and Nettleton 2018).

Careful co-design in practice

    In order to provide an example, the next section of this short paper
explores our co-design process in care homes in which we conducted a
process of technology co-design focused on democratic community build-
ing through storytelling. We spent time observing in the settings as part
of the ‘discovery’ phase of our design work and instead of focussing only
on the human care practices and relations we instead specifically attended
to the material and more than human world and the importance of these
elements to the older people we were working with. For instance, we ob-
served the blackbird that sings outside the window that was given a name
by some of the residents, the touching and grooming activities such as
nail painting that care staff engaged in, the long and deserted corridor
through which residents must walk in order to reach the beautiful garden
room and the sound of the tea trolley that provided a familiar and com-
forting rhythm to the day. We were then able to build on these often in-
visible elements of caring practices in our co-design work, bringing in dif-
ferent material and sensory design interventions such as object orientated
sessions where residents told stories about their favourite objects to other
residents, and sensory sessions involving smells and an array of fabrics
(velvets and silks and furs) for residents to touch and smell.
    In adopting this approach we found that, as designers, we were able
to identify some key tensions or problems related to how assemblages of
care often worked to diminish the relational, emotional and embodied
aspects of care. Relationally we found that older residents struggled to
make connections with each other but also that care staff often felt anx-
ious about having one to one conversation with residents. Emotional is-
sues included those related to living with loss; of objects, relationships,
and homes. Embodied/material problems emerged, for instance, around
the particular aesthetics in the care settings, the constant noise of the TV,
and the noticed disconnect with the natural world and the world ‘outside’
the care setting.
128                                                        Tecnoscienza – 11 (2)

     In identifying these key tensions we felt we were able to move from a
focus on problem solving and towards thinking about our co-design pro-
cess as joint problem making as the matters of care, outlined above,
emerged through doing the designing together. In order to identify these
tensions we had explicitly engaged with how human and non-human enti-
ties emerge, shift and fuse together during our co-design process. This
helped us to understand, through a relation lens, what entities become,
do and produce when they are associated together and the different prob-
lems or matters of care that therefore emerge.
     In order to ensure this joint problem making approach we discovered
the importance of recording, mapping and playing back the different en-
tities and their relations, to our co-designers in multiple ways, bringing
material and immaterial aspects of matters of care, that are not always vis-
ible or tangible, into the open.
     We found that the outcome of the co-design process also then chang-
es as we were then engaged, not in simply co-designing technologies to
solve the problem of lack of community in care settings, rather we needed
to co-design care arrangements or sociomaterial arrangements (Criado
and Rodriguez-Giralt 2017). This might require ‘technology’ designs that
make adjustments to intangible aspects of culture and re-designs of space,
but it might also mean working alongside care staff to develop their con-
fidence to deliver care differently, or alongside policy makers to challenge
the current economic models around social care provision.

Conclusion

    So up to now I’ve suggested that the social and the human has often
been foregrounded in co-design work - a focus has often been on power
relations between humans and the design of more democratic processes,
bringing diverse publics together around matters of concern. This is im-
portant. However, in my work I have found that thinking about co-design
as gatherings around matters of care helps us to focus in on the material
and the more than human in co-design processes, to consider the political
and ethical issues that have various everyday effects in care settings. It
helps us to think about co-design as problem making rather than problem
solving and leads us to co-design technologies as sociomaterial care ar-
rangements.




                                    ***
Cozza et al.                                                            129
Frailing Technology: Ageing between STS and Medical So-
ciology

Tiago Moreira

    In this short essay, I explore how vulnerability could be embedded in
technological design in the ageing domain and beyond. My point of de-
parture is the suggestion that health and activity/mobility play a central
role in the sociotechnical imaginary of ageing societies. I suggest that
crossing the boundaries between medical sociology and science and tech-
nology studies enables us to question this configuration, and to re-think
the socio-materialities of ageing. To do this, I draw on empirical data
from a set of interrelated projects conducted in last 5 years, starting with
a reflection on a fieldnote written in 2017.

Between the molecular and the experiential

    I think it was the fact that I was understanding most of Jennifer’s
presentation about her doctoral research to the other lab members that I
first remarked in my notebook. Contrary to other research progress oral
reports to the Thread Lab – a cell biology of ageing laboratory where I
conducted ethnographic fieldwork between 2015 and 2019 –, Jennifer’s
touched on a subject I knew something about: frailty. In the two years be-
fore I had been involved as a collaborator in a randomised controlled
clinical trial of muscle strength training and protein supplementation as a
means to delay frailty and its musculoskeletal component - sarcopenia - in
older individuals. In the process, I had become interested in the on-going
controversy about the concept age-associated frailty (e.g. Pickard 2018),
its prevalence in the population, and aware of debates about the compli-
cated relationship between frailty and sarcopenia in the ageing popula-
tion.
    What I had recognised in Jennifer’s presentation was not only the use
of a commonly used definition of frailty – as a “state in which the ability
of older people to cope with […] stressors is compromised by an in-
creased vulnerability brought by age-associated declines in physiological
reserve and function” (WHO, 2017) – but more importantly her drawing
on a specific standard, the Frailty Index (Mitnitski, Mogilner and Rock-
wood 2001) – also used in the sarcopenia trial on which I was a collabora-
tor –, to measure ‘health deficits’ in the aged mouse. In an operation that
cell biologist of ageing von Zglinicki and colleagues (2016) described as
“reverse translation”, Jennifer’s aim was to draw and validate equivalenc-
130                                                          Tecnoscienza – 11 (2)

