10.6092/issn.2038-3460/17581
Old age is at the core of complex constellations composed by media discourses, care and mundane activities, and affective and technological practices that involve a wide range of human and non-human actors. While during the last years concepts such as “active” and “successful” ageing have more and more emphasised the individual responsibility of older adults in managing their own health, in the context of the Covid-19 pandemic elderly have been increasingly framed as vulnerable subjects. This Crossing Boundaries will explore the different instances assumed by the “old age” as an emerging object by the enactment of discourses and materialities. In doing so, this Crossing Boundaries mobilizes different theoretical perspectives, such as STS, media studies and sociology of health. The authors will explore three main issues: 1) the public discourse about the health status of older people; 2) the collective management of Alzheimer’s disease in and outside institutions; 3) the involvement of older adults in designing information and communication technologies.
application/pdf
2038-3460
17581
2
en
Enrico Maria Piras
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
vulnerability
On Old Age and Its Multiplicity: Exploring Discourses and Materialities about Getting Older
Text.Serial.Journal
https://tecnoscienza.unibo.it/
13
Crossing Boundaries
2023-02-19
2023-06-30
2023-02-19
2023-10-30
105-132
TS
Enrico Maria Piras
2022
10.6092/issn.2038-3460/17581
105
Bruno Kessler Foundation
2038-3460
2
vulnerability
en
132
On Old Age and Its Multiplicity: Exploring Discourses and Materialities about Getting Older
https://tecnoscienza.unibo.it/article/download/17581/16431
13
                                                                          Crossing Boundaries

On Old Age and Its Multiplicity:
Exploring Discourses and Materialities
about Getting Older
     Francesco Miele                          Nicoletta Bosco             Valeria Cappellato
         University of Trieste                    University of Torino       University of Torino

    Elisa Castellaccio                     Enrico Maria Piras
         University of Bologna                 Bruno Kessler Foundation




        Abstract: Old age is at the core of complex constellations composed by media
        discourses, care and mundane activities, and affective and technological prac-
        tices that involve a wide range of human and non-human actors. While during
        the last years concepts such as “active” and “successful” ageing have more and
        more emphasised the individual responsibility of older adults in managing their
        own health, in the context of the Covid-19 pandemic elderly have been increas-
        ingly framed as vulnerable subjects. This Crossing Boundaries will explore the
        different instances assumed by the “old age” as an emerging object by the en-
        actment of discourses and materialities. In doing so, this Crossing Boundaries
        mobilizes different theoretical perspectives, such as STS, media studies and so-
        ciology of health. The authors will explore three main issues: 1) the public dis-
        course about the health status of older people; 2) the collective management
        of Alzheimer’s disease in and outside institutions; 3) the involvement of older
        adults in designing information and communication technologies.

        Keywords: old age; pandemics, Alzheimer, gerontotechnology; vulnerability.

        Submitted: September 2022 – Accepted: October 2022

        Corresponding author: Francesco Miele, Department of Political and So-
        cial Sciences, University of Trieste, Piazzale Europa 1, 34127, Trieste, Italy,
        francesco.miele@dispes.units.it




    TECNOSCIENZA
    Italian Journal of Science & Technology Studies
    13 (2) pp. 105-132 - ISSN 2038-3460
    www.tecnoscienza.net                                   2022

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106                                                           Tecnoscienza – 13 (2)


Introduction

Francesco Miele, University of Trieste


    To what extent is old age a matter of concern in the contemporary
world marked by the Covid-19 Pandemic? This Crossing Boundaries (CB)
section of Tecnoscienza tries to address this question, gathering three con-
tributions at the crossroads of STS, media studies and sociology of health.
Recent research in the field of age studies1 seeks to understand how the old
age – and, along with it, the aged bodies and the health conditions of older
adults, the self-care practices enacted by them and the expectations that
surround this segment of population – is discursively and materially pro-
duced in different ways, depending on the time and the spatial context.
Across the different historical periods and local settings, new meanings as-
sociated with old age can replace or intertwine previous ones, redefining
what seems possible, desirable, appropriate, or inappropriate for later life
stages. Following the contributions hosted within the Special Issue “Age-
ing and Technology”, previously published for this journal in 2020 (vol 11,
no. 2), old age can be interpreted as an object, i.e., “something people act
toward and with” (Star 2010, 603) – at the centre of complex constellations
of socio-material practices (Cozza et al. 2020). Such constellations are com-
posed by media discourses, care practices and mundane activities, affective
and technological practices that involve a wide range of actors (such as
older adults, but also peers, relatives, neighbours, new and old media, pri-
vate companies, innovative or old-fashioned infrastructures and technolo-
gies) contributing at configure old age as a matter of concern, that is, an
object relevant in a certain temporal and spatial context that, at the same
time, materialised in daily relations (see Latour 2004).
    Drawing on these theoretical insights, the aim of this CB is to reflect
about the different versions of the old age object that emerge from the en-
actment of some of the above cited discursive and material practices. Con-
sidering the so-called “pandemic times” – that have put the elderly and
their health conditions at the core of public debate – it is urgent and polit-
ically pertinent to reflect (once again) on the practices and meanings asso-
ciated with the later stages of life. In enacting such a reflection, the authors
of this CB will consider the following different settings in which the old
age object emerges and takes shape: the public discourse about the health
status of older people (see Bosco and Cappellato, this issue); the collective
management of Alzheimer’s disease in and outside institutions (see Castel-
laccio, this issue); and the involvement of older adults in designing of in-
formation communication technologies (see Piras, this issue). By consider-
ing these different settings in which practices and meanings about later
stages of life emerge, the three contributions hosted in this CB aim at facing
the following questions: 1) What are the different forms that the object


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Crossing Boundaries                                                                   107

“old age” takes in contemporary society? 2) How do the different forms of
old age get in relation to each other? 3) To what extent has Covid-19 af-
fected the stability among these different forms of old age?
    The first question regards the multiplicity of old age. In this regard, ac-
cording to Annemarie Mol (2003, 5):

    If practices are foregrounded there is no longer a single passive object in
    the middle, waiting to be seen from the point of view of seemingly endless
    series of perspectives. Instead, objects come into being – and disappear –
    with the practices in which they are manipulated.

