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Communication, technology and aging : opportunities and challenges for the future
 9780826113726, 0826113729

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Communication, Technology and Aging Opportunities and Challenges for the Future

Neil Charness, PhD, received his BA (1969) in Psychology from McGill University, and his MS (1971) and PhD (1974) in Psychology from Carnegie Mellon University. He was an Assistant Professor of Psychology at Wilfrid Laurier University (1974–1977) and a Professor of Psychology and Gerontology at the University of Waterloo (1977–1994). He is currently a Professor of Psychology at the Florida State University, and a Research Associate at the Pepper Institute on Aging and Public Policy. His current research interests focus on the topics of aging and expert performance across the life span, and age and human factors as related to technology use. He has held grants concerned with these topics from the Natural Sciences and Engineering Council of Canada, the Social Sciences and Humanities Research Council of Canada, the Canadian Aging Research Network (Canada), the DAAD (Germany), the Retirement Research Foundation (USA), and the National Institute on Aging (USA). He is a Fellow of the Canadian Psychological Association, The American Psychological Association, the American Psychological Society, and the Gerontological Society of America. Denise C. Park, PhD, is Professor of Psychology and Senior Research Scientist at the University of Michigan. She is Director of the Center for Applied Cognitive Research on Aging, which is funded by the National Institute on Aging. Dr. Park received her PhD in 1977 at the State University of New York at Albany. She came to the University of Michigan in 1995 from the University of Georgia, where she was Professor of Psychology and Director of the Applied Cognitive Aging Center. She is past president of the Division of Adult Development and Aging of the American Psychological Association, past chair of the NIH Mental Disorders of Aging Study Section, and recently finished a term in the APA Council of Representatives, where she was secretary of the Women's Caucus. She was Chair of the Board of Scientific Affairs of the APA from 1999-2000 and is Associate Editor of The American Psychologist. Dr. Park directs a large and active research program at the University of Michigan, funded primarily by multiple grants from the National Institute on Aging. Her work is highly collaborative as she works with faculty, postdoctoral fellows, and graduate students from Psychology, the Medical School and the Alcohol Research Center. Her research interests include: memory and aging, functional neuroimaging of aging and memory, cognition in medical settings and aging, cognition aging and culture, social cognition and aging, fibromyalgia and memory function, and alcoholism, aging and memory. Bernhard A. Sabel, PhD, received his doctorate in Psychology from Clark University in 1994. He was a postdoctoral research fellow at Massachusetts Institute of Technology and a research scientist at the University of Munich. He served as a visiting neuroscientist at Massachusetts General Hospital, Department of Neurology, Harvard Medical School. Dr. Sabel was also head of the Center for Neuroscience Innovation and Technology. He served as a visiting professor in the Department of Psychology at Princeton University from 1998–1999. Since 1997 he has been the Editor-in-Chief of the Journal of Restorative Neurology and Neuroscience. Dt. Sabel's current research interests include brain plasticity and recovery of function, particularly in the visual system and training-software development for patients with visual field deficits.

Communication, Technology and Aging Opportunities and Challenges for the Future

Neil Charness, PHD Denise C. Parks, PHD Bernhard A. Sabel, PHD Editors

Springer Publishing Company

Copyright © 2001 by Springer Publishing Company, Inc. All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, Inc. Springer Publishing Company, Inc. 536 Broadway New York, NY 10012-3955 Acquisitions Editor: Bill Tucker Production Editor: Pamela Lankas Cover design by Susan Hauley

01 02 03 04 05/5 4 3 2 1 Library of Congress Cataloging-in-Publication-Data Communication, technology and aging : opportunities and challenges for the future/Neil C harness, Denise C. Parks, Bernhard A. Sabel, editors. p. cm. Includes bibliographical references and index. ISBN 0-8261-1372-9 1. Aged—Communication. 2, Communicative disorders in old age. 3. Communication—Technological innovations. I. Charness, Neil. II. Parks, Denise C. III. Sabel, Bernhard A.

HQ1061.C624 2001 305.26 dc21 00-03139 Printed in Canada

Contents

Contributors

vii ix

Preface ix Part I Overview 1 Aging and Communication: Human Factors Issues Neil Charness 2 Over-Accommodations and Under-Accommodations to Aging Susan Kemper

1 30

3 Design Challenges Associated with Longevity: The View From Industry Craig Spiezle and Gary Moulton

47

4 The Internet and Older Adults: Design Challenges and Opportunities Sara J. Czaja and Chin Chin Lee

60

Part II Communication and Sociocultural Issues 5 Culture, Aging, and Cognitive Aspects of Communication 81 Trey Hedden and Denise C. Park

81

6 Aging, Sensory Loss, and Social Functioning Hans-Werner Wahl and Clemens Tesch-Römer

108

V

vi

Contents

7 The Impact of Internet Use Over Time on Older Adults: A Field Experiment 127 Karra L. Bikson and Tom K. Bikson

127

Part III Training and Compensation 8 Aging, Communication, and Interface Design Lila F. Laux

153

9 Face Memory Skill Acquisition Reinhold Kliegl, Doris Philipp, Matthias Luckner, and Ralf Th. Krampe

169

10

11

Index

A Systems Approach for Training Older Adults to Use Technology Wendy A. Rogers, Regan H. Campbell, and Richard Pak Aging, Vision, and Brain Plasticity: Restoring Lost Visual Functions by Computer-Based Training Dorothe A. Poggel, Tilman Schulte, Erich Kasten, and Bernhard A. Sabel

187

209

227

Contributors

Karra L. Bikson, MA Department of Social Welfare UCLA School of Public Policy and Social Research Los Angeles, CA

Trey Hedden, TMA Department of Psychology University of Michigan Ann Arbor, MI

Tora K. Bikson, PhD Senior Scientist Behavioral Sciences Department The RAND Corporation Santa Monica, CA

Erich Kasten, PhD Institute of Medical Psychology Otto-von-Guericke University of Magdeburg Magdeburg, Germany

Regan H. Campbell, MS School of Psychology Georgia Institute of Technology Atlanta, GA

Susan Kemper, PhD Gerontology Center University of Kansas Lawrence, KS

Sara J. Czaja, PhD Department of Psychiatry and Behavioral Sciences University of Miami School of Medicine Miami, FL

Reinhold Kliegl, PhD Department of Psychology University of Potsdam Potsdam, Germany

vii

viii

Contributors

Ralf Th. Krampe, PhD Max Planck Institute for Human Development Center for Lifespan Psychology Berlin, Germany

Dorothe A. Poggel, MA Institute of Medical Psychology Otto-von-Guericke University of Magdeburg Magdeburg, Germany

Lila F. Laux, PhD Human Factors Engineering US WEST IT Denver, CO

Wendy A. Rogers, PhD School of Psychology Georgia Institute of Technology Atlanta, GA

Chin Chin Lee, MS Department of Psychiatry and Behavioral Sciences University of Miami School of Medicine Miami, FL

Tilman Schulte, MA Institute of Medical Psychology Otto-von-Guericke University of Magdeburg Magdeburg, Germany

Matthias Luckner, PhD Department of Psychology University of Potsdam Potsdam, Germany Gary M. Moulton Group Project Manager Microsoft Redmond, WA Richard Pak, BS School of Psychology Georgia Institute of Technology Atlanta, GA Dr. Doris Philipp Department of Psychology University of Potsdam Potsdam, Germany

Craig D. Spiezle, MBA AgeLight LLC Clyde Hill, WA Dr. Clemens Tesch-Romer Director German Centre of Gerontology Berlin, Germany Prof. Dr. Hans-Werner Wahl The German Center for Research on Aging at the University of Heidelberg Heidelberg, Germany

Preface

This volume is based on the May 1999 Ann Arbor conference sponsored by the German-American Academic Council (GAAC) Foundation and organized by the University of Michigan, the National Institute on Aging, and the Fraunhofer Institute of Biotechnology. The goals of the GAAC are to promote linkages between German and American Scientists, and in particular, to foster collaboration among junior (developing) scientists, both in academic and industry settings. To this end, a series of conferences on topics concerned with aging were planned and two were implemented. The Ann Arbor Conference dealt with the topic of Aging and Communication, with an emphasis on the role of newly developing communication technology. No volume can adequately convey the flavor of that conference in terms of the very stimulating interchange of ideas between senior and junior scientists. Nonetheless, our hope is to provide a glimpse into that process via the state-of-the-art reviews and empirical data provided by the contributors. A unique feature of this volume is that we have a mix of authors from Germany and the United States, as well as from industry and the academy. Thus, both theoretical and practical viewpoints are well represented as are the perspectives of two different cultures. Chapters are divided into three sections. The chapters in the first section provide overviews of basic issues in aging and communication from the perspectives of academia and industry. Charness provides an introduction to the basic concepts in the fields of aging, communication, and human factors. Kemper identifies some of the barriers to aging and communication, focusing on over- and under-accommodations to aging in speech and ix

x

Preface

language. Spiezle and Moulton review design challenges for computer users, including guidelines for promoting ease of use. Czaja and Lee examine trends in Internet use and information retrieval by older adults and outline what accommodations need to be made. Chapters in the second section deal with broad sociocultural issues. Hedden and Park review changes in cognition that come with age, as well as cultural differences in cognition; they outline implications of the joint influences of these factors for communication. Wahl and Tesch-Romer examine the impact of hearing loss on communication and social interaction, presenting data from a recent study. Bikson and Bikson discuss a field experiment conducted by RAND on the role of computer networks on communication patterns between about-to-retire and retired people. Chapters in the third section deal with human factors design, training, and compensation issues for communication by older adults. Laux reviews issues in interface design for telecommunication devices. Kliegl, Philipp, Luckner, and Krampe review their work on training older adults to improve in face-name identification, a critical social skill for communication processes. Rogers, Campbell, and Pak discuss age-sensitive approaches for designing effective training for technology use, drawing on work with ATMs, the Web, and telemedicine devices. Poggel, Schulte, Kasten, and Sabel review their pioneering work on restoring impaired visual function with computer training. Neil Charness, Denise C. Park, and Bernhard Sabel Editors

I Overview

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1 Aging and Communication: Human Factors Issues Neil Charness

G

iven that aging, communication, and human factors are each substantive research areas in their own right, the approach here will be to limit this review to general issues. Other chapters in this volume will provide more detailed information. First, the central constructs of aging, communication, and human factors will be defined. Then the "how, what, and why" of communication will be discussed, stressing the twin themes of communicating information and affect. Next, how normal age-related changes in functioning can potentially affect the communication process will be outlined, stressing psychomotor functioning, hearing, vision, and cognition. Finally, areas of inquiry for designing more effective communication environments will be suggested, and the relative usefulness of recently developed communication systems will be considered. A functional approach is being taken in this chapter in the hope of delimiting factors that permit interventions to facilitate communication. Thus, the underlying assumptions are that 1. Processes supporting communication, particularly sensory, cognitive, psychomotor processes, undergo negative age-related changes. Such changes probably degrade communication effectiveness. 2. It is possible to intervene and improve communication effectiveness by either changing the physical channel(s) or training the person to use the same or alternative channels more effectively. This chapter is based on a presentation at the Ann Arbor Conference on "Aging and Communications: Opportunities and Challenges of Technology," May 23-25, 1999, sponsored by the GermanAmerican Academic Council and the University of Michigan. 3

4

Overview

DEFINITIONS Aging One useful definition of aging is " . . . the regular changes that occur in mature, genetically representative organisms living under representative environmental conditions as they advance in chronological age" (Birren & Renner, 1977, p. 4). Human cultures have done a wonderful job of changing the "representative environmental conditions" in which the elderly live during the past few thousand years. For instance, in the past 25 years in the United States of America, we have gone from virtually no households owning personal computers to more than half of the households surveyed in 1997 owning computers. However, those lower in economic power and higher in age have not participated as fully in this revolution (Falling through the NET II: New Data on the Digital Divide, 1998). Still, representative conditions for many adults today involve communicating with such systems, so-called computer-mediated communication (Reaux & Carroll, 1997), as well as with other human beings, often through recently invented communication channels such as e-mail. Such research on computer use reminds us to be mindful of the roles that both chronological age and cohort membership may play in communication. Communication will be considered here primarily in the context of older and younger adults acting in dyads. Characteristics other than age may be important mediators of communication style and success, for instance, gender, so further partitioning may be necessary. The reason to differentiate dyad types is that, particularly for an old-old dyad, there are likely to be multiple perceptual and cognitive impairments present. In terms of communication channels, there will be differential attenuation of message streams across modalities for the dyad. For instance, an older woman with visual impairments (that make some non-linguistic cues difficult to perceive) will most likely be communicating with a spouse who has hearing impairments (that make other such cues difficult to hear). However, as others have stressed (e.g., Shadden, 1997), older adults are a very heterogeneous group. Life experiences and knowledge base are vastly different for between-age dyads. Emotional reactivity probably also varies somewhat across cohorts (Carstensen & Charles, 1999; Levenson, Carstensen, Friesen, & Ekman, 1991). Reactivity to pressure to conform also varies with cohort; older cohorts are less likely to conform in judgments about emotional expression (Pasupathi, 1999). Thus, any age-related differences in communication effectiveness may be difficult to interpret unambiguously.

Human Factors Issues

Source

Encoding Process

Channel

Decoding Process

5

Destination

Noise Source Figure 1.1

Information transmission model.

Communication One terse definition of communication is "The exchange of meanings between individuals through a common system of symbols" (Communication, 1999). Both animal lovers and those who wrestle daily with programmable devices object to being told that they are not engaged in communication. So, more broadly, communication always involves at least two information processing systems (Newell & Simon, 1972), one or more communication channels between them, and a finite time interval (start and end times) during which messages (streams of symbols) are conveyed across the channel(s) in both directions that influence the behavior of the participants. Potential channels for human-to-human communication involve the human sensory systems of vision, hearing, touch, temperature, smell, and taste. If one of the important goals of communication is to convey meaning, it follows that part of the process entails changing the behavior of those to whom messages are being sent. Consider how meaning is conveyed. In the history of the development of the field of communication and later of cognitive psychology, particularly the influential work of Shannon on communication channels (Lachman, Lachman, & Butterfield, 1979), meaning usually referred to the information content of a message or communication, usually in the context of uncertainty reduction or entropy. The Shannon model for a passive communication channel can be roughly conceptualized as in Figure 1.1. Focusing on characteristics of channel capacity led naturally enough to the discovery of the limited bandwidth of the human interpreter of communications (e.g., Miller's, 1956, magical number), which in turn inspired the "cognitive revolution" in psychology (Lachman, Lachman, & Butterfield, 1979). One result has been the strong emphasis on interpreting communication in terms of the cognitive states evoked by messages. Countering this trend was the theme of communication of emotion, derived mainly from consideration of works of art. The inclusion of emotional states with cognitive states provides a better-rounded sense of the notion of meaning.