es between deficit indicators used for humans in the Frailty Index and
markers of health in the laboratory mouse. In practice, ‘reverse transla-
tion’ was a difficult undertaking, because it required knowing and caring
for lab mice in highly specific, detailed ways (Friese 2019) – e.g. assessing,
scoring and maintaining fur shade, texture, grain and general condition.
This process was intended to establish a biomarker baseline to explore
the value of senolytic therapies – “agents that selectively induce apoptosis
[cell death] of senescent cells” (Kirkland et al. 2017, 2297) - in the rever-
sal of frailty, which was the key objective of Jennifer’s research project.
    Underpinning the parallels across sites is a common approach to
technoscientific innovation, supported by a shared standard (Frailty In-
dex). In the sarcopenia trial, the focus was on designing exercise routines
and protein-rich food products, testing their acceptability in the older
population and their efficacy in countering loss of skeletal muscle mass,
and frailty more widely. In Jennifer’s study, the idea was to design and
test therapeutic agents to reverse the accumulation of cells which have
lost their capacity to divide (senescent cells), and thus to prevent the de-
velopment of age-associated conditions such as frailty. This rationale is al-
so evident in the design of ‘healthy ageing’ interventions aiming to involve
older people in urban cycling in many contemporary cities (Lassen and
Moreira 2020). In all these instances, innovation is justified by alignment
with the promise to address a specific socio-economic problem, research
projects and initiatives hinging on the possible impact of technological in-
tervention on the frailty of older populations, where prevalence is esti-
mated to be up to 60% (Collard et al. 2012).
    The choice of frailty as a target of technological intervention is signifi-
cant beyond its prevalence and is intimately linked to how this syndrome
has come to embody the predicaments of growing old in contemporary
societies. As Gilleard and Higgs (2014) have argued, frailty is the defining
condition of the Fourth Age, a collectively imagined last phase of life
characterized by ill health and dependency. They suggest that, contrary to
other stigmatising conditions, the labelling mechanics of ‘frailing’ does
not enact a concrete spoiled identity, as expected by models of stigma in-
spired by Goffman (1963), but rather a sense of abjection towards older
people, thus marked by “a future unspecified adverse outcome”. In this,
research and innovation program to prevent frailty can be seen to deploy
a central sociotechnical imaginary that links health and activity/mobility
to technology in the ageing society.
    It is useful to think of health, activity and technology as being in a
three-way relationship (Moreira 2016, 47-49). In this triangle, practices of
health production and measurement – e.g. exercise routines - become
linked to technoeconomic promises of re-activation of the ageing body
Cozza et al.                                                              131
(e.g. reversing frailty). Relatedly, valuations of activity/mobility become
closely associated with health measurement (e.g. Frailty Index), on the
one hand, and the effects of technologies, on the other. Interestingly, such
technologies are not confined to one single domain, ranging from bio-
cellular therapies, to assistive robotics to the design of protein-rich foods.
The range of possible interventions on the frail ageing body blurs the dis-
tinction between computing, biomedicine, public health, sport, food sci-
ence and technology, and other fields. Technoscientific practices, in do-
main of ageing, as the example of frailty makes clear, offer to modify
health and activity through a set of converging tools and forms of
knowledge that align the “molecular and the experiential” (Lappé and
Landecker 2015, 152).

Frailty at the crossroads

     Understanding and investigating empirically this specific configura-
tion of ageing-related technological practices requires a careful but equal-
ly inventive combination of theories from both science and technology
studies and medical sociology. Using the example of frailty, again, will
help to clarify this argument. In both the clinical trial and the Thread
Lab, technological design and testing relied on a workable category of
frailty, made conspicuously visible in Jennifer’s attempts to ‘reverse trans-
late’ the deficit accumulation model of frailty to the lab mouse. Commit-
ting to a specific formatting of frailty had consequences, for example, for
how exercise protocols were designed in the clinical trial, and in turn, for
the recruitment criteria used. Thus, it was sometimes the case that poten-
tial participants became classified as ‘too frail’ or ‘too vigorous’ to be in-
cluded in the trial (Otto and Moreira 2018), making their situation poten-
tially excluded from the networks of health production the trial was pre-
cisely attempting to build (Star 1991).
     Attending to these situations is one of medical sociology’s unique
strengths, taking the point of view of the ‘patient’ and exploring the dy-
namic relationship between identity and the person’s social world (e.g.
Charmaz 1983). In distinction from the deficit accumulation model of
frailty (see above), medical sociology’s analysis of the experience of frailty
focuses on how bodily disruption – e.g. a fall –calls into question the per-
son’s habitual, socially grounded way of being and unsettles her hitherto
unproblematic relation to the world (Pickard 2018; Bury 1982). In this
process, reconstructing one’s identity does not necessarily entail identify-
ing fully with the label of frailty, but might lead to a reconstruction of
one’s activities and social networks, so that physical limitations can be
contained, and a sense of continuity maintained, despite increased aware-
132                                                         Tecnoscienza – 11 (2)