    Age studies have underlined how since the 80s the role of older people
in the contemporary societies has been redefined by the reproduction of
complex textures composed by media discourses (Asquith 2009; Shimoni
2018), institutional policies (Lassen and Moreira 2014), technological in-
novations and daily practices (Lassen 2015; Siira et al. 2020; Carlo and
Bonifacio 2021) in which old age is enacted as a period of life compatible
with an active role in different everyday domains such as work, health, so-
cial engagement and sexuality. This way of conceiving and practicing old
age clashes with the pre-existing ones in which older people were repre-
sented as passive recipients of pensions (Cumming and Henry 1961), homo-
geneously characterised by frailty, dependency, loss of cognitive and physical
functions (Seefeldt et al. 1977; Midwinter 1991; Ainsworth and Hardy 2007;
Martin 2009). Despite the heterogeneous empirical contexts considered by
the contributions of this CB, the authors share a common interest toward
disentangling the tensions and interactions between the “passive” and the
“active” versions of old age: if in the first case older adults are conceived as
people needing support (Cozza and De Angeli 2015), in the second one they
become directly responsible for their own health and wellbeing.
    The second question mentioned above regards the relationships be-
tween different forms of old age that emerged over the last few years. As
we will see in the next pages, the passive and active versions of old age exist
in relation to each other, being characterised by a mutual constitution rela-
tionship. Paraphrasing Brent Slife (2004, 158):

    the representations and the practices concerning old age – even if they ap-
    pear absolutely at odds – are not first self-contained entities and then inter-
    active (...), they start out and forever remain in relationship.

    A first kind of relationship among the different versions of old age con-
cerns the development of contrasting dichotomies. As argued by various
media studies scholars (see Holstein and Minkler 2003; Markson and Tay-
lor 2000; Kessler et al. 2004), the two recurrent versions of old age object
– the old old (i.e., the elderly with bad health conditions), and the young
old (i.e., the active and independent older adult) – coexist only in constant
conflict with each other. In the media sphere these two versions of old age


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108                                                         Tecnoscienza – 13 (2)


are used for reenforcing the idea that the old age can be experienced in two
main ways and that – coherently with the neo-liberal ideology that turn
bad/poor health in a matter of individual responsibility – the choice among
them is up to the individual. Within this CB Bosco and Cappellato, by re-
ferring to the Covid-19 pandemic, investigate the juxtaposition between
the active ageing/successful ageing rhetoric, the “vulnerability narrative”
and the “burden” one. In contrast, Castellaccio and Piras explore collabo-
rative dynamics among the different shape that the object old age can take.
In the first contribution, the wide use of digital technologies during the
Covid-19 pandemic assured both the assistance to people with Alzheimer’s
disease and their active involvement in social interactions, useful to treat
the symptoms associated with the disease progression. In the second one,
in the design processes aimed at developing new gerontechnologies, pater-
nalistic representations of elderly’s needs and rhetoric about the im-
portance of their active participation in the enactment of new technologies
can coexist. If the rhetoric of older people as active experts is useful for
accessing to competitive calls announced by major national and interna-
tional funding institutions, the image of elderly as passive recipient of care
persists both in the projects and their implementation, preserving the in-
terests of research and industrial partners involved in these projects (e.g.,
developing, evaluating, testing products and services that must have certain
characteristics, despite the users’ preferences).
    The last question addressed by this CB regards the relevance of the
Covid-19 pandemic in reshaping and reconfiguring the old age object. As
recently observed (Miele and Nunes 2021) the Covid-19 pandemic
strengthened mainstream rhetoric that objectified older individuals and fa-
voured the enactment of practices (e.g., selective social isolation and mar-
ginalisation) that treat them as fragile recipients of care. Under this per-
spective, this CB explore in depth the changes and tensions produced by
Covid-19 pandemic around old age, defining in detail the public discourses
emerged during this global outbreak. In particular, authors focus on the
ways through which the discourses emerged during pandemic challenge or
reinforce some pre-existent trends in the public sphere, such as the empha-
sis on their individual responsibility of older adults (see Bosco and Cappel-
lato, this issue) or on the importance given to social relations for their
health (see Castellaccio and Piras, this issue).
    Overall, this CB provide an understanding of old age object as a collec-
tive matter of concern marked by a multiplicity shaped by discourses and
materialities enacted by complex networks of actors (Miele and Fornasini
2021). In doing so, this CB open a lively dialogue among different disci-
plines, as a fruitful way to approach the object old age from different angles
and to reach a fully understandings of the ongoing changes that have af-
fected it in the recent times.




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Crossing Boundaries                                                                109

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    paradox and policy, in “Discourse & Communication”, 1(3), pp. 267-285.
Asquith, N. (2009) Positive ageing, neoliberalism and Australian sociology, in “Jour-
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Carlo, S. and Bonifacio, F. (2021) Ageing in rural Italy through digital media: Health
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Cozza, M. and De Angeli, A. (2015) Infrastructuring diversity in stereotypes, in Pro-
    ceeding of the 5th International workshop on Infrastructures for healthcare (IHC):
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Latour, B. (2004) Why has critique run out of steam? From matters of fact to matters
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Martin, J. (2009) The portrayal of older people in Disney live action films from the
    1990s and the 2000s, Provo, Brigham Young University.
Midwinter, E. (1991) The British Gas report on attitudes to ageing, London, British Gas.
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    ter of concern, in “Rassegna Italiana di Sociologia”, 62(2), pp. 279-291.
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    Turns in Technology Discourses and Practices Related to Ageing, in “Tecnosci-
    enza: Italian Journal of Science & Technology Studies”, 12(2), pp. 61-67.
Mol, A. (2003) The body multiple, Durham, Duke University Press.
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    model and agenda, in “Ageing & Society”, 41(12), 2845-2866.
Seefeldt, C., Jantz, R.K., Galper, A. and Serock, K. (1977) Using pictures to explore
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Shimoni, S. (2018) “Third Age” under neoliberalism: From risky subjects to human
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Siira, E., Yndigegn, S., Rolandsson, B., Wijk, H. and Wolf, A. (2020) Co-production of
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     in “Science, Technology, & Human Values”, 35, pp. 601-617.

                                         ***

Aging Discourses during the Covid-19 Pandemic

Nicoletta Bosco, University of Torino
Valeria Cappellato, University of Torino


    Through public discourse, concerned groups of people can establish –
though not always intentionally or by consensus – what problems should
be considered urgent and what issues need to be addressed. During the
Covid-19 pandemic, the narratives enacted by different actors (such as pol-
icymakers and politicians, academics, “traditional” and digital media) have
played a central role in defining how the public views and acknowledges
the condition and needs of the older population. This paper explores how
public discourses – in their performative dimension – can reveal the collec-
tive (partial) capacity to respond to the many issues affecting older adults
that emerged during the pandemic emergency.