6

Overview

Various communication styles and techniques are adopted for conveying such states. The reader should consult Giles and Street (1994) for a thorough review of communication styles. Human communication can be best understood as a process that results in the exchange of cognitive and emotional or motivational states between individuals. Communication channels are apparently weighted differently for cognition (information) and emotion (affect). Nonverbal aspects of communication, termed "paralanguage" or "kinesics," are the usual channels for emotional expression. These channels, usually visual and auditory, convey information about emotional or motivational state via pause patterns in speech, volume, pitch, rhythm, and facial and postural expression. Experiments have shown that when facial expression and tone of voice are manipulated factorially, facial expression carries almost 50% more weight than does tone of voice when people are asked to judge the attitude of the speaker toward a hypothetical target (Mehrabian & Ferris, 1967). This experiment used young adult women as judges and presented black and white photos of facial expression in combination with tone of voice variations for the word maybe. Although one could argue that affective state is well covered by entropy aspects of information theory, it is clear that specialized brain structures (e.g., the amygdala) have evolved to integrate and interpret such information (e.g., Heath, 1986; Whalen, 1998). Finally, consider the outcome of conveying meaning. To the extent that one person changes the cognitive, emotional, or motivational state of another, there should be concomitant changes in their behavior. One example might be one person successfully persuading the other person to perform some overt act ("Can you please pass me the salt?"). Another example might be one person inducing an emotional state in another that facilitates later instrumental acts (such as inflaming a mob to commit violence). Communication

Effectiveness

The construct of communication effectiveness seems to be poorly specified. In fact the index for the second edition of the Handbook of Interpersonal Communication did not even have an entry for effectiveness or efficiency. The closest approach to that concept was a chapter by Parks (1994) on communicative competence, which was defined as Communicative competence represents the degree to which individuals satisfy and perceive that they have satisfied their goals within the limits of a given social situation without jeopardizing their ability or opportunity to pursue their other subjectively more important goals, (p. 595)

Human Factors Issues

7

One important feature of this definition is that competence is not equated with goal satisfaction, given that goals may be satisfied as much by good luck as by skilled interaction with others. Many experimental studies in the field of communication examine perceptions or attributes of communicators. Some view communication competence as a trait, as in "President Reagan was a great communicator." Other studies assess communication styles by analyzing the content of communications, such as elements of speech (linguistic features) or paralanguistic features such as tone of voice and pause structure. Other projects look at one or more of the component processes that should influence effectiveness, such as hearing efficiency. Ultimately, though, we will have to deal with the thorny problem of comprehension in the communication process, particularly how people build situation models (e.g., Zwaan & Radvansky, 1998) over sets of messages. Situation models are mental representations of states of affairs (events, people, objects, goals, emotions, etc.) rather than of the message itself. They allow people to integrate information from different modalities (e.g., gestures with speech or pictures with text). Such representations permit people to communicate meaning effectively, and much of the communication process deals with ensuring that important facets of those models are shared. Ideally, effectiveness measures rely on the assumption that there are goals for the communicators and that progress toward those goals can be measured objectively. For instance, assume that the goal of the conversation (for some communication interval) is to ensure that person A has comprehended how to drive from the current location to a target location. A measure such as the length of time needed to convey the information about route could provide an efficiency index for that part of the communication process that deals with information exchange. Some way to assess comprehension would also be needed to validate person A's judgment that he or she really understood, for instance, requiring A to draw a map of the route or even to drive to the target location. Note that the skill of both members of the dyad probably mediates both efficiency and effectiveness. On the other hand, if the primary goal of a communication process is to be sociable and friendly, it is not as easy to see how efficiency can be measured. Techniques such as the use of adjective checklists and measurement of the latency to make a "friendly" judgment might be one approach. (In the domain of consumer persuasion, it may be useful to determine whether a salesperson can convey the impression of friendliness.) Similarly, if the goal of the communication is to convey sadness over a loss, judgments about the emotionality of the face or of the voice (e.g., Bachorowski, 1999) could also be useful ways to operationalize effectiveness.

8

Overview

Unfortunately, such microanalytic approaches to assessing communication goals may not be broad enough to capture effectiveness when communication involves several goals and, more critically, when goals change across the conversation. Nonetheless, the difficult issue of measuring communication effectiveness and efficiency needs to be addressed better than it has been in the past. Human Factors In this chapter, human factors (e.g., Charness & Bosman, 1992) or the gerontechnology (Bouma & Graafmans, 1992; Graafmans, Taipale, & Charness, 1998) approach to communication are also being explored. A good functional definition of human factors is given by the editor of the Handbook of Human Factors and Ergonomics (Salvendy, 1997). Human factors examine ". . . the role of humans in complex systems, the design of equipment and facilities for human use, and the development of environments for comfort and safety" (p. xvii). Human factors as a discipline typically relies on two tools for influencing the efficiency, safety, and comfort of tools and environments: redesign of tools and environments and training the user to work with tools and environments more effectively and safely. In the case of communication, much of the emphasis has been on designing tools (e.g., microprocessor-based systems, software interfaces) although there are also efforts to improve training procedures to help people acquire skill more quickly with such tools. Further, medical science is becoming increasingly adept at literally changing the person to improve subsystems that fail because of aging or disease (e.g., lens replacement surgery to eliminate cataracts; cochlear implants for hearing disorders). As chapter 11 shows, computer-based training for vision can result in remarkable improvements in people with visual field losses. However, availability of such personal redesign and general access to communications technology is subject to financial and political constraints (Broehle, 1997).

THE HOW OF COMMUNICATION In early classic work, Watzlawick, Beavin, and Jackson (1967) argued for a form of analysis for communication that envisions processes operating on a number of levels. Syntactics deals with how to transmit information and includes topics related to traditional information theory constructs such as coding, channels, capacity, noise, and redundancy. Semantics deals with the

Human Factors Issues

9

meaning of the communicated information. Pragmatics deals with the issue of how communication affects behavior. We can probably assume that syntactic competence does not vary greatly across generations, although syntactic performance certainly does. Kemper (chapter 2; 1992) reviews work showing that language production in older cohorts tends to involve simplified syntactic structures and that comprehension of language by older cohorts is degraded by the presence of complex embedded clause structures. Nonetheless, communication success is not likely to be strongly affected by generation differences in syntactic knowledge. In fact, a sobering observation in one area of communication effectiveness, storytelling, is that older adults are judged to be superior to younger ones (Kemper, Rash, Kynette, & Norman, 1990; James, Burke, Austin, & Hulme, 1998). Beginning a Conversation: Calibrating to a Speaker Why do I start my end of a conversation on the telephone by saying "hello" or "Neil Charness, Psychology Department?" In part this informs the initiator of the call that he or she has connected and to the right person. It also enables both parties to determine the quality of the connection and hence how loudly each should speak. An important but generally neglected aspect of communication is testing and calibrating the state of the channel or channels. This is akin to how telephone-based modems "negotiate" a rate of communication that depends on active testing of the characteristics of the other modem and the state of the channel (phone line noise). There is a similar anticipatory process evoked when we size up a listener for conversational competence, as the work by Ryan, Kwong See, Meneer, and Trovato (1994) has shown. We make inferences about the capabilities of others and sometimes overcompensate when we make the wrong inference (by adopting "elderspeak" inappropriately or by assuming language barriers, etc.) On the other hand, as Kemper points out in chapter 2, we may also undercompensate for age-related changes in language processing by providing linguistic messages that demand excessive processing resources from older adults. This description of part of the communication process as negotiation should make it clear that communication is a dynamic process. Unlike competitive games, such as chess, you do not always have to get it right with each move in the dialogue. (Exceptions come to mind, such as a mother yelling to her toddler "Stop! Don't go into the street!) Dyads usually have the opportunity to correct and restructure the shared meaning or

10

Overview

developing situation model across messages. There is very little evidence in the literature to support the belief that many older adults have a problem communicating effectively, although there is evidence that they may communicate less efficiently.

THE WHAT OF COMMUNICATION For humans, communication typically involves language. Language can be spoken, visually displayed (alphabetic or pictorial forms of writing, sign language), and presented in tactile form (braille). Language consists of welland ill-formed strings of symbols having a grammar. As alluded to earlier when discussing emotion, there are also nonlinguistic channels available during communication episodes. Paralanguage (body language, kinesics) refers to nonlinguistic speechlike acts across communication channels. There are postural cues (rigid or relaxed, head nodding) as well as vocal cues (pause structure, rhythm, intonation, pitch, volume) that often reveal a speaker's attitudes or emotional state. Other channels such as touch and smell (perfume) can convey important information about a participant in a communication process.

THE WHY OF COMMUNICATION Communication serves at least three important purposes: instrumental, affective, and social. (Others have made finer differentiations, e.g., Jakobson, 1960.) First, people typically communicate for instrumental reasons. They try to influence others to help them accomplish some goal. Second, people typically communicate affective state (perhaps involuntarily), serving the important purpose of alerting others to internal affective and motivational states. For instance, people might frown to indicate unhappiness, or they might maintain eye contact and smile to indicate interest in a member of the opposite sex. Emotional state may be conveyed intentionally (instrumentally, as in an acting situation) or unintentionally (no awareness). Third, people often communicate to be sociable, for the pleasure of interacting with another human being. The purpose may be to build social ties. As a large literature on social support and aging points out (e.g., Rook, 1995), forming companionships is probably a prime motivator for communication in older adults.

Human Factors Issues

11

AGE-RELATED CHANGES THAT CAN AFFECT COMMUNICATION In general, aging is accompanied by negative changes in cognitive and perceptual capabilities that can degrade the communication process. For one, morbidity and disability increase strikingly with age, and major catastrophic events such as stroke can cut off whole systems of communication by seriously impairing language and speech processes. Diseases such as dementia can erode cognition to the point where much communication becomes ineffective (Kemper & Lyons, 1994). For most of the population, however, aging is likely to be associated with less severe and more manageable losses that nonetheless can impair communication effectiveness. A quick overview of sensory channels follows. Risk Factors for Difficulty with Communication It is useful to look at population statistics for chronic conditions that might be expected to contribute to communication difficulties. Benson and Marano (1998) provide data from the National Health Interview Survey on chronic conditions per 1000 persons by sex and age for the noninstitutionalized United States population in 1995. (Given that disability is often the reason for institutionalization, the figures are going to be somewhat conservative estimates for the whole population.) A subset of their data is abstracted in Table 1.1. In this study, a chronic condition was defined as one that the individual first noticed more than 3 months before the reference date of the interview or as a type of condition that ordinarily has a duration of more than 3 months. Impairment is defined as a chronic or permanent defect, usually static in nature, that results from disease, injury, or congenital malformation. It represents a decrease in or loss of ability to perform various functions, particularly those of the musculoskeletal system and the sense organs. Arthritis is being presented because it may have profound effects on the control of input devices when interacting with computer-based communication systems (e.g., keyboard and mouse for e-mail or for chat sessions). Arthritis can be expected to affect gestural fluency as well. Cerebrovascular disease (e.g., stroke) is often associated with severe cognitive impairments. Other chronic conditions can be seen to affect communication more directly. Among the notable features from Table 1.1 is the striking increase in chronic conditions with age and the notable gender differences. Women show a higher prevalence of arthritis than do men. Men show higher prev-

Table 1.1 Communication-Related Chronic Conditions (Percentage) for the United States of America 1995 Chronic condition (%) Arthritis Visual impairment Hearing impairment Speech impairment Cerebrovascular disease

Male < 45 y

2.24 2.77 4.14 1.62 0. 12

45-64 y

65-74 y

75+ y

< 45 y

17.67

38.55 6.87 33.28 1.53 5.24

43.7 13.56 43.25 0.65

3.6 1.28 2.63 0.65

11.3

0.21

6.03 20.36 1.39 1.63

Values in italics represent unreliable or imprecise estimates.

Female 45-64 y

65-74 y

75+ y

28.54 3.71 8.97 0.46 1.36

49.82 4.31 15.9 0. 21 4.58

61.61 8.87 30.73 0.8

9.02

Human Factors Issues

13

alence of hearing and visual impairments than do women. It is also worth remembering that the very old population is predominantly female. One important lesson we can take from Table 1.1 is that relative impairments differ substantially by sensory modality. Older populations are going to be more impaired when the communication channel stresses auditory reception capabilities compared with visual ones. Further, speech impairments are relatively infrequent compared with impairments in movements of limbs (arthritis). Thus, new technologies that take advantage of voice for controlling operating functions appear to be particularly promising. Voicebased command systems for microcomputer-controlled devices coupled with high-resolution visual displays could help break some of the communication bottlenecks that may exist now. Still, it is worth multiplying out the estimates by population size to see the true extent of the potential problems. There are in excess of 70 million "baby-boom" cohort members in the United States (e.g., Charness, 1998), many of whom can be expected to reach old age. If only 0.5% develop serious speech impairments (and that is their only impairment), that will still sum to more than 333,000 individuals at risk for severe communication problems. Still, such self-report figures leave something to be desired for deciding on the real impact of a chronic condition on communication effectiveness or in providing recommendations for redesigning tools or environments. Potential sources of problems from a human factors perspective will be quickly surveyed. Psychomotor Function Output systems responsible for communication (particularly speech and gestures) can be damaged or impaired through a variety of injuries and disease processes. Arthritis Disease processes such as arthritis (osteoarthritis and rheumatoid arthritis) can interfere with gestural processes, such as typing e-mail or typing in chat sessions, and even with normal movement of hands for augmenting conversation (e.g., pointing). Between 40 and 60% of older adults (65+) report some arthritis. Stroke Strokes can directly damage the cortical sites responsible for language functions (e.g., resulting in neuropsychological disorders such as Broca's aphasia and Wernicke's aphasia). They can also damage voluntarily controlled mo-

14

Overview

Figure 1.2

Repeated trauma disorders (from Drudi, 1997).

tor systems resulting in paralysis of one side of the body (hemiparesis). Strokes can seriously degrade mental functioning (e.g., produce multi-infarct dementia). Work-Related Injuries Repetitive stress injuries can also directly affect limbs, particularly the hands. The baby-boom generation is likely to be the test-bed generation for such disorders given that the work environment was "computerized" earlier and more extensively than were households in general. Figure 1.2 provides a graph of the trend for repeated trauma disorders derived from data in a Bureau of Labor Statistics study (Drudi, 1997). Such disorders represent about 60% of all work-related injuries. Placing, grasping, or moving objects other than tools are the most frequent sources of injury. Example tasks are scanning groceries, typing, and key entry. Vision Normal age-related changes in the visual system, starting with the amount of light that reaches the retina, can render visually conveyed information more difficult to perceive and comprehend. Thus, conveying emotional state via facial expressions in face-to-face conversations (or in videoconferences) can suffer. So too can computer communications based on visually presented text (e-mail, chat sessions). The typical 65-year-old eye admits one third of the light to the retina in low light conditions that a 20-yearold eye admits (Weale, 1963). Such diminution results primarily from changes in the optical media such as yellowing of the lens, diffusion of light in the vitreous humor, and inability to open the pupil as widely (senile miosis).