ness of decline. What, in the deficit accumulation model, is cast as risk, is
experienced by older people as uncertainty, enacted in a cautious and
continuously re-invented navigation of their socio-material world.
    Contrasting this nuanced understanding of frailty with the ‘scripted’
specification of technological use I encountered in the trial and the labor-
atory is useful for two key reasons. On the one hand, it contextualises us-
es of technology in a mode of pragmatic engagement – that of the activi-
ties of everyday life –, and thus helps in STS’ aim to deflate technology-
focused solutions to the ‘problems of ageing’. From this perspective, as I
observed, protein-rich food products for frail older people often merely
add functionality to an already ‘healthicised’ meal, where ingredients are
included mainly for their physiological benefits to reduce the risk of dis-
ease. Reluctance of older people to participate in this arrangement of eat-
ing should thus not be surprising and cannot be understood through the
frame of therapeutic ‘compliance’ or ‘adherence’ (e.g. Conrad 1985).
    On the other hand, understanding living with frailty as form of mun-
dane work offers an alternative, diversity-focused, and embedded ‘con-
figuration of the user’ to be used in technological design (Peine and Ne-
ven 2020). Medical sociology recognises living with chronic illness, disa-
bility or frailty as both a mode of practice – often conceptualised as a
form of work (Corbin and Strauss 1988) - and a way of knowing: these
two dimensions are inextricably connected. For medical sociologists, ‘ex-
perience’ is not a uniquely individual set of impressions but rather a form
of socially grounded knowledge (Bury 1982), collectively produced by the
interactions and negotiations of a variety of actors across formal and in-
formal settings. This provides another point of fractional contact between
medical sociology and STS in the domain of ageing. How are the forms of
situated cognition that we usually see as living with and caring for frailty
better supported through technological devices or processes? Addressing
this question requires starting from an understanding of existing practices
of frailty - a grounded theory of frailty – to identify technological needs
and possible forms of user involvement. It might also invite us to recon-
sider technological practices in the arena of ageing.
    Medical sociology direct STS further into praxiological investigations
(Mol 2002) of the sociotechnical or socio-material constitution of ageing.
It does so, however, by emphasising the human perspective – the ‘pa-
tient’, user, older person, etc. Indeed, a consistent critique of medical so-
ciology by STS scholars has been its belief in the intrinsic character of
human agency (e.g. Moreira 2004). Medical sociology’s orientation to
agency is problematic because of how it overlaps with calls and prompts
to make older people more ‘active’ in society through technology inter-
vention (see above). In this, ‘active ageing’ technologies have become the
Cozza et al.                                                               133
target of criticisms for their inability to integrate the experience of de-
cline, loss of function and passivity in their enactment of ageing, that is to
say, to encompass the diversity and tensions inherent to a condition like
frailty, as detailed in medical sociology’s own empirical investigations of
it. By drawing uncritically on medical sociology’ humanist commitment,
STS partakes uncritically in the normative aim “to reconceptualise older
individuals as active users of technology rather than as passive recipients”
(Czaja and Barr 1989, 128). In doing this, STS thus risks neglecting its
own tradition in problematizing agency (Latour 1988; Callon and Law
1992; Gomart and Hennion 1999; Barad 2007).

Frailing technology

    What would be consequences of conceptualising older people as both
passive and active users of technology? To do this, we might want to start
by taking frailty as an object lesson. As suggested above, frailty is interest-
ing because it both deploys technological expectations about innovation
in the ageing society and challenges the parameters on which those expec-
tations rely. Frailty is both the defining condition of older age and the
most puzzling and difficult to stabilise, define and measure both in the
clinic and the lab. Its experience is marked by hesitation and uncertainty,
with pragmatic engagement defined by fluctuation between inaction and
careful mobility. How could technology for older people be re-imagined
if frailty became its paradigm; if, instead of taking as point of departure
an able bodied, active, engaged human, we would begin with vulnerabil-
ity?
    In this shift, vulnerability should not be conceptualised as an excep-
tional state but as a relationally produced human attribute (Mackenzie,
Rogers and Dodds 2014), rooted in socio-technical systems (Hommels,
Mesman and Bijker 2014). Frailty could thus become the model for re-
search on technoscience in the ageing society, specifying a pragmatic and
fragile balance between autonomy/activity/mobility and dependen-
cy/passivity/delicacy. Rather than aiming for technology to fix and estab-
lish the right balance between these two poles, we should try to under-
stand how technoscience can care for the dynamic between them, ena-
bling a continuous mutual adjustment of the capacities of ontologically
heterogeneous actors. In this process, technology would undergo what
we, after the process of adapting a physiological scale to lab mice describe
above, could call a ‘reverse frailing’, where technological expectations are
embedded in uncertainty and enacted in a cautious and continuously re-
invented imagination of the materialities of ageing.
134                                                               Tecnoscienza – 11 (2)

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