The Precarious Status of Older Adults

    During the first global Covid-19 lockdown, some US economists esti-
mated the cost of reopening at an average of $14.5 million per lost life. For
older people, the figure dropped to $9 million, while other estimates valued
the lives of people over seventy at only $3.7 million (Feltri 2020). Economic
estimates aside, the idea of assigning a lower value to people as they age is
not new. Indeed, early theories of aging focused primarily on the deficits
associated with it (Bugental and Hehman 2007). Assuming that physical
and cognitive decline is inevitable, some scholars described aging as a pro-
cess of progressive withdrawal or disengagement associated with loss of
roles (Cumming and Henry 1961), dependency and frailty (Priestley 2003),
and, in some cases, a general deterioration in personal characteristics and
emotional state (Makita et al. 2021). This deterioration is often associated
with ageism, which the American physician and gerontologist Robert But-
ler described as early as the 1960s as:



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Crossing Boundaries                                                                111

    a deep-seated uneasiness on the part of the young and middle-aged – a per-
    sonal revulsion to and distaste for growing old, disease and disability; and
    fear of powerlessness, “uselessness,” and death. (Butler 1969, 243)

     Over the years, scholars have deepened, broadened, and clarified our
understanding of aging processes by adding new concepts and articulations
of social and physical characteristics and representations of old age. In ad-
dition to explicitly negative attitudes and stereotypes (Cesari and Proietti
2020), hidden and implicit mechanisms have also been identified. One is
the so-called compassionate or benevolent ageism, which leads to paternal-
istic actions and forms of social support that implicitly assign the older
population with attributes such as incompetence, frailty, dependency, pas-
sivity, and victimhood (Ayalon et al. 2020; Vervaecke and Meisner 2021).
     Giving voice to older adults shows that their views of what constitutes
wellbeing given the objective or inevitable changes brought by ageing are
more varied and positive than younger people tend to believe (Jolanki and
Spännäri 2019). Moreover, as reflected in the concept of “gerotranscend-
ence” (Tornstam 1997), aging may be associated with greater emotional
stability, life satisfaction, and a more conscious acceptance of human na-
ture despite possible functional limitations under certain conditions.
Drawing on physiological, psychological and sociological studies, Rowe
and Khan (1997) have introduced the concept of successful aging, suggest-
ing that people can often maintain their cognitive function, good health,
and engagement in the community as they age. Over the years, an increas-
ing number of public initiatives have made this prospect more concrete.
Since 2002, the World Health Organization (see WHO 2002) has pro-
moted a comprehensive, positive concept of active aging through actions
that support older people’s health, participation, security and quality of
life. In 2012, the European Parliament proclaimed the “Year of Active Ag-
ing” and promoted a communication campaign under the slogan “Good
health adds life to years” with images of healthy, active older people engaged
in working, taking care of children, and even such extreme physical exercise
as bungee jumping (see Gibbons 2016). However, both the successful aging
paradigm and the active aging paradigm have come under criticism. This is
largely due because they have been translated into economically oriented
policies that focus on extending working lives without considering the other
aspects, such as doing things that make us feel good in stimulating, inclusive,
and relational environments (Foster and Walker 2015). Moreover, these per-
spectives that emphasize individual responsibility risk blaming those who
cannot adapt to a rigid model of aging that makes no allowance for the un-
deniable fact that not all older people are the same (Stephens 2017).
     As a result, it seems likely that the value – and not just the economic value
– of older people has always had an ambiguous status in different cultures
and countries. This has led to narratives that have helped to normalise some
representations to the detriment of others. At the same time, older people’s


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situation in recent decades has been marked by a further intensification of am-
bivalent dynamics that facilitate the coexistence of contradictory narratives.
    According to Becca Levy (2017), the ambiguity is due to processes that,
on the one hand, increase the visibility of older adults and their rights, but
on the other, make supporting them an extremely demanding burden. Bet-
ter living conditions have significantly extended the average lifespan. The
growing presence of older people in Western societies has been accompa-
nied by an increase in policies and services for them. In addition, increasing
efforts to battle diverse discriminations led to the assumption that “age dis-
crimination” against older adults could also be successfully fought. In
Levy’s view, however, the potential for destigmatising change has been
thwarted by several opposing forces: 1) the rapid growth of the anti-aging
industry has emphasised the negative aspects of aging in order to boost the
silver economy; 2) smaller families and younger adults’ geographical mo-
bility have decreased intergenerational contact, leading to loneliness and
social exclusion among seniors; 3) due to the lack of specific education
aimed at increasing the recognition of the older population’s worth, legis-
lations and policies have proven insufficient to change stigmatising beliefs
and behaviours; 4) and lastly, the heterogeneity of this segment of the pop-
ulation has slowed the formation of organised groups capable of coordi-
nated action springing from a shared sense of identity (Levy 2017). Tech-
nology itself, as well as medical developments, have taken on an ambivalent
role, as the extension of life expectancy and the increasing longevity of
fragile people increase the cost for the community of their health and social
care (Ayalon and Tesch-Römer 2018).

Aging Discourses in the Covid Era

    The higher number of deaths among the older population during the
Covid-19 pandemic reinforced the assumption that there is a correlation
between age and vulnerability, with far-reaching negative consequences
(CDC 2021; Alicandro et al. 2022). Assuming that “only certain popula-
tions are at risk for infection” creates “an environment in which younger
generations may have felt invulnerable to the virus and that health recom-
mendations did not apply to them” (Guest and Peckham 2022, 11). The
perception that government measures to contain the virus were necessary
to protect older adults intensified intergenerational conflicts (Anderson
and Gettings 2022). This fostered resentment and anger toward those
blamed for the restrictions that also affected younger people. Lastly, the
arbitrary categorisation of older adults based on chronological age bound-
aries leads to a false homogenisation of the many individual differences and
personal diversities seen in later life. The combined effect of these dynam-
ics exacerbated the ambivalent status of older people, for instance by rein-
forcing ageist stereotypes while reducing attention to the context in which
many older people lived (and died) during the long months of the


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Crossing Boundaries                                                          113