Human Factors Issues

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Thus, virtually all printed materials (alphanumeric characters, icons, symbols) will be less legible to older adults under typical ambient illumination conditions than to younger adults. Similar problems may arise when sign language is conveyed under low illumination. Light levels are typically pretty low in homes and public places compared with work environments (Charness & Dijkstra, 1999). An important feature of text materials is the contrast ratio between the dark ink and the background of the page. Usually, black text on white yields ratios of 5% (black ink) to 50% (white page) reflectances. Technically, the contrast ratio is defined as the difference in the luminance of the ink and page divided by the luminance of the page: (0.5—0.05)/0.5 = 0.9. Contrast does not change as illuminance increases or decreases, although at low luminance values the ability to discriminate text from page will drop, more so for older than for younger adults. Similar conclusions can be drawn about emissive displays conveying visual information, such as VDT and LCD displays, that tend to have lower absolute ratios of luminance between parts of the screen that contain text and background than does black ink on a white page. As noted by Bennett, Nagy, and Flach (1997), emissive displays tend to wash out as ambient light levels increase because the screen surfaces reflects ambient light and lowers the contrast between text and background. Glare (both disability and veiling forms) can hurt both reflective and emissive displays, although the problems are probably more severe for emissive ones at lower levels of ambient light. Further, emissive devices, such as a computer terminal, can suffer from "bleeding" of pixels that makes edges less discriminable. There are specific guidelines for displaying information on VDT devices, such as using white-on-black rather than black-on-white text for those with serious visual impairments (Legge, Rubin, Pelli, & Schleske, 1985). In the best of all possible worlds, such options would be under the control of the user, although that user needs to be well-informed. Minor changes in color sensitivity with increased age can also be expected as a function of the yellowing of the lens, although these are most likely to be restricted to discriminating among short wavelengths, for instance, colors in the violet to blue part of the spectrum. Hence, when signaling via color differences, short wavelengths (e.g., pairing blue and violet) should probably be avoided. More serious changes in visual capability are due to disease processes such as the formation of cataracts (opaque regions on the lens), glaucoma (damage to the structures in the eye from increases in ocular pressure), and macular degeneration (destruction of the light-sensitive rod and cone transducers at the back of the eye). The incidence of such diseases increases

16

Overview

strikingly in old age. Thus, by age 75, nearly 10% of older adults suffer from some degree of visual impairment. This mostly takes the form of reductions in static visual acuity, being able to make out fine visual detail in nonmoving visual displays. There is also evidence that dynamic visual acuity can suffer serious age declines, as in the case of the useful field of view for driving that Owsley, Ball, Sloane, Roenker, and Bruni (1991) have investigated. We can speculate that moving displays, such as scrolling text displays, may not be an efficient way to communicate with older adults, although there does not seem to be research evidence bearing on this issue. Hearing Hearing, as measured by pure tone thresholds, typically declines in sensitivity from its peak during the preteen years. The ability to separate signal from signal-plus-noise also shows striking age effects. As well, disorders such as tinnitus (internal noise perceived as a constant background sound such as buzzing) can undoubtedly degrade hearing. About 6—7% of adults over age 75 report tinnitus (Benson & Marano, 1998). However, the picture is more complex for processing speech. Speech comprehension processes make use of the auditory signal as well as knowledge of syntax and semantics to produce an internal representation (situation model) of language utterances. So, knowledge can partially compensate for less fidelity in transduction of sound energy through the hearing apparatus. As a result, despite declines in hearing sensitivity from young adulthood for pure tone thresholds, speech discrimination measures (e.g., ability to identify monosyllabic words) rise into the twenties, are typically fairly intact through the forties, and then show fairly sharp decline after the fifties, particularly for men (e.g., Jerger, 1973). It is sometimes difficult to draw strong conclusions about speech discrimination and age (see Pickett, Bergman, & Levitt, 1979). First, different measures are used across studies, with better performance seen for sentence tasks than for those tasks using isolated words. Second, the populations used in the studies have varied enormously and are rarely representative of the general population. However, one reasonably consistent finding is that when normal speech is modified in some way from the usual situation of speech in a quiet environment, older adults seem to be more disadvantaged than are younger ones, even compared with younger ones with equivalent pure tone hearing loss (Pickett, Bergman, & Levitt, 1979). Modifications explored include speeding up speech, compressing speech, adding white noise, adding irrelevant background speech, and so on. Another important variable is familiarity with the language, for instance, whether it is a second

Human Factors Issues

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language, even for those with 50 years or more of experience with the second language. One possible explanation for the word versus sentence differences in agerelated comprehension performance is that experienced listeners may be able to use compensatory processes. An important finding is that older adults have been shown to be more sensitive than younger ones are to the influence of higher level knowledge such as prosody and semantics to enable them to encode and remember speech (Stine & Wingfield, 1987). Losses in hearing acuity may also affect other component systems critical to effective communication, such as the ability to deploy attention appropriately. Ability to orient and attend to auditory information in the face of competing sound sources may also be limited by age-related declines in hearing acuity (Murphy, McDowd, & Wilcox, 1999). Further, poor hearing acuity is a correlate, hence a risk factor, for cognitive impairment, as work from the Berlin BASE project has shown (Lindenberger & Baltes, 1994), as well as an obvious hazard for effective social functioning (chapter 6). Noise Effects

on Speech

As mentioned before, older listeners are more impaired by the masking effects of noise. People attempt to cope with increasing noise during conversations by raising their own speech intensity, usually not quite matching background noise levels (Crocker, 1997). However, this increased volume can have the side effect of lowering the intelligibility of speech if intensity moves above 78 dB. (Crocker cites some research showing that people attempt to compensate by raising speech to as high as 90 dB.) So, older adults are likely to be more seriously impaired for communication effectiveness in noisy environments. They will be more impaired by noise, probably less able to raise their voice volume, and more likely to be affected by declines in speech intelligibility as speech volumes increase. A good example of how well-intended artistic effects in movies can go awry was brought home recently at a social gathering of a group of seniors. The topic turned to movies and two individuals (one man, one woman) independently complained that background music in movies made it difficult for them to understand the ongoing dialogue between the actors. Hollywood movie producers might take a cue from this complaint as the huge wave of "baby-boomers" surge into their "presbycusic" years. Presbycusis can also have more subtle effects on communication. Not only is it more difficult for those with hearing loss to discriminate speech sounds, it is also more difficult to process paralinguistic cues, such as emotional valence (Villaume, Brown, & Darling, 1994).

18

Overview

Noise Effects

on Reading

Noise can impair communication that draws on visual channels. Crocker (1997) notes two effects of noise on reading performance. First, loud nonspeech noise (68 dB and above) disrupts reading comprehension. Second, background irrelevant speech is disruptive to comprehension and memory processes even at relatively low levels (40—76 dB). Because the effect is not "dose-dependent," it is likely to be due to attentional mechanisms being engaged by speech that compete for resources from comprehension processes for the reading task. These data are derived from adult, but generally not older adult, populations, so it is possible that the effects might be even larger for older adults, particularly given their greater distractibility or inability to inhibit irrelevant information (e.g., Carlson, Hasher, Zacks, & Connelly, 1995). Such work suggests that multimedia communication systems could prove problematic for older adults, particularly in the one-way situation of transmitting to multiple participants when there is asynchrony between spoken and visually presented information. However, in dyadic communication situations there is obviously the opportunity to negotiate changes in the pace of presentation. Speech Production There are a variety of disorders that can impair speech production. Diseases such as Parkinson's, muscular dystrophy (MD), and amyotrophic lateral sclerosis (ALS) can interfere with vocalization processes as well as with facial and gestural expression. Further, diseases such as cancer of the larynx may require laryngectomy, removal of parts of the vocal apparatus. Most of these diseases appear past the age of 50 (Hull, 1989). Speech can also be impaired when age-related declines in oral health necessitate the wearing of dentures. Changes in the sensory and motor channels used to encode visual and auditory information, then transmit it, may also produce cascading effects on the interpretation of communicated information. Degradation in the quality of information can slow the rate of processing of information generally. However, as Rabbitt (1993) has noted, some cognitive modules may be more resistant to age-related degradation than others are. This brings us to the issue of the role that higher-level cognitive processes play in communication. Cognition Age-related cognitive deterioration (see Salthouse, 1991) can also play a critical role in communicative efficiency. Cognition depends on knowledge

Human Factors Issues

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of the world, particularly the social world. When it comes to meaning, cultures provide the necessary infrastructure for communicating meaning (see chapter 5, and Park, Nisbitt, & Hedden, 1999), with one's native language being an essential component. The loss of expressive language, through a cerebrovascular disease episode such as a stroke (or even via simple laryngitis), can be devastating to normal communication. It is easy enough to simulate the effects of being bereft of one's native language. When in a foreign country and trying to communicate to a nonEnglish speaker, travelers often have the humbling experience of being reduced to paralanguage (particularly facial expressions and gestures) and written language as the main channels for communication. Even the ability to find "workarounds" for sensory impairments (e.g., vision loss and hearing loss) probably depends heavily on cognitive functioning for the person in question (or that person's resource network). Lack of knowledge about alternative technologies can prevent those undergoing losses from compensating (Backman & Dixon, 1992) for those losses. Dementias, such as Alzheimer's disease and multi-infarct dementia, can also wreak havoc with language-based communication. These disease processes increase strikingly with age, with estimated prevalences of about 10% for those over the age of 65, rising to as high as 50% for those over 75 (Nebes, 1992). Dementia can disrupt communication in many different ways. It can affect most processing modules from expressive functions such as instantiating appropriate words to receptive functions such as comprehension of a speaker's meaning. It can also affect the coordination of expressive and receptive functions, such as appropriately modulating conversational elements based on the current context (Kemper & Lyons, 1994). One of the defining features of dementia is memory failure, particularly the failure to be able to store and access new information (episodic memory formation). Another problem that arises in the later stages of dementia is loss of access to earlier-stored episodic and semantic information. Such a loss can have a serious impact on the social and emotional dimensions of communication. Particularly catastrophic is the inability to recall personal history and the failure to recognize family members. There are innovative attempts to use external memory aids to try to buttress access to these memory structures. For instance, Bourgeois (1992) used "memory wallets," physical collections of personal information, to help Alzheimer patients communicate more successfully. Camp et al. (1993) have used a variety of training techniques to help people with Alzheimer's disease overcome memory problems that often result in repetitive questioning of caregivers.

20

Overview

Discourse Comprehension Gould and Dixon (1993) and Gould, Kurzman, and Dixon (1994) note that older adults are sometimes as competent as young adults are when collaborating on tasks that require communication between dyads, even for the case of normally age-sensitive memory recall tasks. To the extent that the outcome of communication is deemed important (communication efficiency for task performance), such work shows the potential importance of acquired knowledge for successful communication and interaction. Conversely, there is evidence that a few older adults suffer from excess verbosity or off-topic speech in their communications (Gold, Andres, Arbuckle & Zieren, 1993), although this may be attributable to different communication goals for younger rather than older speakers (James et al., 1998).

DESIGN SOLUTIONS Vanderheiden (1997), paraphrasing another specialist, noted that "disability is the inability to accommodate to the world as it is currently designed" (p. 2013). How might we train and redesign to accommodate normal agerelated changes in communicative functioning? Training Training can play a role in overcoming the natural reluctance (attitudes) of people with hearing impairments to remind others to speak louder to them. It can also play a role in information transmission, teaching those with impairments to use alternative communication devices, such as computer systems. There is a growing literature on training older adults to use computer technology (Baldi, 1997; Baracat & Marquie, 1994; Czaja, 1996; Kelley & Charness, 1995; Mead & Fisk, 1998; Morrell & Echt, 1997). Design To be able to design successfully, a major prerequisite is "knowing the user." The database for design-relevant characteristics of aging adults is showing signs of improvement (Steenbekkers & van Beijsterveldt, 1998). Nonetheless, there is still a dearth of population-representative data that could help designers in their quest to produce more effective tools. The second requirement for being able to design well is to put user characteristics to work in the context of helping users reach their goals.