pandemic (Heymann 2021; Seifert 2021). There were widespread and doc-
umented human rights violations against old people in places intended for
their protection, such as social and health care facilities and nursing homes
(Amnesty International Italia 2020).
     During the Covid-19 pandemic, there was a surge of ageist discourses
focusing on the need to isolate and distance people over a certain age (An-
derson and Gettings 2022). These narratives are linked to an emphasis on
the ableism perspective (van der Horst and Vickerstaff 2021), which as-
cribes value only to a “particular kind of self and body […] that is projected
as the perfect, species-typical, and therefore essentially and fully human”
(Campbell 2001, 44). Such a view emphasises the otherness of those who do
not meet standards, marginalising or nullifying their presence (Chouinard
1997), and promoting the internalisation of self-stigmatisation processes by
people with functional limitations (Ayalon and Tesch-Römer 2018). Both
European and North American media have “naturalised” a uniform narra-
tive of older people as vulnerable, not self-sufficient and frail, thus reinforc-
ing the intersections between ageism and ableism (Swift and Chasteen 2021;
Vervaecke and Meisner 2021). Moreover, ageist practices in hospitals and
nursing homes, such as adverse selection in the allocation of scarce resources
(i.e., assigning higher priority for access to intensive care to younger people),
have long been shrouded from attention (Emanuel et al. 2020).
     As a result, the emphasis on individual responsibility for aging that was
central to narratives in the pre Covid-19 pandemic period (Miele and
Nunes 2022) took on new nuances suggesting mechanisms of blame and
paternalism during the global outbreak. Online contents referring to
Covid-19 as the “Boomer Remover” which first appeared on Reddit in the
US and spread across social media such as Twitter, TikTok, and Instagram,
suggested that older people should be sacrificed for younger generations
(Meisner 2020; Ehni and Wahl 2020). This is a further instance of inter-
generational conflict (Ayalon and Tesch-Römer 2018), with expressions of
hostility that legitimised a “process of demographic cleansing of society of
over sixty people (Godawa 2021, 92).
     Statements by politicians in several countries denoted an explicit nega-
tive ageism (Cesari and Proietti 2020), which intentionally justifies preju-
diced beliefs by spreading the message that older people are expendable
(Barrett et al. 2020). The words of the lieutenant governor of Texas (who
called for the self-sacrifice of those over seventy for the economic benefit
of America’s future generations) or those of the Italian governor of the Li-
guria region2 are just a few examples of the widespread anti-aging narrative
during the pandemic. Even in the case of benevolent ageism, well-inten-
tioned efforts became harmful by homogenising older adults with phrases
such as “our old people” and reinforcing stereotypes related to a suppos-
edly non-self-sufficiency through a paternalistic ethos assuming that older
adults need and want help because of their age, even when they do not
(Vervaecke and Meisner 2021, 161). Similarly, the “vulnerability narrative”


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114                                                           Tecnoscienza – 13 (2)


– which views older people as a homogeneous and undifferentiated group
of fragile and vulnerable people who needed to be protected – ties in with
the “burden narrative”, which focuses on the hardships that young people
have had to deal with to protect the older population (Kornadt et al. 2021).
Both narratives have been reinforced by the widespread “silver tsunami
narrative,” which depicts the growing number of old people in Western
societies as a problem in terms of sustainability and inflationary healthcare,
social, and financial costs (Kingsley 2015).

Conclusions: How Social is Health?

    A large multidisciplinary body of research has explored the character-
istics and heterogeneity of aging processes, as well as the worrying preva-
lence of ageist language (Nussbaum et al. 2005) and the unsatisfactory re-
sponses to older people’s needs in various health and social service settings.
Numerous scholars have also emphasised that age itself is not necessarily
predictive of Covid-19’s clinical outcomes (Ehni and Wahl 2020; Meisner
2020). The etiologic correlation of Covid-19 and advanced age is much
weaker when patients’ comorbidities are taken into account. The location
of outbreaks in terms of settings (e.g., in nursing homes) and geographical
areas (especially northern Italy compared with the rest of the country) are
also relevant factors for the spread of this disease (Poli 2020, 274). In ad-
dition, numerous studies have addressed the “double jeopardy” posed by
the combination of ageism with gender- or ethnicity-based stigma (see
Bugental and Hehman 2007 for a review about this issue). These studies
have critically scrutinised key misconceptions about aging with a wealth of
evidence refuting taken-for-granted assumptions. Some scholars argue that
aging does not necessarily involve loss and decline, or that under certain
conditions we have more control over the aging process than we are led to
believe. Moreover, researchers note that many age-related losses may be
reversible, as recent studies of brain neuroplasticity confirm. However, if
we concentrate our gaze on the years leading up to the pandemic, we can
see what Levy (2017) calls the persistent “age stereotype paradox” with a
marked increase in prejudice toward older people. Two key discourses on
aging continue to emphasise the rising costs to welfare systems’ sustaina-
bility of extending life spans and reject the collective methods of activation
and prevention that call for individual responsibility. This has led to a one-
sided, unsatisfactory, and wholly unsubstantiated reading of aging.
    Very few of the findings briefly reviewed here have been echoed in public
discourses promoted by mainstream media and institutions. Here, it is worth
noting that the unsatisfactory status of public debate is not specifically re-
lated to discourses on aging. Rather, it reflects the criteria of newsworthiness
that emphasise content according to the attention it can receive, without
delving into complex social phenomena. Although the pandemic has brought
older adults back to the centre of discourses (Miele and Nunes 2022), the latter


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Crossing Boundaries                                                               115

have reaffirmed the oversimplification and normalisation of representations
and content in new and traditional media (Makita et al. 2021) and in the posi-
tions of many institutional and political representatives around the world.
    Lastly, aging seems to be the litmus test for what Nancy Fraser in her
discussion of the crisis of care (2017) attributes to the social contradictions
of contemporary capitalism. On the one hand, as Jolanki and Spännäri
(2019) note, the fact that the lack of resources and cuts in social services
have meant that welfare systems now seek to cover only what are regarded
as basic needs does not allow us to address people’s more complex require-
ments. We thus forget that “human life is much more than meeting the
needs defined as basic needs in care contracts” (Jolanki and Spännäri
2019). On the other hand, even if the discourses about our inevitable de-
cline were true, the question arises whether we really want to live in a soci-
ety that excludes the frail and vulnerable (Dirindin 2018). Moreover, “the
‘othering’ of ‘the elderly’” (Verbruggen et al. 2020, 230) – the claim that
older adults are a separate, homogeneous social group – seems unfounded.
Older people’s condition tells us something about our future and our
finitude, which causes us so much anxiety and denial.
    Echoing John Rawls’ (1971) thoughts on the veil of ignorance, whereby
no one knows today what state they may be in tomorrow, “othering” and
the idea of inevitable decline can be rejected without resorting to compas-
sionate ageism. Frailty and its implications are not something that concerns
only older adults. It concerns society as a whole, and policy makers must
decide how to deal with it. The way we care for older people not only af-
fects the people involved, but is one of the most important features of the
(more or less) democratic society in which we live.


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                                     ***

Pandemic and Alzheimer’s Disease. Have Care Practices
for Elderly Patients Been Reconfigured?