Human Factors Issues

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Particularly in the context of users with a variety of impairments in perceptual and psychomotor functions, the so-called disabled user, there is a fairly sound set of guidelines for designing tools and environments (Vanderheiden, 1997). There is a wide range of low-tech to high-tech assistive devices for circumventing weaknesses in transmission channels (e.g., Lubinski & Higginbotham, 1997). Nonetheless, design is not done in a vacuum. Political, technical, and market constraints strongly influence the range of commercial designs. Communications technology is undergoing rapid change. Companies that run the voice networks for telephones using the public switched telephone network (PSTN) are planning to shift away from circuit-switched connections. With this technology a dedicated connection is set between telephone or fax devices, opening a circuit between them. Instead, the companies plan to use packet-switching "voice over internet protocol (IP)." This is the method by which e-mail is currently transmitted through the Internet. Such connections can improve the bandwidth of the voice signal that is conveyed (compared to the narrow bandwidth used in normal telephone transmissions). However, voice over IP involves a "best-effort" delivery of data packets that encode voice. Such connections can also degrade the quality of the information stream, however. Delays in packet arrival and reassembly can produce echo, clipping, and delay (Rigney, 1999). There is little evidence that the needs of older persons are being considered in this transition. Guaranteed quality of service (QOS) is one technique being considered for ensuring priority for information packets on the Internet that serve voice or video functions. Certainly those with hearing impairments should get priority service if and when voice traffic is reassigned to packet-switched networks that degrade quality of transmission, much in the same way that telephone companies are required to provide telecommunication devices for the deaf (TDDs). An even more demanding technology for the Internet is videoconferencing. Desktop videoconferencing is still mainly a hobbyist's activity, although use is growing, thanks in part to the widespread availability of sound cards, digital cameras, and free software such as Microsoft's NetMeeting1M. Such videoconference capability is likely to become a mainstream option for computer users in the coming decade as high-speed access to the Internet becomes more widely available and less expensive. However, videotelephony is actually a fairly old technology, first demonstrated in the 1930s ("videophone," Encyclopedia Britannica Online}. The author has vivid memories of visiting the Bell Pavilion at the New York World's Fair in 1964 as a teenager and being fascinated by the videophones. However, the public phone companies were unable to develop and market this technology effectively, and it

22

Overview

has remained a niche product for large corporations and institutions. Such technology offers seniors with serious mobility impairments a new way to hold face-to-face conversations. In its present desktop use form, however, the quality of both video (size of image and quality of image) and audio channels (voice over IP) leave much to be desired when using PSTN channels via telephone modems. Desktop videoconferencing may be nearly useless for those with any significant visual and auditory impairment. Further, the training requirements to use the software (and maintain the computer hardware) are onerous for novice users. Videotelephony between seniors and medical personnel and peers can be done successfully with dedicated videotelephony equipment, as studies in Germany and Portugal have shown (Erkert, 1998; Moniz-Pereira & Lebre, 1998). Those projects have used relatively fast cable television and ISDN connections rather than the more widely available but relatively slow-speed PSTN system. Advantages and Disadvantages of New Communication Technologies Nonetheless, as the chapters in this volume indicate, consumers of communication technologies are moving into something of a golden age, with both greater options and lower prices on the horizon. A speculative look at the range of advantages and disadvantages of some of these newer communication channels is provided, stressing those that are computer related. The following matrix represents guesses about advantages and disadvantages. There is little research to draw on at this point. Also, technology advocates should not conclude that the Internet will become a panacea for communication. We need to heed warning signs that heavy use of the Internet may lead to negative consequences, such as minor increases in depression and loneliness and minor decreases in family communication (Kraut et al., 1998). On the other hand, chapter 7 also shows a positive outcome: community building. Most of the technologies mentioned in Table 1.2 communicate primarily via text that is displayed visually. Visual channels tend to be impoverished from the perspective of conveying affect (via paralinguistic cues). Users of these communication channels have developed symbols for conveying affective state: "emoticons," combinations of alphanumeric symbols that portray emotional states, such as using :-) to represent being happy; however, new users must learn these conventions. There are also opportunities for conveying affect via "earcons," sounds that could signal affective state. Nonetheless, purely visual channels can handicap users who have visual impairments. There are now guidelines for web-based design that attempt to meet the

Table 1.2 Communicating Across Space and Time Communication channel Issues for channel

Telephone over PSTN

Fax over PSTN

E-mail over IP

Chat over IP

Videotelephony over IP

Web Site over Personal meeting IP

Infrastructure cost Low Setup cost for real Intermediate for time connection different time zone High Cost/min

Low Low

Intermediate Low

Intermediate Intermediate

High Intermediate

Intermediate Intermediate

Very High High

High

Intermediate Low High

Low (USA)/ Intermediate (Europe) Low High Low

Low (USA)/ Intermediate (Europe) Low High High with shared document Intermediate to high depending on bandwidth available

Low (USA)/ Intermediate (Europe) Intermediate Low High

Low

Latency to dialogue Low Intrusiveness High Document sharing Low

Low (USA)/ Intermediate (Europe) Intermediate Low High with enclosure Low with emoticons, earcons

Low

High

High

Low

High

High

Low

High

Affect

Intermediate

Low

Trust in validity of message Interactivity

High

Intermediate

Intermediate

Low

Low

Low

Low with emoticons, earcons, speed of response Low Intermediate (depends on typing speed)

Low High High

Table 1.2 Continued Communication channel Issues for channel Time to plan content of transmission Permanence of transmission Can be kept in database

Telephone over PSTN

Fax over PSTN

E-mail over IP

Chat over IP

Videotelephony over IP

Web Site over Personal IP meeting

Low

High

High

Low

Low

High

Low

Low Low unless save session Low/high after Low save session

High

Low (human memory) Low/Modest with videotape/audiotape High

High High memory) High Low/intermediate Low/high after optical character after speech recognition recognition Low Low Socializing value Intermediate Intermediate Training need Intermediate Low High Intermediate High Convenience High High with Synchronization of Low attachments documents Intermediate Intermediate Legal standing Low

Privacy

Low (human

High if dedicated line or encrypted (low with cellular)

Low

High

Low High Low Low High Low High if document Low (one-way) High if brought Low to meeting sharing enabled Low Low Low unless Low recording capability is present High (if Low High to intermeIntermediate (high Intermediate (depends on encrypted, diate dependif encrypted) ing on others how many in otherwise, present chat group) intermediate)

Intermediate Intermediate Intermediate

High High

Human Factors Issues

25

needs of such users: for example, Web Content Accessibility Guidelines 1.0, W3C Recommendation 5-May-1999 (1999) and Microsoft's "Effective Web Design Considerations for Older Adults, May 12, 1999 (1999)." The communication situation to be envisioned when considering the channels in Table 1.2 is one in which the two (or more) communicators are significantly separated in space and time (e.g., different countries or same country across time zones). Some of the factors in the first column are rarely considered in the usual literature on communications and human factors. Dimensions such as cost, privacy, trust in source, and, particularly, training need (see chapter 10) are likely to be crucial determinants of adoption of these technologies. Research for such dimensions is rather sparse, particularly concerning older users. Filling in the cells with other than educated guesses would be a valuable endeavor for the joint fields of aging, communication, and human factors.

ACKNOWLEDGMENTS This manuscript was prepared while the author was supported by NIA grant 5R01 AG13969 and NIA 1 PO1 AG17211-01. The author thanks Katinka Dijkstra, Susan Kemper, and Rolf Zwaan for comments on an earlier draft.

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Falling through the NET II: New data on the Digital Divide, 1998. (Accessed May 5, 1999). Available: http://www.ntia.doc.gov/ntiahome/net2/falling.html Giles, H., & Street, R. L., Jr. (1994). Communicator characteristics and behavior. In M. L. Knapp & G. R. Miller (Eds.), Handbook of interpersonal communication (2nd ed.) (pp. 103-161). Thousand Oaks, CA: Sage. Gold, D. P., Andres, D., Arbuckle, T, & Zieren, C. (1993). Off-target verbosity and talkativeness in elderly people. Canadian Journal on Aging, 12, 67-77. Gould, O., & Dixon, R. A. (1993). How we spent our vacation: Collaborative storytelling by young and old adults. Psychology and Aging, 8, 10-17. Gould, O., Kurzman D., & Dixon, R. A. (1994). Communication during prose recall conversations by young and old dyads. Discourse Processes, 77(1), 149-165. Graafmans, J., Taipale, V., & Charness, N. (Eds.). (1998). Gerontechnology: A sustainable investment in the future. Amsterdam, The Netherlands: IOS Press. A Guide for Effective Web Design and Usability for Users of All Ages. (Accessed May 8, 2000). Available: http://www.agelight.org/wesdocs/Usability/ contents.htm Heath, R. G. (1986). The neural substrate for emotion. In R. Plutchik & H. Kellerman (Eds.), Emotion: Theory, research, and experience (Vol. 3). Orlando, EL: Academic Press. Hull, R. H. (1989). Demography and characteristics of the communicatively impaired older adult. In R. H. Hull & K. M. Griffin (Eds.), Communication disorders in aging (pp. 9-21). Thousand Oaks, CA: Sage. Jakobson, R. (I960). Closing statements: Linguistics and poetics. In T. Sebeok (Ed.), Style in language (pp. 350-377). Cambridge, MA: MIT Press. James, L. E., Burke, D. M., Austin, A., & Hulme, E. (1998). Production and perception of "verbosity" in younger and older adults. Psychology and Aging, 13, 355-367. Jerger, J. (1973). Audiological findings in aging. Advances in Oto-Rhino-Laryngology, 20, 115-124. Kelley, C. L., & Charness, N. (1995). Issues in training older adults to use computers. Behaviour and Information Technology, 14(2), 107—120. Kemper, S. (1992). Language and aging. In E I. M. Craik & T. A. Salthouse (Eds.), The handbook of aging and cognition (pp. 213-270). Hillsdale, NJ: Erlbaum. Kemper, S., & Lyons, K. (1994). The effects of Alzheimer's dementia on language and communication. In M. L. Hummert, J. M. Wiemann, & J. E Nussbaum (Eds.), Interpersonal communication in older adulthood: Interdisciplinary theory and research (pp. 58—82). Thousand Oaks, CA: Sage. Kemper, S., Rash, S. R., Kynette, D., & Norman, S. (1990). Telling stories: The structure of adults' narratives. European Journal of Cognitive Psychology, 2, 205-228. Kraut, R., Patterson, M., Lundmark, V., Kiesler, S., Mukopadhyay, T, & Scherlis, W. (1998). Internet paradox. A social technology that reduces social involvement and psychological well-being? American Psychologist, 53, 1017-1031.

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Lachman, R., Lachman, J. L., & Butterfield, E. C. (1979). Cognitive psychology and information processing. Hillsdale, NJ: Erlbaum. Legge, G. E., Rubin, G. S., Pelli, D. G., & Schleske, M. M. (1985). Psychophysics of reading-II. Low vision. Vision Research, 25, 253-266. Levenson, R. W., Carstensen, L . L, Friesen, W. V., & Ekman, P. (1991). Emotion, physiology, and expression in old age. Psychology and Aging, 6, 28-35. Lindenberger, U., & Bakes, P. B. (1994). Sensory functioning and intelligence in old age: A strong connection. Psychology and Aging, 9, 339—355. Lubinski, R., & Higginbotham, D. J. (Eds.) (1997). Communication technologies for the elderly: Vision, hearing, and speech. San Diego: Singular Publishing. Mead, S., & Fisk, A. D. (1998). Measuring skill acquisition and retention with an ATM simulator: The need for age-specific training. Human Factors, 40, 516-523. Mehrabian, A., & Ferris, S. R. (1967). Influence of attitudes from nonverbal communication in two channels. Journal of Consulting Psychology, 31, 248—252. Miller, G. A. (1956). The magical number seven, plus or minus two: Some limits on our capacity for processing information. Psychological Review, 63, 81—97. Moniz-Pereira, L., & Lebre, P. (1998). Videotelephony as a tool for recreation programming for elderly people. In J. Graafmans, V. Taipale, & N. Charness (Eds.), Gerontechnology: A sustainable investment in the future (pp. 187—190). Amsterdam, The Netherlands: IOS Press. Morrell, R. W, & Echt, K. V. (1997). Designing written instructions for older adults: Learning to use computers. In A. D. Fisk & W. A. Rogers (Eds.), Handbook of human factors and the older adult (pp. 335-361). San Diego: Academic Press. Murphy, D. R., McDowd, J. M., & Wilcox, K. A. (1999). Inhibition and aging: Similarities between younger and older adults as revealed by the processing of unattended auditory information. Psychology and Aging, 14, 44—59. Nebes, R. D. (1992). Cognitive dysfunction in Alzheimer's disease. In F. I. M. Craik & T. A. Salthouse (Eds.), The handbook of aging and cognition (pp. 373446). Hillsdale, NJ: Erlbaum. Newell, A., & Simon, H. A. (1972). Human problem solving. Englewood Cliffs, NJ: Prentice-Hall. Owsley, C., Ball, K., Sloane, M. E., Roenker, D. L, & Bruni, J. R. (1991). Visual/ cognitive correlates of vehicle accidents in older drivers. Psychology and Aging, 6, 403-415. Park, D. C., Nisbett, R., & Hedden, T. (1999). Aging, culture, and cognition. Journal of Gerontology: Psychological Sciences, 54B, P75—P84. Parks, M. R. (1994). Communicative competence and interpersonal control. In M. L. Knapp & G. R. Miller (Eds.), Handbook of interpersonal communication (2nd ed.). (pp. 589-618). Thousand Oaks, CA: Sage. Pasupathi, M. (1999). Age differences in response to conformity pressure for emotional and nonemotional material. Psychology and Aging, 14, 170—174. Pickett, J. M., Bergman, M., & Levitt, H. (1979). Aging and speech understanding. In J. M. Ordy & K. Brizee (Eds.). Sensory systems and communication in the elderly. (Aging Vol. 10) (pp. 167-186). New York: Raven Press.

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Rabbitt, P. (1993). Does it all go together when it goes? The nineteenth Bartlett memorial lecture. Quarterly Journal of Experimental Psychology, 46A, 385-434. Reaux, R. A., & Carroll, J. M. (1997). Human factors in information access of distributed systems. In G. Salvendy (Ed.), Handbook of human factors and ergonomics (pp. 1783—1807). New York: Wiley. Rigney, S. (1999, May). Voice over everything. ComputerShopper, p. 251. Rook, K. S. (1995). Support, companionship, and control in older adults' social networks: Implications for well-being. In J. E Nussbaum & J. Coupland (Eds.), Handbook of communication and aging research. Mahway, NJ: Erlbaum. Ryan, E. B., Kwong See, S., Meneer, W. B., & Trovato, D. (1994). Age-based perceptions of conversational skills among younger and older adults. In M. L. Hummert, J. M. Wiemann, & J. E Nussbaum (Eds.), Interpersonal communication in older adulthood: Interdisciplinary theory and research (pp. 15—39). Thousand Oaks, CA Sage. Salvendy, G. (Ed.). (1997). Handbook of human factors and ergonomics (2nd ed.). New York: Wiley. Salthouse, T. A. (1991). Theoretical perspectives on cognitive aging. Hillsdale, NJ: Lawrence Erlbaum Associates. Steenbekkers, L. P. A., & van Beijsterveldt, C. E. M. (Eds.). (1998). Design-relevant characteristics of ageing users. Delft, The Netherlands: Delft University Press. Shadden, B. (1997). Language and communication changes with aging. In B. Shadden & M. A. Toner (Eds.), Aging and communication (pp. 135—170). Austin, TX: Pro-Ed. Stine, E. L., & Wingfield, A. (1987). Process and strategy in memory for speech among younger and older adults. Psychology and Aging, 2, 272—379. Vanderheiden, G. C. (1997). Design for people with functional limitations resulting from disability, aging, or circumstance. In G. Salvendy (Ed.), Handbook of human factors and ergonomics (pp. 2010—2052). New York: Wiley. "Videophone" [On-line]. Encyclopaedia Britannica Online. (Accessed May 12, 1999). Available: http://www.eb.com: 180/bol/topic?eu=77266&sctn= 1 Villaume, W. A., Brown, M. H., & Darling, R. (1994). Presbycusis, communication, and older adults. In M. L. Hummert, J. M. Wiemann, & J. E Nussbaum (Eds.), Interpersonal communication in older adulthood: Interdisciplinary theory and research (pp. 83—106). Thousand Oaks, CA: Sage. Watzlawick, P., Beavin, J. H., & Jackson, D. D. (1967). Pragmatics of human communication. A study of interactional patterns, pathologies, and paradoxes. New York, Norton. Weale, R. A. (1963). The aging eye. London: H. K. Lewis. Web Content Accessibility Guidelines 1.0, W3C Recommendation 5—May-1999 (Accessed May 6, 1999). Available: http://www.w3.org/TR/1999/WAI-WEBCONTENT-19990505/ Whalen, P. J. (1998). Fear, vigilance, and ambiguity: Initial neuroimaging studies of the human amygdala. Current Directions in Psychological Science, 7, 177-188. Zwaan, R. A., & Radvansky, G. A. (1998). Situation models in language comprehension and memory. Psychological Bulletin, 123(2), 162-185.

2

Over-Accommodations and Under-

Accommodations to Aging Susan Kemper

A

n extensive literature now documents what is known about the effects of aging on language production and comprehension (see Kemper & Kliegl, 1999). It establishes that some aspects of language are spared and unaffected by age-related changes, whereas other aspects of language are affected by age-related changes in motivation, processing speed, working memory, and inhibitory function. This chapter re-examines two implications of this body of research on language and aging: overaccommodations and under-accommodations. Over- and under-accommodations to aging constitute the "communicative predicament of aging" described by Ryan, Giles, Bartolucci, and Henwood (1986) in a seminal paper. Both over- and under-accommodations put older adults at risk. Overaccommodations put older adults at risk because over-accommodations are often perceived by older adults as insulting and patronizing and therefore may disenfranchise older adults from full participation in a conversational interaction. Under-accommodations also put older adults at risk because under-accommodations lead to comprehension failure and, hence, to the possibility of deception and exploitation.

OVER-ACCOMMODATIONS Over-accommodations to aging are often marked by the use of a special speech register, termed secondary baby talk or elderspeak, in interactions between young adults and older adults (Ashburn & Gordon, 1981; Caporael, 1981; Caporael & Culbertson, 1986; Caporael, Lukaszewski, & Cul30

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OLD AGE CUES

AGE-RELATEDCHANGES

STEREOTYPES OF OLDER ADULTS

PSYCHOLOGICAL DECLINE LOSS OF SELF-ESTEEM

ELDERSPEAK

CONSTRAINED OPPORTUNITIES REINFORCEMENT OF STEREOTYPES

Figure 2.1 Downward spiral triggered by over-accommodations to aging. Note. From "Psycholinguistic and Social Psychological Components of Communication by and with the Elderly," by E. B. Ryan, H. Giles, G. Bartolucci, and K. Henwood, 1986, Language and Communication, 6, p. 16. Copyright 1986 by Elsevier Science. Adapted with permission.

bertson, 1983; Gibb & O'Brien, 1990; Kemper, 1994; Lanceley, 1985; Ryan, Giles, Bartolucci, & Henwood, 1986). Elderspeak has been assumed to be an accommodation to the perceived communication needs of older adults because it involves a slow rate of speaking, simplified syntax, vocabulary restrictions, and exaggerated prosody. It also is judged to be patronizing and disrespectful because the use of elderspeak presumes that the older adult is cognitively impaired (Edwards & Noller, 1993; Hummert, Shaner, Garstka, & Henry, 1998; Ryan, Bourhis, & Knops, 1991; Ryan, Hamilton, & Kwong See, 1994; Ryan, Hummert, & Boich, 1995; Ryan, MacLean, & Orange, 1994). In some contexts, such as nursing homes, older adults may be more accepting of elderspeak (O'Connor & Rigby, 1996). Ryan et al. (1986) suggested that over-accommodations to aging such as elderspeak may trigger negative self-assessments by older adults of their own communicative competence and thus contribute to a downward spiral of sociocognitive limitations (Figure 2.1). On the other hand, elderspeak is often viewed as helpful and facilitative to the extent that it reduces processing demands and enhances comprehension. Most research on elderspeak has been observational and descriptive in nature (cf. Kemper, 1994). In order to evaluate its efficacy, it is necessary to study elderspeak under controlled conditions using established experimental techniques. Simulation paradigms have been used to elicit evaluations of elderspeak (cf., Cohen & Faulkner, 1996; O'Connor & Rigby, 1996; Ryan et al., 1991) or to elicit elderspeak itself under different conditions (cf.,

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Overview

Hummert et al., 1998). Using a controlled referential communication task, Kemper and colleagues (Kemper, Ferrell, Harden, Finter-Urczyk, & Billington, 1998; Kemper, Finter-Urczyk, Ferrell, Harden, & Billington, 1998; Kemper, Othick, Gerhing, Gubarchuk, & Billington, 1998; Kemper, Othick, Warren, Gubarchuk, & Gerhing, 1996; Kemper, Vandeputte, Rice, Cheung, & Gubarchuk, 1995) have investigated elderspeak addressed by young adults to older adults in a laboratory setting. The referential communication task involves two participants who can hear but not see each other. Both are provided with maps of a hypothetical town. The participants alternate roles as speaker and listener. A route has been drawn on the speaker's map, and the speaker is required to verbally describe this route so that the listener can trace it on her or his map. The referential communication task generates a language sample from each participant that can be analyzed for speech accommodations such as the use of elderspeak. It also provides measures of the listener's immediate comprehension in terms of the accuracy of the listener's route. This task permits experimenter control over a number of factors that influence the use and nature of elderspeak. Using this task, Kemper et al. (1995, 1996) observed that young adults will spontaneously adopt a form of elderspeak when paired with older adults. The form of elderspeak spontaneously used by young adults with older partners during this referential communication shares all of the major properties and characteristics ascribed to elderspeak from the naturalistic observations, with one exception. During referential communication tasks, young adults rarely use "diminutive" terms when addressing older partners. These terms, such as "honey" or "dear," are often listed as a characteristic of elderspeak. Young adults use more utterances, directions, and checks on the listener's comprehension when addressing older partners than when addressing young partners, and they use shorter sentences; simplified syntax; exaggerated prosody, including a slower rate of speaking; and reduced prepositional density (Kintsch & Keenan, 1973). The speech of the young adults to their older partners is redundant and repetitive. Elderspeak is not necessarily cued by older adults' comprehension problems because young adults use the same form of elderspeak when their partners are permitted to interrupt and ask clarification questions (Kemper et al., 1995) and when the older partners are not permitted to respond, ask questions, or comment on the task (Kemper et al., 1996). These studies suggest that the speech register is composed of two sets of parameters. One set of correlated parameters is linked to the perception that the older listener is cognitively impaired; these parameters affect how much information is conveyed and include semantic elaborations such as expansions and repetitions of previous map directions. Young adults provid-

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ed semantic elaborations when paired with an older partner, and they increased their use of these semantic elaborations whenever they perceived the older listener to be cognitively impaired (Kemper, Ferrell, et al., 1998; Kemper, Finter-Urczyk, et al., 1998). The other set of correlated parameters includes fluency, prosody, and grammar. These speech accommodations are also elicited by older listeners, and they are modified by extended practice and task familiarity (Kemper, Othick, et al., 1998). These modifications to fluency, prosody, and grammar do not appear to benefit older listeners. Young adults adopt both sets of speech accommodations, providing semantic elaborations that aid older listeners while also altering their fluency, prosody, and grammar in ways that may be construed as patronizing or insulting. In these studies, the young adults' use of elderspeak did appear to improve the performance of the older listeners on the referential communication task. However, the older adults also reported experiencing more receptive and expressive communication problems when they were paired with a young adult who used elderspeak than when they were paired with another older adult. Note that their self-reported communication problems were contrary to fact, because they actually did better as listeners and their partners had few complaints about their performance as speakers. The use of elderspeak by the young partners appeared to trigger older adults' perceptions of themselves as cognitively impaired, consistent with the "communicative predicament of aging" model of Ryan et al. (1986). Although elderspeak is intended to be a beneficial accommodation to the communication limitations of older adults, it may also contribute to older adults' negative self-assessments of their own communicative competence and, hence, to social isolation and cognitive decline. Orange, Ryan, Meredith, and MacLean (1995) and Ryan, Meredith, MacLean, and Orange (1995) have called for the development of "communication enhancement strategies." Kemper and Harden (1999) conducted a series of experimental studies to disentangle the beneficial parameters of elderspeak that enhance older listeners' comprehension from those that contribute to older adults' negative self-assessments of their own communicative competence. Three experiments were conducted to systematically test the efficacy of speech accommodations to aging, using a modified referential communication task, to study how systematic variations in the content and form of elderspeak affect older adults' comprehension and evaluation of elderspeak. The referential communication task required listeners to trace a route on a map following the directions given by a video-recorded speaker. Online comprehension was assessed by comparing the listener's route to the target route, scoring all deviations from the correct route as well as whether

34

Overview

the correct terminus was reached. Listeners were asked to rate their own communicative competence in terms of expressive and receptive communication problems. Experiment 1 The first experiment contrasted scripted map directions varying in syntactic complexity and semantic elaboration. The speakers used prepared scripts to record four blocks of map directions using a different speech style for each block. The speakers were instructed to use the same rate of speaking and the same prosody for each condition. This was confirmed with an acoustic analysis; speech rate in words per minute did not vary across conditions, nor did the duration of matched segments (identical phrases occurring in each condition), the pitch range, and the pitch of selected vowels vary in these matched segments. The map directions varied orthogonally on two dimensions: syntactic complexity and semantic elaboration. The base versions matched those produced by young speakers addressing young listeners in Kemper et al. (1995, 1996) in terms of mean length of utterance in words, mean number of clauses per utterance, and incidence of embedded clauses. One version reduced syntactic complexity by eliminating sentence embeddings; a second version provided semantic elaborations such as expansions and repetitions; a third version combined both the syntactic simplifications and the semantic elaborations. When semantic elaborations were provided, syntactic complexity had no effect on performance; when no semantic elaborations were provided, syntactically complex map directions were more difficult to follow than were the syntactically simplified versions so that participants completed fewer maps correctly and made more deviations from the correct route. Syntactic simplifications particularly benefited the older adults, confirming the positive benefit of this component of elderspeak. However, elderspeak is characterized not only by syntactic simplifications and semantic elaborations but also by exaggerated prosody. Experiment 2 The second study contrasted map directions varying in syntactic complexity and prosody. Four versions were contrasted, each using a different elderspeak style: a base version, a version syntactically simplified version, a version with exaggerated prosody, and a version combining syntactic simplifications and exaggerated prosody. The base version of the map directions differed from the syntactically simplified ones in terms of mean length of utterance (MLU) in words, mean clauses per utterance (MCU), and the

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use of left-branching clauses (%Left). The base versions matched values on these dimensions produced by the young speakers addressing young listeners in Kemper et al. (1995, 1996). The exaggerated prosody scripts differed from the neutral prosody scripts in that key directions were contrastively stressed, pauses were introduced before and after each key direction, and a slow rate of speaking was used in which vowels were prolonged. Acoustic analysis was used to confirm these prosodic exaggerations. The exaggerated prosody map directions were constructed to be similar prosodically to those used by young speakers addressing older listeners in the Kemper et al. (1995, 1996) studies. The four versions of each set of map directions did not differ in semantic content; no semantic elaborations were provided. In this experiment, prosody not only affected the older adults' ratings of their own communicative competence but also had an impact on their actual performance. When the speaker used exaggerated prosody, older adults reported experiencing more communication problems, and their actual performance on the referential communication task was impaired slightly by the use of exaggerated prosody. Syntactic complexity affected both their actual performance and their ratings of communicative competence. The older adults completed fewer maps correctly and made more deviations from the correct route when syntactically complex scripts were used than they did when syntactically simple scripts were used. Older adults judged themselves to have fewer communication problems when the speaker used syntactic simplifications with neutral prosody. The young adults' performance and their communication competence ratings were unaffected by the manipulations of prosody or syntactic complexity. Experiment 3 The syntactic simplifications used in Experiments 1 and 2 involved two types of modifications: sentence length in words was shortened and embedded, and subordinate clauses were eliminated. Experiment 3 examined each modification separately, comparing map directions that were simplified by shortening sentence length with those simplified by eliminating embedded clauses. The prosodic exaggerations used in Experiment 2 also involved two general sorts of prosodic changes. On the one hand, contrastive pitch was used to emphasize key words, resulting in an overall increase in pitch and an increase in pitch range. On the other hand, pauses were inserted before and after key words, and the key words were prolonged, resulting in slower speaking rates and longer segment durations. Experiment 3 examined the