Elisa Castellaccio, University of Bologna


    Alzheimer’s disease is a condition increasingly common among older
people and relevant for understanding broader phenomena (that may also
involve other sectors of older populations), such as the reconfiguration of
family networks around an especially debilitating disease, the strengths,
and the weaknesses of services for non-autonomous elderly and the unmet
needs of their caregivers. Considering the impact Alzheimer may have on
people, this disease can be considered not only medical, but also “social”
for several reasons (Frisone 2002; Pin Le Corre et al. 2009; Ngatcha-Ribert
2012). While there is no doubt that, on a physical-pathological-relational
level, it predominantly affects older individuals, this disease also has signif-
icant implications for the people who care for them, with roughly 3 million
people caring for the sick directly or indirectly. For caregivers and profes-
sionals, the social and personal cost is significant since their care work im-
plies immense mental and physical fatigue with episodes of stress, burnout
and social withdrawal (Cheng 2017; Moretti and Radin 2019). The onset
of Alzheimer’s disease acts as a true biographical disruption since, almost
always, the disease and its management imply a drastic modification of
one’s life (Bury 1982; Altable and de la Serna 2020). In addition, this dis-
ease produces organizational and political-economic consequences on
health care systems. As Alzheimer’s cases grow, the demand for external
and in-home care services increases, with regional networks of public ser-
vices needing to be strengthened and reorganized. The burden associated
with care also represents a point of economic strain, with growing cases
calling for further instrumental examinations for diagnostics and monitor-
ing. Beyond material needs, the intense social stigma of Alzheimer’s disease
persists. According to the World Alzheimer’s Report 2019, 35 percent of
people have hidden a family member’s diagnosis of dementia from at least
one person (Alzheimer’s Disease International 2019).


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Crossing Boundaries                                                         119

    The growing biographical, organizational, political, and economic re-
percussions of Alzheimer’s disease for patients, caregivers, and society have
been further aggravated by Covid-19 (Cohen et al. 2020). In this respect, it
is essential to investigate how care practices for older people with Alz-
heimer’s have changed during the Covid-19 pandemic. Covid-19 has exac-
erbated the disease, and the psycho-physical and social conditions of care-
givers (Cohen et al. 2020), and consequently, caregivers and professionals
have reconfigured their care practices, often with the help of digital tech-
nologies. This contribution to the CS does not claim to be exhaustive, con-
sidering that the Covid-19 pandemic still cannot be said to have ended.
Hence, this contribution mainly focuses on patients and caregivers, both
inherently inseparable, through a theoretical lens developed at the cross-
road between Sociology of Health and Science and Technology Studies.

The Pandemic and Critical Issues for Alzheimer’s Patients

    During the Covid-19 pandemic in Italy, two lockdowns were particu-
larly relevant regarding restrictions and potential social and economic con-
sequences: the first from March to May 2020 and the second from October
2020 to March 2021, coinciding with the return of winter the following
year. These measures were decided on a national scale to reduce the spread
of Sars-COV-2, involving social distancing and isolation. The Covid-19
pandemic had enormous social consequences, affecting every sphere and
daily activity of the individual (Favretto et al. 2021).
    In the context of chronic diseases such as Alzheimer’s and other forms
of dementia, two scenarios were presented during the pandemic to manage
the condition: those who were residing in dedicated facilities3 and those
who instead were at home.
    Sick people staying at home in the pre-pandemic period, could take ad-
vantage of an array of home care professionals (e.g., geriatrician doctors,
nurses, social workers, physiotherapists, and educators) who went to patients
and caregiver’s homes, and other local support services offered in the area
(daycare centers, Alzheimer’s Cafes, volunteer work, and Association events).
    However, these types of homecare resources were discontinued with
the advent of Covid-19. In nursing homes and domestic environments, care
practices had to quickly reconfigure to cope with the disintegration of care
networks and the rapid worsening of caregivers’ social and psychological
health resulting from Covid-19 containment measures. Not only did lock-
down measures create significant challenges to the practical management
of Alzheimer’s patients (Caratozzolo et al. 2020), but also to the mental
health and well-being of caregivers and professionals who reported cases
of chronic stress and burnout (Arcuri et al. 2020; Cravello et al. 2021).
Regarding people with Alzheimer’s disease, it has been argued that social
connection is the best form of treatment for disease progression and, in
particular, for preserving the so-called residual abilities (i.e., the cognitive

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and physical capabilities not yet affected by the disease): maintaining active
relationships, especially with family members, and giving to older persons
a role and identity (Kovacs et al. 2021; Cravello et al. 2021). During the
pre-Covid-19 pandemic period, those who did not live in residential facili-
ties could access many services: daycare centers; parish-related events; Alz-
heimer’s Cafes; voluntary support groups; city-sponsored events in the
area; events and spaces provided by associations; but also, family and
friend support; home visits by care aides, educators, nurses, physiothera-
pists, and geriatricians. Alzheimer’s patients, since March 2020, have been
largely isolated to reduce virus spread and risk of exposure, resulting in
social isolation. This situation has contributed to the sudden progression
of the disease as most care and treatment activities have been suspended
(Numbers and Brodaty 2020). In general, patients with this type of demen-
tia saw a worsening and deterioration of psychological and physical condi-
tions (El Haj et al. 2020; Lara et al. 2020).
    Compounding these stressors, Alzheimer’s patients carry a high risk of
contracting Covid-19 given the cognitive impairments inherent in the def-
inition of the disease that causes difficulties in following health prevention
procedures (such as respecting the physical distancing rules). At the same
time, caregivers have also experienced an exacerbation of their condition,
coping with several complex issues, such as disrupting the daily routines
and increasing caregiving load.

Digitizing Alzheimer’s Care: According to a Process of Co-
constitution with Digital Technologies

     In the context of the Covid-19 pandemic, care practices performed by
caregivers in their own home, as well as within healthcare facilities for people
with Alzheimer’s, have been transformed by the increasing use of infor-
mation and communication technologies (ICTs). For many families, the dig-
ital has entered homes and daily lives in ascendant ways. Using ICTs for daily
support has been feasible and, in some cases, useful for contact with the out-
side world (e.g., using a cell phone or tablet for calls). Since the early 2000s,
video calls have been practiced for diagnostic consultations regarding Alz-
heimer’s disease (Loh et al. 2007), putting an early form of telemedicine into
practice (Dai et al. 2020). Following the Covid-19 pandemic, telemedicine
was readily applied to ensure appropriate support for patients and caregiv-
ers: facilitating a virtual network of immediate communication on day-to-day
activities between individuals and the care system, thereby activating a “hu-
manized communication” in which the position of the individual was central.
     However, technology cannot be reduced to a mere technical tool. As
technology is increasingly used in everyday life by older people (including
those with medical conditions), the popular image of aging changes: from
smartphones, and fitness devices, to electric bicycles and tablets; older
adults are seen as capable figures, exercising agency through the use of