36

Overview

effects of each set of prosodic changes independently by comparing map directions that were delivered with high pitch to those delivered at a slower rate. As in previous research, pitch exaggerations and slow speaking rates appeared to trigger negative self-assessments by older adults of their own communicative competence, resulting in their self-report of more communication problems. Pitch exaggerations and slow speaking rates did not enhance the older adults' comprehension. Lowering MCU does appeared to help older adults process map directions but only when prosodic exaggerations did not occur. Reducing MLU alone appeared to have little effect on older adults' performance, and reduced MLU alone does not appear to affect older adults' assessment of their own communicative competence. The optimal form of elderspeak appeared to combine reduced MCU with neutral prosody. Discussion It is possible to develop a form of elderspeak that benefits older adults and that does not give rise to negative self-assessments of communicative competence and is not perceived as insulting or patronizing. This form of elderspeak would provide semantic elaborations, such as those used in Experiment 1. Repeating or expanding 50% of the map directions and providing four location checks per map enabled the older adults to perform as well on the referential communication task as the young adults did, even when the map directions were presented in complex syntax. Reducing syntactic complexity also benefits older adults but must be done carefully. Reducing syntactic complexity by reducing MLU and MCU, as in Experiments 1 and 2, may enhance older adults' performance but does so at a cost of increasing older adults' report of communication problems. Reducing MCU without affecting MLU benefits older adults in two ways: it improves their performance and reduces their communication problems. Eliminating subordinate and embedded clauses appears to benefit older adults by lowering processing demands (Kemper, 1992). Reducing MLU without reducing MCU, on the other hand, has no effect on older adults' performance and it increases communication problems. Chopping up directions into short two- to five-word sentences does not benefit older adults and may actually impair their comprehension by dribbling out information over multiple sentences, thus taxing working memory. The exaggerated prosody of elderspeak appears to convey no positive benefit to older adults in terms of their performance on the referential communication task and may actually hurt their performance, as in Exper-

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iment 2. Whether high pitch and slow speaking rates are combined, as in Experiment 2, or distinguished, as in Experiment 3, these prosodic variations contribute to older adults' negative assessment of their own communicative competence as well as to negative evaluations of the speaker. To be addressed in a "baby talk" version of elderspeak made up of short, simple sentences with exaggerated prosody seems to convey the impression to older adults that they were cognitively impaired and have communication problems.

UNDER-ACCOMMODATIONS Under-accommodations to aging can be as devastating to older adults as over-accommodations can be. Consider the following bit of "helpful advice"; it is the opening paragraph from "What to Expect from Medicare" appearing in Consumer Reports (1997); it was designed to educate readers about the purchase of long-term care insurance. The principal reason to buy long-term care insurance is to preserve from a Medicare spenddown the assets that a spouse may need to live on or that you are determined to leave to children or grandchildren. If the income from the assets a spouse can keep combined with other income allowed by the state is enough to support him or her, you may not need insurance to preserve more. Nor do you need insurance if you can set aside roughly $160,000 at compound interest solely to pay for nursing home care. These funds would pay for about four years of care. (p. 36) The first sentence has 35 words, the simple main clause ("the reason is...") is hidden among six other clauses. The second sentence begins with a subordinate clause ("if income is enough); this subordinate clause itself contains three embedded reduced relative clauses ("spouse can keep assets," "assets combined with other income," and "income allowed by state")! Now compare that to a revised version: You must "spenddown" your assets before you will qualify for Medicare payments for long-term care. The state allows your spouse to keep some assets and your spouse may have other income. Your spouse may have enough to live on. If not, you will need long-term care insurance to preserve more assets for your spouse. There is a second reason for long-term care insurance. You may be determined to leave assets to your children or grandchildren. If so, you will need long-term care insurance to preserve these assets. You may not need insurance. You may be able to set aside roughly $160,000 at compound interest. This will pay for nursing home care for about four years.

38

Overview AGE-RELATED CHANGES

PROCESSING LIMITATIONS

PSYCHOLOGICAL DECLINE LOSS OF SELF-ESTEEM

COMPREHENSION PROBLEMS

VULNERABILITY TO FRAUD LACK OF INFORMATION

Figure 2.2

Downward spiral triggered by over-accommodations to aging.

Despite many appeals for "clear writing" and "simple English," badly written, confusing, hard-to-understand texts are a problem that does not seem to go away. Incomprehensible texts, such as insurance documents, health-care guidelines, and other medical and legal texts, not only fail to inform the reader but also may render the older adult vulnerable to fraud and deception if they must rely on others to inform, explain, or clarify (Figure 2.2). Style guides, such as Strunk and White's Elements of Style (1959), "readability" formulas, and computerized grammar editors offer general prescriptions for improving writing, but these recommendations are often not based on techniques that have been proven to enhance comprehension. General prescriptions for improving writing such as "avoid passives" and "be positive" are often based on editorial practices, prescriptive models of grammar, or other subjective criteria. Reading researchers have developed readability formulas to measure the overall difficulty, or the grade level suitability, of reading materials (Bruce & Rubin, 1988; Duffy, 1985). Readability formulas are typically regression equations, obtained from a largesample study of children or adults who are tested on a wide range of texts. The texts are scored for possible sources of reading difficulty such as measures of word difficulty, word familiarity, or sentence length. Regression techniques are then used to identify a weighted combination of variables that predict reading difficulty, typically long sentences and long words (Anderson & Davison, 1988; Bruce & Rubin, 1988). This approach has been extended by Kirsch and Mosenthal (1990) to a wide range of documents, including signs, labels, directions, tables, graphs, bills, and advertisements. Readability formulas are typically combined with a "redesign-test" procedure (Wright, 1978) in order to validate the formula as a guide for enhancing reading speed or accuracy, or both.

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The readability approach has been widely used to establish normative criteria for basal readers (formula-written materials graded for use in elementary school reading curriculum), publication standards for newspapers and college textbooks, training materials developed by the U. S. Army, and insurance policies and other financial and legal materials in some states under so-called "clear writing" legislative mandates (Anderson & Davison, 1988). This approach has become dominate; "grammar checkers," usually variations of a readability formula that is easy to compute from a simple "surface" analysis of texts, are now routinely embedded in word processing packages. In some cases, these formulas do little more than count the number of key strokes occurring between major punctuation marks (e.g., periods and commas) and compare these keystroke counts to normative tables obtained by reanalyzing basal readers that, in turn, were written to conform to a readability formula based on sentence and word length. Readability formulas have also been widely criticized for a number of other reasons grounded in cognitive science (Anderson & Davison, 1988). For example, their application can destroy the cohesiveness of texts by reducing causally and temporally connected prose to a series of short, disjointed clauses through the deletion of "long" connectives such as "although" and "because." The variables assessed by readability formulas are often chosen for convenience or computational ease rather than relevance to contemporary models of reading. Readability formulas do not measure the true, underlying sources of reading difficulty or comprehension failure. An extensive literature documents the existence and nature of older adults' text-processing problems (for reviews, see Light & Burke, 1988; Stine, 1992; Stine, & Wingfield, 1990; Stine-Morrow & Soederberg Miller, 1999). Most of this research has focused on text recall and examined the nature of older adults' text memory deficits with regard to text encoding and retrieval processes. Age-related deficits in encoding and retrieval have been attributed to two general classes of variables: reader/listener variables and text variables. Reader/listener variables that may impair encoding and retrieval of texts by older adults include working memory limitations, strategy and organizational differences, and intrusion of irrelevant information. Reading comprehension imposes many simultaneous demands on the reader to recognize individual words, parse the words into phrases and clauses, establish logical and temporal connections among the clauses, determine the referents of pronouns, and infer unstated causes and consequences of events. These simultaneous processing demands are handled by working memory, a limited-capacity storage and processing component of the human information processing system. Working memory is typically characterized as involving

40

Overview

(1) a central executive that schedules and assigns processing tasks and (2) multiple temporary storage buffers that retain information until it can be processed and that store the intermediate results of the processing operations (Baddeley, 1986). Whenever the amount of information to be processed or the number of simultaneous processing tasks exceeds the capacity of working memory, perhaps by overloading the buffers or central executive, processing deficits result. Working memory appears to decline with advancing age, perhaps as a result of a loss of processing capacity or slowed processing speed, impairing older adults' reading and listening comprehension (Kemper & Kemtes, 1999; Stine-Morrow & Soederberg Miller, 1999; Wingfield & Tun, 1999). Older adults' text processing may also be hindered by interference because of the intrusion of irrelevant thoughts; Hasher & Zacks (1988) propose that inhibitory mechanisms weaken with age and permit the intrusion of irrelevant thoughts, personal preoccupations, and idiosyncratic associations during text encoding and retrieval. These irrelevant thoughts compete for processing resources, such as working memory capacity, and so impair older adults' comprehension and recall. Hence, older adults' comprehension may be affected by distractions or intrusive thoughts. For example, when a text contains distracting words printed in a different font, young adults are able to ignore the distracting material, even when it is related to the text, whereas older adults are not able to ignore the distracting material, which slows their reading, impairs their comprehension, and renders them subject to memory distortions. Other reader/listener variables affecting reading comprehension include strategy and organizational differences that may impair older adults' ability to distinguish more and less important ideas and to establish coherence among ideas. Age group differences in text recall are attenuated when educational level or verbal ability, or both, are controlled. This suggests that education leads to the development and use of powerful text processing and organizational strategies that can compensate for age-related processing deficits because of, for example, working memory limitations. Text variables also contribute to reading and comprehension difficulty. The extensive experimental literature on discourse processing (see Graesser, Swamer, & Hu, 1997, for a review) has identified a number of text variables predictive of processing difficulty, typically measured by word or sentence reading times, and comprehension or memory problems. Freedle (1997) has shown that these experimental text variables are also predictive of comprehension accuracy when applied to standardized reading materials used with multiple-choice testing paradigms. This approach also suggests that individual differences in verbal proficiency, represented by ability grouping

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on the Scholastic Assessment Test, may be interpreted as coming from an interaction of reader variables, derived from Baddeley's (1986) model of working memory, and text variables, derived from experimental psycholinguistics. A preliminary study by Kemper, Jackson, Cheung, and Anagnopoulos (1994) combined a psycholinguistic analysis of sentence complexity with a regression analysis of older adults' reading to investigate older adults' text processing comprehension problems. Texts were selected from a variety of sources such as local and national newspapers, sports magazines, and current events digests. Each text was then subjected to a set of textual analyses including syntactic analyses of sentence complexity (Cheung & Kemper, 1992), a readability analysis using the Dale-Chall formula (Dale & Chall, 1948), and a lexical redundancy analysis using type-token ratios. A panel of 60 older adults, 65 to 90 years of age, read each passage and attempted to answer a set of factual questions about the passages. Comprehension test scores and reading times were collected for each passage as well as ratings by the readers of their preferences for the texts In general, older adults' reading comprehension and reading rate correlated with the measures of syntactic complexity and prepositional density. Reading comprehension and rate decreased as the texts became more complex because of an increase in the use of embedded clauses, reflected in the syntactic measures, and as prepositional density increased. The preference ratings were not correlated with any of these measures. Prepositional density appeared to account for approximately 37% of the variance in comprehension and 36% of the variance in reading rate, whereas syntactic complexity independently accounted for 48% of the variance in comprehension and 50% of the variance in reading rate. Prepositional density and type of embedding appear to be relatively independent contributors to text difficulty; these two measures jointly accounted for 59% of the variance in older adults' comprehension and 64% of the variance in older adults' reading speed This study combined a psycholinguistic analysis of texts with a regression analysis of older adults' reading and comprehension. Although readability formulas; style guides, such as Strunk and White's classic (1959) Elements of Style; and computerized grammar editors offer general prescriptions for improving writing, these prescriptions are not based on psychological models of reading nor are they validated by empirical research. Such prescriptions may, in fact, impair comprehension (Anderson & Davison, 1988). In addition, proposals for enhancing reading based on research with young adults may not generalize to older adults. The study avoided such pitfalls by focusing on text variables that have been shown to contribute to older

42

Overview

adults' reading problems. These text variables include propositionally dense sentences and the amount and type of embedding. The Kemper et al. (1994) study suggested that older adults' reading comprehension can be enhanced by avoiding propositionally dense sentences and complex syntactic constructions. Further research, investigating a wider range of texts is surely warranted in order to develop formal guidelines for the preparation of documents targeted at older adults.

CONCLUSIONS Although much research on language and aging has accumulated in the years since the publication of the paper by Ryan et al. (1986) on the "communicative predicament of aging," it has done little to resolve this dilemma. Caregivers and service providers are still urged to use elderspeak in order to enhance communication with older adults while lawyers, medical writers, and financial planners continue to inundate older adults with incomprehensible documents. Both over- and under-accommodations arise from the failure to accurately assess the communication needs of older adults: over-accommodations from the failure to assess communication strengths, under-accommodations from the failure to assess communication limitations. Kemper and Hummert (1997) conceptualized this as a "resources/competence" issue reflecting a shifting balance between primary/ external control processes and secondary/internal control processes (Heckhausen & Schulz, 1995). In some circumstances older adults are able to use primary/external control processes to signal others to make appropriate speech adjustments. Older adults can request clarification, signal comprehension or miscomprehension through the use of "backchannel" affirmatives or negatives, interrupt to paraphrase or summarize, and use patterns of gaze or other gestures as feedback as to the success of others' communications. When they fail to do so or when they are unable to do so, as in the case of printed materials or broadcast television or radio programs, they must rely on secondary/ internal control processes. Secondary/internal control processes use practical knowledge of the social uses of language; communication goals and motivations; and preserved conceptual and linguistic knowledge of word meanings, semantic and pragmatic constraints, and discourse structure. Older adults may not be able to use such secondary/internal control processes when they are confronted with unfamilar, technical, or abstract information. Hence, over- and under-accommodations may arise because others fail to appropriately assess how well older adults are able to compensate (Backman

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& Dixon, 1992; Dixon & Backman, 1993) for sensory limitations and cognitive processing bottlenecks such as those imposed by working memory. On the other hand, under-compensations may arise because such compensatory strategies are insufficient or ineffective and older adults cannot draw on sufficent reserves of social and linguistic knowledge.

REFERENCES Anderson, R. C., & Davison, A. (1988). Conceptual and empirical bases of readability formulas. In A. Davison & G. Green (Eds.), Critical approaches to readability (pp. 23—54). Hillsdale, NJ: Erlbaum Associates. Ashburn, G., & Gordon, A. (1981). Features of a simplified register in speech to elderly conversationalists. International Journal of Psycho linguistics, 7, 31-43. Baddeley, A. (1986). Working memory. Oxford, UK: Clarendon Press. Backman, L., & Dixon, R. A. (1992). Psychological compensation. Psychological Bulletin, 112, 259-283. Bruce, B., & Rubin, A. (1988). Readability formulas: Matching tool and task. In A. Davison & G. Green (Eds.), Critical approaches to readability (pp. 5—21). Hillsdale, NJ: Erlbaum. Caporael, L. (1981). The paralanguage of caregiving: Baby talk to the institutionalized aged. Journal of Personality and Social Psychology, 40, 876-884. Caporael, L. R., & Culbertson, G. H. (1986). Verbal response modes of baby talk and other speech at institutions for the aged. Language and Communication, 6, 99-112. Caporael, L. R., Lukaszewski, M. P., & Culbertson, G. H. (1983). Secondary babytalk: Judgments of institutionalized elderly and their caregivers. Journal of Personality and Social Psychology, 44, 746-754. Cheung, H., & Kemper, S. (1992). Competing complexity metrics and adults' production of complex sentences. Applied Psycholinguistics, 13, 53—76. Cohen, G., & Faulkner, D. (1986). Does "elderspeak" work? The effect of intonation and stress on comprehension and recall of spoken discourse in old age. Language and Communication, 6, 91-98. Dale, E., & Chall, J. S. (1948). A formula for predicting readability. Educational Research Bulletin, 27, Jan. 11-20 & Feb. 37-54. Dixon, R. A., & Backman, L. (1993). Reading and memory for prose in adulthood: Issues of expertise and compensation. In S. R. Yussen & M. Smith (Eds.), Reading Across the Life Span (pp. 193-213). New York: Springer-Verlag. Duffy, T. M. (1985). Readability formulas: What's the use? In T. M. Duffy & R. Waller (Eds.), Designing usable texts (pp. 113-143). Orlando, FL: Academic Press. Edwards, H., & Noller, P. (1993). Perceptions of overaccommodations used by nurses in communication with the elderly. Journal of Language and Social Psychology, 12, 207-223.

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Freedle, R. (1997). The relevance of multiple-choice reading test data in studying expository passage comprehension: The sage of a 15 year effort towards an experimental/correlational merger. Discourse Processes, 23, 399—440. Freedle, R., & Kostin, I. (1991). The prediction of SAT reading comprehension item difficult for expository prose passages. Princeton, NJ: ETS. Freedle, R., & Kostin, I. (1992). The prediction of GRE reading comprehension item difficulty for expository prose passages for each of three item types: Main ideas, inference, and explicit statement items. Princeton, NJ: ETS. Gibb, H., & O'Brien, B. (1990). Jokes and reassurances are not enough: Ways in which nurses related through conversation with elderly clients. Journal of Advanced Nursing, 15, 1389-1401. Graesser, A. C., Swamer, S. S., & Hu, X. (1997). Quantitative discourse processing. Discourse Processes, 23, 229—264. Hasher, L., & Zacks, R. T. (1988). Working memory, comprehension, and aging: A review and a new view. In G. H. Bower (Ed.), The Psychology of Learning and Motivation (Vol. 22, pp. 193-226). New York: Academic Press. Heckhausen, J., & Schulz, R. (1995). A life-span theory of control. Psychological Review, 102, 284-304. Hummert, M. L., Shaner, J.L., Garstka, T. A., & Henry, C. (1998). Communication with older adults: The influence of age stereotypes, context, and communicator age. Human Communication Research, 25, 124-151. Kemper, S. (1992). Language and aging. In F. I. M. Craik & T. A. Salthouse (Eds.), Handbook of aging and cognition (pp. 213-270). Hillsdale, NJ: ErIbaum. Kemper, S. (1994). "Elderspeak": Speech accommodations to older adults._Aging and Cognition, 1, 1—10. Kemper, S., Ferrell, P., Harden, T, Finter-Urczyk, A., & Billington, C. (1998). The use of elderspeak by young and older adults to impaired and normal older adults. Aging, Neuropsychology, and Cognition, 5, 43—55. Kemper, S. Finter-Urczyk, A., Ferrell, P., Harden, T, & Billington, C. (1998). Using elderspeak with older adults. Discourse Processes, 25, 55-73.. Kemper, S., & Harden, T. (1999). Disentangling what's beneficial about elderspeak from what's not. Psychology and Aging, 14, 656-670. Kemper, S., & Hummert, M. L. (1997). New directions in research on aging and message production. In J. O. Greene (Ed.), Message Production: Advances in Communication Theory (pp. 127—150J. Mahwah, NJ: Erlbaum. Kemper, S., Jackson, J. D., Cheung, H., & Anagnopoulos, C. A. (1994). Enhancing older adults' reading comprehension. Discourse Processes, 16, 405-428. Kemper, S., & Kemtes, K. A. (1999). Limitations on syntactic processing. In S. Kemper & R. Kliegl (Eds.), Constraints on language: Aging, memory, and grammar (pp. 79-106). New York: Kluwer Academic. Kemper, S., & Kliegl R. (Eds.). (1999). Constraints on language: Aging, memory, and grammar. New York: Kluwer Academic. Kemper, S., Othick, M., Gerhing, H., Gubarchuk, J., & Billington, C. (1998).

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Practicing speech accommodations to older adults. Applied Psycholinguistics, 19, 175-192. Kemper, S., Othick, M., Warren, J., Gubarchuk, J., & Gerhing, H. (1996). Facilitating older adults' performance on a referential communication task through speech accommodations. Aging and Cognition, 3, 37-55. Kemper, S., Vandeputte, D., Rice, K., Cheung, H., & Gubarchuk, J. (1995). Speech adjustments to aging during a referential communication task. Journal of Language and Social Psychology, 14, 40—59. Kintsch, W., & Keenan, J. M. (1973). Reading rate and retention as a function of the number of the propositions in the base structure of sentences. Cognitive Psychology, 5, 257-274. Kirsch, I. S., & Mosenthal, P. B. (1990). Exploring document literacy: Variables underlying the performance of young adults. Reading Research Quarterly, 25, 5-30. Lanceley, A. (1985). Use of controlling language in the rehabilitation of the elderly. Journal of Advanced Nursing, 10, 125-135. Light, L. L., & Burke, D. M. (1988). Language, memory, and aging. New York: Cambridge University Press. O'Connor, B. P., & Rigby, H. (1996). Perceptions of baby talk, frequency of receiving baby talk, and self-esteem among community and nursing home residents. Psychology and Aging, 11, 147—154. Orange, J. B., Ryan, E. B., Meredith, S. D., & MacLean, M. J. (1995). Application of the communication enhancement model for long-term care residents with Alzheimer's disease. Topics in Language Disorders, 15, 20-35. Ryan, E. B., Bourhis, R. Y., & Knops, U. (1991). Evaluative perceptions of patronizing speech addressed to elders. Psychology and Aging, 6, 442—450. Ryan, E. B., Giles, H., Bartolucci, G., & Henwood, K. (1986). Psycholinguistic and social psychological components of communication by and with the elderly. Language and Communication, 6, 1—24. Ryan, E. B., Hamilton, J. M., & Kwong See, S. (1994). Younger and older adult listeners' evaluations of baby talk addressed to institutionalized elders. International Journal of Aging and Human Development, 39, 21-32. Ryan, E. B., Hummert, M. L., & Boich, L. H. (1995). Communication predicaments of aging: Patronizing behavior toward older adults. Journal of Language and Social Psychology, 14, 144-166. Ryan, E. B., MacLean, M. J., & Orange, J. B. (1994). Inappropriate accommodation in communication to elders: Inferences about nonverbal correlates. International Journal of Aging and Human Development, 39, 273-291. Ryan, E. B., Meredith, S. D., MacLean, M. J., & Orange, J. B. (1995). Changing the way we talk with elders: Promotion health using the communication enhancement model. International Journal of Aging and Human Development, 41, 89-107. Stine, E. (1992). The way reading and listening work: A tutorial review of discourse processing and aging. In E. A. Lovelace (EdJ, Aging and Cognition:

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Mental processes, self-awareness, and interventions (pp. 310-327). Amsterdam: North Holland. Stine-Morrow, E. A. L, & Soederberg Miller, L. M. (1999). Discourse processing and aging: Resource allocation as a limiting factor. In S. Kemper & R. Kliegl (Eds.), Constraints on language: Aging, memory, and grammar (pp. 53-76). New York: Kluwer Academic. Stine, E. A. L., & Wingfield, A. (1990). How much do working memory deficits contribute to age differences in discourse memory? European Journal of Cognitive Psychology, 2, 289-304. Strunk, W., & White, E. B. (1959). The elements of style. New York: Macmillan. Wingfield, A., & Stine-Morrow, E. A. L. (2000). Language and Speech. In F. I. M. Craik & T. A. Salthouse (Eds.), Handbook of aging and cognition (2nd ed., pp. 359-416). Mahwah, NJ: Erlbaum. Wingfield, A., & Tun, P. A. (1999). Working memory and spoken language comprehension: The case for age stability in conceptual short-term memory. In S. Kemper & R. Kliegl (EdsJ, Constraints on language: Aging, memory, and grammar (pp. 29-52). New York: Kluwer Academic. Wright, P. (1978). Feeding the information eaters: Suggestions for integrating pure and applied research on language comprehension. Information Science, 7, 249— 312.

3 Design Challenges Associated with Longevity: The View From Industry Craig Spiezle and Gary Moulton

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s we head into the 21st century, we are faced with the convergence of two worldwide revolutions: Increased longevity and a growing dependence on technology in almost every form imaginable, technology that is rapidly becoming an integral part of our society. This juxtaposition is posing interesting challenges for developers and designers of Web sites and computer programs. Meeting the needs of an aging population will require a paradigm shift in how programs, devices and Web sites are created. The product development cycle, business planning and content functionality will have to accommodate new considerations; the bottom line is business and designers will have to think differently. But why, really, is anyone concerned about "old people" using computers? What is the impact of this issue? What is currently being done about it? The answers to these questions form the basis for what can and should be done.

WHY BE CONCERNED ABOUT HOW OLDER ADULTS USE COMPUTERS AND INTERNET APPLIANCES? As part of the natural aging process, our ability to see, hear, and use the keyboard or mouse diminishes. If technology is not equipped to deal with these natural human changes, it is poorly designed, and further disenfranchises segments of society. That is because the technological revolution has outpaced advances in 47

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usability. Things are designed first, then revised to meet the needs of "consumers." At best, this process works for some consumers—those people whom sales and marketing organizations have targeted as customers. At worst, it excludes people who do not meet the targeted customer criteria. Norman, an ardent advocate for design modifications, describes the current situation as one of trade-offs (Norman, 1998). Trade-offs occur between what might be required (in some predetermined standard or guideline) and what is woven into the Web or product development philosophy. According to Norman, current state-of-the-art favors technology-centered and feature-driven designs. Consideration for users comes in further down the line. The traditional method of development is to follow a linear sequence, from specifications, through design, manufacture, sales and deliver, usage, and then repair, service, and assistance. Marketing provides the specifications, the engineers design to meet them, then pass the design on to the manufacturing experts. Somewhere along the way, the industrial designers and human-interface teams are asked to do their jobs, and when all is finished, the technical writers are called in to write a cohesive, intelligible set of instructions or user manual. Finally, the sales teams are asked to sell the finished package and the service and maintenance people are trained on its operation and on the kinds of programs that are expected." (Norman, 1998), p. 211) The fact of the matter is, the entire multitrillion-dollar technology and Internet industry was created and grown without anyone having to ask (or care about) what consumers thought (Anderson, 1999a). How the computer industry defines and measures "ease of use" reinforces this concern. For instance, the DVD (digital video disc) drive and the hard drive on different IDE (integrated drive electronics) channels are items on the ease-of-use list. Ease of use neither addresses whether people can use the program (or Web site) to access e-mail, create business plans and spreadsheets, or write the next great American novel. These oversights are compounded by the fact that the face of the consuming public has slowly been changing. Customers of technology are no longer the youthful, feature-oriented "first adopters" of all things bright and fast. Today, seniors are the segment of the computer-using population that spend the most time on the Web. Older adults are lining up for computer classes. They are buying computers in record numbers. Those over age 55 continue to show the largest increase in computer and Internet Applicance purchases since 1998 (Spiezle, 2000). If computers and Internet Appliances cannot meet the usability needs of an aging population,

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society cannot take advantage of the contributions of seniors to the workforce, to society, to our culture, or of the wisdom they can provide to the younger generation. seniors cannot take advantage of the benefits of on-line technology (e-mail, online banking, online purchases, etc.) Web-based businesses and organizations cannot sell or offer services to these consumers personal computer sales to this customer base will not be what they could be older adults cannot realize their potential to enhance their community, creativity, and employability The biggest impact, however, is yet to be felt. As the "baby boom" generation continues to advance in age, this country will have more seniors than ever before. (This demographic trend is discussed in detail in Gray Dawn by Peter G. Peterson [1999].) The ramifications of this trend are profound and far reaching and will herald changes in all aspects of marketing and communications (Dychtwald, 1999). As boomers age they will not be entering retirement, but a period of rebirth, renewal, and revitalization. Our society is changing, and the way we communicate with it must change as well. Products designed for and regarded as acceptable in a youthoriented culture are simply not going to meet the needs of our senior population. For instance, since its inception, the Web has been a medium constantly surpassing itself. Web sites have evolved dramatically as technology has improved and new features have become possible. Recently we have seen the introduction of audio, streaming media, and innovative new design concepts that have revolutionized the way we think about and interact with the Web. Compounded by exciting new high-speed, always-on Internet access, for some, the Internet has become a Web lifestyle. For many seniors, however, the Web is still a brand-new experience. They have not had the benefit of witnessing the evolution of site design and interactive media. They are more likely to be frustrated than impressed by the innovation of a site's design and may not have an "intuitive" sense of how to navigate through a site. Aside from being novice Web (and computer) users, seniors have physical needs that can be better met by improved program and Web design.