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Crossing Boundaries                                                        121

technologies (Peine et al. 2017; Peine and Neven 2021). In this regard, the
concept of “gerontechnology” has been proposed to define specific tech-
nologies for older users, emphasizing how aging inevitably influences (and
is influenced by) the design of technology (Kwon 2017). As highlighted in
the field of Science and Technology Studies, technologies require to be an-
alyzed within situated settings of interactions, where human subjects and
technological objects can cooperate or conflict (Sismondo 2010). Peine and
Neven (2021) described such process through the “co-constitution of aging
and technology model” (CAT) from the observation that the forms and prac-
tices of aging are not given apart from gerontechnologies, but rather aging is
constitutive of the technology itself. The CAT model predicts a close and
evolving relationship between aging and technology, with both influencing
and contaminating each other. Four essential areas cyclically interact with
each other: 1) the lives of older people, 2) the imagery of aging, 3) techno-
logical artifacts, and 4) their design processes. This process continuously re-
shapes everyday practices, technologies and the collective imaginary of aging.
     The CAT approach may be relevant for understanding the implemen-
tation of digital technologies that occurred during the pandemic by Alz-
heimer’s patients, caregivers, and professionals (nurses, healthcare work-
ers, physiotherapists, psychologists, and educators) involved in their daily
care. The daily lives of these three actors (patients, caregivers, and care
professionals) have changed as a result of being mediated and co-consti-
tuted by technologies. From this perspective, aging is seen and understood
as a phase of life capable of using ICT. The Covid-19 pandemic has accel-
erated a process already underway and offered the opportunity for recon-
figuring the view of aging concerning the use of digital technologies. As a
result, the world for older adults has also changed (despite the fact that the
pandemic has cast them into an even more at-risk category). Both technol-
ogies and older people shaped each other in many ways: on the one hand,
technologies adapted to respond to health emergency needs by using dif-
ferent devices and tools, for example tablets that allowed video calls to
maintain a connection with the outside world. On the other hand, older
people adapted to technologies to find solutions to meet their needs, re-
quiring them to enhance their expertise, for example for having calls with
doctors, professionals, and relatives, but also to perform cognitive exercises.
     Technologies stimulated interaction between people with Alzheimer’s
disease and actors that were required to stay in isolation due to virus con-
tainment measures. Smartphones and other digital devices allowed people
and patients hosted in healthcare facilities to maintain contact with their
relatives and exercise different forms of socialization. Technologies also
enable the performance of playful-educational activities for patients. Tele-
medicine created space for linkages between older people, home patients,
and health professionals to create therapeutic alliances. ICT, then, made
the provision of online training possible, as well as psychological and legal
support services for caregivers. In addition, digital technologies have


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122                                                          Tecnoscienza – 13 (2)


changed the everyday life for older adults, and have in-turn been reshaped
by them (users). The organizational logic of healthcare facilities and the
needs of family members certainly shaped the ways and purposes for which
technologies were used. For example, the limited availability of technolog-
ical infrastructure within nursing homes led to long-distance calls being
conducted for limited periods so that all patients and family members had
access to this mode of communication.
    Finally, the emerging images of Alzheimer’s patients have also been re-
configured. The diffusion of ICTs in the everyday life of people with Alz-
heimer’s disease often represented as “living dead” in western societies
(Peel 2014), has enhanced the idea that these actors can be in connection
with the rest of the world through digital technologies and, at the same
time, can become competent and active users of these objects. As technol-
ogies are used, new values, practices, and subjectivities are also continu-
ously negotiated (Peine and Neven 2021).

Conclusions

   The changes that have emerged during the Covid-19 pandemic con-
cerning the care practices of Alzheimer’s patients mainly concern:
    1.! The increased circulation of digital and ICT, often understood as
         e-health technologies, that is digital health services, platform, and
         tool supporting the management of health, illness and wellbeing
         (Lambousis et al. 2002);
    2.! An acceleration of co-constitution in the relationship between tech-
         nology and aging (which had already begun before the pandemic).

    Despite the growing implementation of digital technologies, the spe-
cific experiences of Alzheimer’s patients and their caregivers are still ex-
ceptionally precarious and still unfortunately invisible. The precarious re-
ality of caregiving is attributed mainly to the personal and social commit-
ment that disease management requires being overlooked. The caregiver is
often not socially recognized or valued, thus constituting a form of unpaid
“invisible work” (Star and Strauss 1999), and the pandemic has exacer-
bated an already fragile situation.
    In this framework, the concept of co-constitution between aging and
technologies leads to rethinking the relationship between representations
of aging, caregiving practices, and digital technologies. In the specific case
of Alzheimer’s care in the context of the Covid-19 pandemic, this contri-
bution highlighted how digital technologies have changed the lives of pa-
tients and their caregivers, setting up a network of relationships that allow
for the continuous negotiation by concerned actors of the perception of
aging, technology design, elderly life, and digital technologies.
    The turning point, also for future studies, lies in considering aging (and
related pathologies) appears as a “collective process” that internally involves


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Crossing Boundaries                                                               123

media discourses, care and daily living activities, clinical and medical rou-
tines, and marketing strategies forming complex constellations (Cozza et al.
2020). According to this view, aging is not only about older adults, but also
about other actors (relatives, caregivers, social media, companies, infrastruc-
ture, etc.) who, in the process of co-constitution, define what aging is and
how the challenges that arise, such as Alzheimer’s disease, can be addressed.


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Crossing Boundaries                                                          125

In Need of Seniors in Need: Paternalism, Tensions and Par-
adoxes in Users’ Participation in Gerontechnology Design

Enrico Maria Piras, Bruno Kessler Foundation


    The inclusion of seniors in the design of gerontechnologies is part of a
broader discourse that has been developing since the 1970s. Such inclusion
affects several domains and promotes the involvement of citizens in the co-
production of public services (Osborne et al. 2016), workers in production
processes (Bannon et al. 2018) and marginal subjects in rural communities
(Chambers 1981), to name a few of the areas of intervention. Despite sig-
nificant differences, these experiences are united by identifying participa-
tion as the key to pursuing the dual goals of encouraging bottom-up dem-
ocratic processes and proposing technical solutions that are more efficient
by increasing the chances of adoption. Although these two objectives are
always present, the instrumental view that regards participation as a “good
thing” because it enables the creation of better technologies, processes or
projects often prevails (Mackay et al. 2000).
    The debate is rich, and it questions the very meaning of involvement, which
is often presented as a level in scale, given Arnstein’s (1969) pioneering work.
In such scales, more marginal forms (i.e., consultation) are distinguished to
gradually proceed towards more inclusive forms (i.e., involvement, partici-
pation) until a role of full and equal collaboration (i.e., co-production) is at-
tributed to prospective users (Stark et al. 2021). In this contribution, similar
to much of the relevant literature, I shall use the terms “involvement” and
“participation” interchangeably regarding the diverse set of approaches in-
volving different forms of relationships between designers and users4.
    The recent Covid-19 pandemic has made the issue of users’ participation
in technology design even more relevant, given the growing attention in this
period on remote monitoring addressed to older and/or clinically fragile peo-
ple, with the aim of reducing their access to healthcare facilities and prevent-
ing the circulation of virus among these sectors of population. Moreover, the
involvement of the elderly in the design of gerontechnologies constitutes a
privileged vantage point for analysing some of the diverse social representa-
tions of aging. Indeed, in this field, political-institutional drives, epistemic-
methodological considerations and pragmatic needs are mixed together and
operationalised in policy documents and research practices. Involvement in
design processes, when observed from these different perspectives, offers the
possibility of highlighting paradoxes and tensions between visions of the el-
derly, who are at various times considered active subjects, passive receivers
of care, subjects in need and individuals needed to realise technologies.
    This paper focuses on three representations of the elderly that emerge
from their implicit conceptualisation in relation to their contribution to
design activities. To present them, I shall build on Robert Cooper


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126                                                             Tecnoscienza – 13 (2)


distinction between distal and proximal thinking (1992), the former refer-
ring to a structured view of the social in terms of codified interactions and
functions and the latter to the continuous network of actions that shapes a
set of heterogenous materials. The first representation, the elderly as active
expert, presents a distal, high-level and formalised institutional perspec-
tive. The other representations, the elderly as diminished user and legiti-
mizer of the design process, emerge from confronting the mundane and
pragmatic demands of design practices with users.

Distal Representations of Involvement in Design: The Elderly as
Active Experts

    From early pioneering experiences, participation has been increasingly
codified in institutional processes that often explicitly call for the inclusion of
stakeholders in the design, implementation and evaluation processes, with re-
search often becoming a requirement in competitive calls for major national
and international funding institutions (Compagna and Kohlbacher 2015), in
addition to having a legitimising function (infra, the “legitimising elder”).
    From a distal perspective, collaboration between designers and the el-
derly appears to be an opportunity for a positive-sum game, where the
adoption of participatory methodologies would enable forms of mutual
learning between users and designers, thus contributing to the enrichment
of the latter’s skills (Björgvinsson et al. 2010; Kushniruk and Nøhr 2016)
or transforming their role into that of “facilitators” who would enable users
to make the relevant decisions in the process (Sanders and Stapper 2008).
This perspective is based on the dual assumption that older people are “ex-
perts by experience” (Beimbor et al. 2016) who are capable (if properly
guided) of providing guidance to planners while simultaneously taking for
granted their interest in active involvement.
    From this view, participation in design processes can be considered a
specific instance of a general trend. With some level of simplification, the
elderly person involved in the development of assistive technology can be
likened to a chronic patient who wishes to take charge of their condition
by acquiring increasing skills in self-management and making their
knowledge gained through personal experience available to peers.
    These assumptions, while intercepting and embodying a general “spirit
of the times” in the specific realm of the implementation of health and
wellness technologies, align with the rhetoric of putting patients “at the
centre” or “in the driver’s seat” of their own care, which coincides with the
notion of gerontechnologies as assistive tools that promote independent
living and reduce their need to access to social and health services. Partic-
ipation is thus welded to a representation of active aging in which individ-
uals are eager to manage their own care and compensate for deficiencies
related to the decline of the welfare state (Katz 2000). The elderly people
participating in designing technologies of which they may become users are


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Crossing Boundaries                                                          127

thus an emblem of “successful aging” that is characterised by an ability to
remain productive, active, capable of self-determination and vigorous that
comes from staying healthy and managing the risks associated with the pas-
sage of age and is presented as a model to be imitated in the neoliberal
representation (Latimer 2018; Miele and Nunes 2022). This representation
of participants in the design stages transfers to future users of technologies
who are discursively configured as individuals interested in self-manage-
ment of their own health, which aligns with a representation of the expert
patient capable of requiring fewer interventions from health services and
saving time and costs to the system as a whole (Greenhalgh 2009).
    This distal perspective is widely shared in institutional representations
and comes in the form of stimulating the adoption of participatory meth-
odologies to the point of prescribing their use (Compagna and Kohlbacher
2015) due to the belief that this constitutes a beneficial situation for all
people involved. Elderly patients would exercise their desire to stay active
and put their experiences to use, designers would enrich their knowledge
and skills, and society would benefit from the implementation of tools that
are more closely aligned with the real needs of the target population, with
spill-over effects on their condition.

Participation in Collaborative Design Practices: The Elderly as
“Diminished” Users

     The idea that the elderly population needs digital technologies specifi-
cally made for them accompanies the history of the internet and mobile tech-
nologies. Underlying this focus is the consideration that the elderly, even the
young elderly (55-64 years), as non-natively digital, should be provided with
simplified tools that are ergonomically adapted to their limited skills and abil-
ities. The example of a cell phone equipped with large buttons and icons
constitutes the best-known manifestation of this trend (Joyce et al. 2007).
     This view of the elderly as “diminished users” becomes even more pro-
nounced in the field of assistive technology design, wherein a generic age-
related inadequacy is compounded by specific needs related to health con-
ditions, and the elderly are often “implicated but not present in the devel-
opment” (Frennert and Östlund 2014). Such representations are also re-
flected in participatory methodologies designed to engage the elderly,
which rest on the dual belief that they are characterised by generic age-
related deficits and passive receivers of technologies. As noted by Peine et
al. (2014), forms of engaging older people in technology design often im-
plicitly assume that this population is unable to actively collaborate in re-
thinking their living contexts by incorporating new technologies. Instead,
the techniques adopted assume the existence of a predetermined set of
static needs and demands that the technology should satisfy, and these
must be identified by researchers through various techniques. In line with
this perspective, critical analyses of gerontechnology implementation


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128                                                              Tecnoscienza – 13 (2)


processes have observed how the involvement of seniors is limited to cer-
tain stages and not the entire arc, from design to implementation, typically
preferring assessment or having seniors’ needs represented by their care-
givers (Lazar et al. 2016). While from a distal perspective, seniors are consid-
ered active subjects, engagement practices are permeated by a “paternalistic
stance” (Peine et al. 2014) that infantilises seniors by emphasising their deficits.
    Widening our gaze to the debate on approaches to user involvement,
the case of gerontechnology development takes some of the tensions high-
lighted by critical perspectives on participatory approaches to the extreme.
Participatory design, for example, considers the encounter between de-
signers and users as the moment at which use is imagined before it happens
or “use-before-use” in Redström’s (2008) definition. This perspective,
which is considered unrealistic by its critics, is countered by several meth-
odological proposals to enable users to take ownership of flexibly made
technologies to adapt to unexpected uses. Concepts such as “continuing
design-in-use”, “continuous design and redesign”, “unfinished design”
and “meta design” have been proposed to imagine forms of “designing for
design after design” (see Ehn 2008). While influential in theoretical debate,
such critical perspectives rarely find application in participatory design
practices and are virtually absent in the field of gerontechnology develop-
ment. As a result, the representation of the elderly as a subject character-
ised by deficits qualifies them as incapable of active participation in pro-
cesses of appropriation and redesign by relegating them to the role of pas-
sive users of tools made to satisfy a stable set of needs.
    However, as Peine et al. (2014) observed, the perspective of the elderly
person as a “diminished” user cannot be rejected outright, as it allows for
the condition to be adequately represented and contributes to the realisa-
tion of technologies that offer substantial help for elderly people with se-
vere and well-defined problems. This perspective highlights the tensions
between an inclusive view of participation and the existence of difficulties
to be overcome in the mundane practices of participatory processes with
users with age-related limitations.

Institutionalised Participation: The Legitimising Elder

    Since the pioneering experiences of half a century ago, participatory
methods have become a prerequisite in various fields, including gerontech-
nology (Peine and Neven 2019). The institutionalisation of participation as
crucial strategy in technology implementation (Compagna and Kohlbacher
2015) finds its concretisation in the policy documents of research-funding
institutions. While this constitutes undoubted success for the promoters of
participatory methods, it also transforms participation into a required act
and a design goal to be achieved with others. In this context, participation
in design, regardless of its actual contribution, operates as a legitimation
mechanism in which elders involved in design vouch for the appropriateness


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Crossing Boundaries                                                         129

of the technical solution in terms of both ease of use and usefulness. In this
perspective, elderlies’ participation is not perceived as the inclusion of an
active expert in the design process (see above) nor it is shaped by the rep-
resentation of elderlies as diminished users. Rather, participation is re-
quested to fulfil the task of “user involvement” required by funding insti-
tutions or expected at societal level.
    In the context of competitively funded research, the emergence of pa-
ternalism, which is partly inscribed and partly an emerging effect of fund-
ing policies, deserves attention. Paternalism is often implicit in funding
calls for projects that describe the elderly as subjects “in need” to be sup-
ported through dedicated technologies. However, the characteristics of
such technologies are often detailed in the call itself and are part of a re-
search and innovation agenda dictated by the research community and the
officials of funding institutions. Moreover, the needs of the elderly must be
met through the implementation of tools that go “beyond the state of the
art”. Rather than being at the centre of the process, older people’s involve-
ment is confined to moments predetermined by researchers at the funding
proposal writing stage and framed in a rigid and barely modifiable
timeframe. The combination of this dual mechanism is that any “need” ex-
pressed by the elderly must meet the dual requirement of being answered
in the technology described in the announcement and particularly in a ver-
sion of it that requires knowledge advancement (Piras 2021). In this con-
text, it is not surprising that participation is often restricted to the evalua-
tion stages and less present in the actual design stages (Frennert and
Östlund 2014), even to the point of indirect forms of involvement, purely
for the purpose of legitimising the process (Östlund et al. 2015).
    The widespread rhetoric about the centrality of users in design and pa-
tients in care processes is supported by implicit assumptions about the de-
sire for participation, which are rarely empirically found. Several papers
have shown that involving older people requires significant effort that re-
searchers could not put forth without the support of intermediary organi-
sations (i.e., senior centres, non-profit organisations) (Merkel and Ku-
charski 2019), whose role in the processes of selection, recruitment and the
ability to modify project goals is insufficiently investigated (Piras 2021).
    Complexity in recruitment is sometimes related to the representation
of the elderly as a condition characterised by a high availability of free time.
However, elderly people who are in good condition are often busy with
personal or family commitments. Paradoxically, it is these elders who most
frequently participate in activities carried out by intermediate organisa-
tions. Thus, they become overrepresented in the selection aspect of the de-
sign-involvement processes. Conversely, marginal or low-educated individ-
uals become marginalised or uninvolved in favour of older people with
more resources, with the design exacerbating social inequalities instead of
reducing them (Ku!nemund and Hahmann 2016). A limiting case of selec-
tion bias is that offered by the SARS-CoV-2 pandemic, in which traditional


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130                                                               Tecnoscienza – 13 (2)


in-person collaborative working methods were made impossible. Only a
handful of papers testified to engagement processes via digital systems
(Cerna et al. 2022; Muñoz et al. 2022), with selection bias favouring elders
with sufficient digital literacy and appropriate communication tools who
may not be representative of the technology’s target population.
    Pandemic-related restrictions pose an additional conceptual and prac-
tical challenge in imagining methodologies that can combine the pragmatic
needs for communication via technology-mediated engagement without
excluding segments of the population.

Conclusions

     The participatory design processes of gerontechnologies offer a privi-
leged vantage point for analysing aging representations and the tensions
and paradoxes among them. The tensions and paradoxes are the product of
the gap between idealised forms of participation, which originate from the his-
tory and evolution of participatory approaches in technology development and
its institutionalisation, as well as the complexity of its implementation.
     While the involvement of elderly users is unanimously considered a goal
to be pursued, the concrete conditions under which involvement takes
place influence not only its forms but also the implicit configurations of
users. While the progressive institutionalisation of participation may have
consolidated the awareness of the ability of older people to be active part-
ners in every stage of the design process, it risks turning their involvement
into “yet another task” and leading to opportunistic approaches.


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Notes
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      1
       As also done by Peine and Neven (2021), the term Age Studies is used as a label
that include a broad strand of studies that have reflected on contemporary representa-
tions and practices associated with ageing, using a broad variety of disciplinary back-
grounds, including the humanities and the social sciences.
     2
       “Yesterday in Liguria, 22 out of 25 deaths were very old patients. Most of them
were pensioners who are no longer indispensable to the productive efforts of our coun-
try, but who must be protected”, see https://tg24.sky.it/politica/2020/11/01/corona-
virus-toti-anziani (Accessed May 1, 2022)
     3
       It is a socio-sanitary residential facility dedicated to elderly people who are not self-
sufficient, who need full-time medical, nursing and rehabilitation assistance and for
whom keeping them in their own environment/home is not possible. In Italy it is called
RSA (Residenza Sanitaria Assistenziale) which means “health care residence”. In the
Emilia-Romagna region, it is called CRA (Casa Residenza Anziani) which stands for
“home for the elderly”.
     4
       User-Centered Design refers to those processes in which users contribute to the
understanding of the context and needs to be met by designers. Participatory Design
refers to active involvement in design, typically through workshops. In co-design, there
is a symmetrical relationship between designers and users, who are seen as equal collab-
orators. Other labels have also been proposed over time and, as mentioned above, are
often used interchangeably to refer (generically) to all those design processes that utilise
users’ involvement in some way.




          !