HOW ARE THE NEEDS OF OLDER ADULTS DIFFERENT? The most common problem we all face as we age is the natural deterioration of our eyesight. We all spend increasingly larger amounts of time in

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front of a computer screen, sometimes having to look through bifocal or trifocal corrective lenses, and it is little wonder that eyestrain and eye fatigue have become a reality for many. By age 65, most people have lost at least some of their ability to focus, resolve images, distinguish colors, and adapt to changes in light. In the United States alone more than 10 million Americans have significant vision impairments, and at least 3 million have partial sight loss. More than 60% of those considered visually impaired are older persons (Cloud, 1996). As part of the natural aging process, the need for contrast increases because of discoloration in the eye fluids and lens. Common impairments such as clouding of the lens or cataracts reduce the amount of light that passes through the eye. Yellowing of the eye lens causes images to appear as if they were being seen through a yellow veil. Another result of yellowing is that less violet light is registered by the eye, which makes it easier to see reds, oranges, and yellows than it is to see blues, greens, and violets (Cloud, 1996). Most people have a loss in color perception that accompanies their dimmed vision. As a result, two colors that look very different to an individual with normal color vision may be far less distinguishable to someone with partial sight. Color combinations such as brown on tan or green on gray could be indiscernible. We often experience other degenerative effects in addition to the impact on vision. Varying degrees of hearing loss are common, as is difficulty with small motor coordination, often because of arthritis or stiffening of the joints. Simply using a traditional mouse (or for some, even the keyboard) can often provide a formidable challenge.

WHAT IS CURRENTLY BEING DONE? Over the last few years, standards and guidelines have been developed that address the design challenges associated with aging. For instance, Agelight Institutes developed a white paper, "Effective Web Site Design and Usability for Users of All Ages," which contains comprehensive design guidelines for businesses and Web developers. It describes how to make Web sites more accessible and user friendly for young and old alike. The urgency associated with attending to the needs of seniors has not been lost totally on other companies and organizations. Government, nongovernmental organizations, nonprofit organizations, and private enterprises are all starting to work toward the goal of creating usable and accessible Web sites for people of all ages, including seniors. This is definitely a good first step. Concrete, specific things designers can do can achieve a great deal and should be adhered to now. For those who

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design Web sites and communicate through the Web, it is crucial that new technologies are balanced with solid design and usability principles. It is essential that Web designers do what can be done now to make their sites usable to all segments of the population. For instance, designers should avoid color combinations that are difficult to differentiate (such as brown on tan). Because many seniors are new to the Internet, designers should keep cleverness where it belongs: in the content. Web sites should be clear, logical, legible, and informative. Standards and guidelines are only the beginning, however. They raise awareness of the issue and meet head on the design challenges associated with aging. Because they prioritize improvements, they start the process of doing the most important things first. As a remedy, however, they go only so far. Too often they become part of a checklist, which in and of itself serves to curtail significant technological increases or creative problem solving. Designers and engineers are left in the position of thinking passively, "in the box": Just tell me what to do. To make the far-reaching changes that are necessary, something more needs to happen.

WHAT COULD BE DONE? Product engineers and designers need to think differently, more universally, about their customers. Instead of adding something after the fact from a checklist that someone else has created, technicians need to design it correctly from the start. In other words, technicians and designers need to be aware of what is needed to make products and Web sites usable by everyone. A recent edition of Technology and Disability showcased an argument for a design world that addresses the changes in who we are, what we can do, and where we live; a design world that is more accommodating to variances in mobility, vision, hearing, cognition, and manual dexterity (Sanford et al., 1998). The authors maintain that the sheer magnitude of the population shift (toward more seniors) necessitates greater design sense and expertise. They point to the science of "universal design." The philosophy of universal design grew out of frustration over lack of product availability (eventually fostering a market for "special" design solutions). As a science, universal design has found support among designers who see in the practice a mechanism to achieve a more pluralistic definition of good design, one that is predicated on its responsiveness to the needs of users. That is, a better designed product for person x is a better designed product for person y and a lot of other people.

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Following the dictates of universal design also results in a better definition of consumers. Consumers are defined as people of varying ages and abilities (including those who traditionally have been excluded during design research and product development). With universal design, designers would remember not to forget anyone. Additionally, Norman (1998) advocates a transition between technologydriven and consumer-driven product development. He would add social scientists to the product research and development teams. In his scenario, social scientists would address the senior segment (or at least would give voice to it) and, importantly, would be on equal footing with engineers and marketers. Product design would be a cooperative, interactive, and iterative process between engineers, marketers, and the social scientists (with the social scientists thinking more inclusively). Norman (1998) also emphasizes the importance of "designing" something into the product as opposed to "testing" it into the product. Norman is quick to acknowledge, however, that corporate America is not structured to do the job correctly. According to him, corporations are organized for vertical communication whereas products require horizontal communication at the level where the work is done. This necessitates building a product many times (Norman, 1998).

WHAT SHOULD BE DONE? Solving, once and for all, the real design challenge associated with aging (or the design challenge associated with whatever the needs are) is not about standards and guidelines to follow, nor is it about "practiced" universal design. Neither option will ever be good enough, singularly or in tandem. Notwithstanding the remarkable progress that could be made if either or both option were used, something would still be missing. What is really necessary to address the design challenges associated with aging is for engineers and designers to "get it." That is it. No standard or guideline to follow. No new design paradigm to model. Rather than being given the solution to a problem, "getting it" necessitates that the engineer or designer sees the solution to a problem that no one else even knows exists.

WHAT DOES "GETTING IT" ENTAIL? Basically, "getting it" means focusing on the unique needs of seniors by internalizing their concerns and needs. The engineer or designer needs to

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dvelop an ingrained understanding of how seniors think, see, hear, use the keyboard or mouse; understand what the information needs of seniors are; understand the world from their perspective; and understand that as individuals, the needs and concerns will vary person by person. Has this type of thinking happened before? Has it been successful? Is it a one-time brain shift or is it an on-going process? Yes, yes, and yes—it is a dynamic process. A good example of a designer "getting it" can be drawn from milk cartons. In the mid-1950s, two competing technologies were being used to seal milk cartons. Only one of the technologies survived: the one designed and developed by Excello/PurePak. Why did it win? Adults could open both. Children could open both. Children could only open one without spilling, however. One company tested its technology with children, the other likely did not. Even so, the traditional means for catching product design issues are usually things such as focus groups, expert meetings, consumer research, and feedback surveys. People who design these product feedback tools often are not aware that their research is skewed by their own lack of awareness about the breadth of their customer base or about the continuum of needs their customers have. No one is at fault. We do not know what we do not know until we experience it, or stumble upon it by accident, or are struck by a bolt of genius, or perhaps "we" are a company with milk carton-sealing technology that happens to have an experimental machinist with three young children who open milk cartons. "Getting it" is about capturing direct life experiences or having a unique personal understanding, or both. In more recent times, the shift in banking toward automated teller machines (ATMs) serves as an example. Since their inception, ATMs have gradually become more and more user friendly. We can make deposits, withdrawals, and check on our account status 24 hours a day, 7 days a week. We can control the technology that makes this possible from kiosks anywhere in the world, from a cell phone, or from a personal computer (PC). Automated tellers are designed for wheelchair access. Some have instructions in braille. They have over-sized buttons. The 5 key is sometimes nibbed. In some machines, users must remove their ATM cards before they get their money. This one line of code demonstrates that some engineer really understands human beings, or perhaps some designer insisted on the code after observing people using ATMs or after having left his or her own card at an ATM. Someone discovered that it is human nature to take the money and run. Someone "got it" about us.

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Could a design model address humans in a hurry? Certainly. Could some standards and guidelines be written? Yes. Is there technology right now that could be built into ATMs to yell at bank customers who leave their cards in the machine, by name? Yes. That is not the point. The design problem associated with abandoned ATM cards was solved by an engineer or designer who "got it." How something works requires an examination from the financial, physical, social, and spiritual perspectives. Humans are complex animals. It is very hard to solve problems for everyone. Standards, guidelines, and design models will not do. However, it is difficult to really "get it." For instance, remote control technology for televisions (TVs) is an example of designers and engineers not "getting it." State-of-the-art remote controls consist of two relatively new devices, Harman Kardon/Microsoft's Take Control and Marantz Mark II. The former is $349; the latter is $249. (Stop. A TV owner needs a product that costs almost as much as the set itself to turn channels? Wouldn't not hiring a grandson or granddaughter to turn the channels be less expensive?) Although one could argue that we need remote controls because no one can find the controls on a TV set any longer, do we solve that problem by requiring users to spend additional dollars? Is the real problem the fact that dials are not adequate or sufficient to navigate 500 channels of cable or satellite delight? Granted, a dial containing 500 channel locations would take up a far larger amount of real estate in a living room, family room, or bedroom. So, remote control is necessary. The fact of the matter is, they are not easy to use, either. Just how were these two new state-of-the-art remote controls designed? The designers reported that they looked at people's coffee tables and found them cluttered with hard-to-use remotes. As a result, they designed the new remote to simplify and replace the operations performed by up to five old remotes. Had they been looking at human beings using remotes rather than coffee-table clutter, what might they have built—something along the lines of the world's first cordless phone, which is also a universal remote; something that can be easily and quickly found? Snider (1999), in a recent USA Today article, looked at our current remote-control technology in general and discovered that the designers and engineers still do not "get it" (even after designing $249 and $349 TV remote control devices). Will TVs become easier to use? Yes. Will remote-control technology, status quo, accomplish the goal? Probably not by itself. We do not "get it" yet. Our desire to deliver newer, brighter, faster technology often clouds our ability to discover, in addition to the fact that trying to get engineers or designers really engaged in the social science of it can be difficult. It is much

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easier to draft some standards or guidelines or point to a design paradigm, but since the real answer lies with the difficulty, how can we do it better? PC ease of use can be used as a example of trying to "get it." There certainly are usability standards and guidelines to follow in the quest for ease of use. Ease of use could even be the defining signature of the product development process (e.g., we started by wanting to make something that was easy to use). To date, no one in the PC industry can lay a legitimate claim to "getting" ease of use. As a result we are seeing numerous innovative Internet Appliances (lAs) coming to market. Most agree that we have an opportunity to make PCs and lAs that are easier to use than they currently are. Industry leaders and consumers agree that this need is not being addressed. People complain that PCs are too hard to use, but no one does anything about it. This is changing with the competition of lAs. Although it is true that many people have a PC "use" complaint of some magnitude, it is not entirely true that no one is trying to solve the problem. PC software and hardware engineers know a design problem exists. There is a tremendous amount of effort going into fixing this problem. No doubt a solution to this design problem will be found, and the PC will be easier to use by everyone (including seniors)—some day. The design problem is not a problem that cannot be fixed. We are not on the fix it path yet, however. We do not understand all of the problem yet. Today the graphical user interface (GUI) is the de facto standard of the computing industry. Pioneered at Xerox PARC, the GUI was successfully commercialized by Apple with the Macintosh and extended further with the Microsoft Windows® operating systems. It has had cosmetic attention over the years, but the original metaphor (point and click) remains essentially unchanged. In spite of its huge success and relatively long history, however, the GUI is still neither universally accessible nor univeresally adopted. One, clear, concise, and compelling indication that PC use is still not understood. In addition, although the GUI has been made more accessible over the years to make it easier for people with disabilities to use, much of the accessibility has been a result of the efforts of adaptive hardware and software manufacturers. Their adaptive devices have made it possible for individuals with disabilities (no matter their age or what the disability or how severe) to have access to PC operating systems and programs. Even so, this accessibility has not been enough to increase the number of users. There are several reasons why. First, these products are add ons and, as a result, complicate the usability of the operating systems and programs for users. Second, compatibility is never assured between operating systems,

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programs, and adaptive hardware and software products. Third, these products do not "age" gracefully and are in need of periodic tune ups. Fourth, the added functionality they are trying to serve competes with the focus on core functions. These compatibility problems create havoc and nothing short of panic for users who continually have to wonder whether they will be able to use x?* However, because PC technology levels the playing field for individuals with disabilities and seniors with functional limitations as a result of the aging process, people will use whatever technology is available to overcome any and all barriers to the use of other technology—even though they should not have to. Although there has been a steady and healthy increase in the number of people using PC technology as a result of the GUI, the increase is more evolutionary than revolutionary. The learning curve is steep for new users for both operating systems and programs. Technology superiority cannot continue to win out over convenience, user experience, and value without hassle. Technology is not the solution to a problem with technology. When things do not work, it is an indication that we do not "get it." It has been said that a more valuable PC can be made by removing complexity, adding relevancy, connecting it to everything, and making it easy to operate. In other words, giving "people the power to do anything they want, anywhere they want, and on any device" (Remaking Microsoft, May 17 1999). (It needs to be mentioned that the Internet can contribute relevance, simplicity, and value.) Fantastic, futuristic scenarios have been written for a PC or IA that would turn on instantly. It would be preconfigured for connectivity or would be autoconflgurable via a phone call. The user could immediately begin browsing the Web, doing e-mail, or shopping. The PC would autoupdate. If it were a second PC, settings and data would be transferred from the old PC to the new. Via a Web connection, the system could self-diagnose, install fixes, or autoescalate problems to an engineer who could resolve them remotely. The user could share files, roam files and settings, and backup to Web storage. All programs and hardware a person owned would be compatible. Does it sound like something a manufacturer would want to be the first to market? Yes. What rings true here, however? The PC industry cannot even communicate what it is about in a way that makes sense outside a pretty well-prescribed inner circle. The problem is that the "right" people at this point in time do not really *This document does not address either Microsoft's efforts at crafting "electronic curb-cuts" or technology (e.g., MSAA, MSAM, SAMI) created to facilitate compatibility between the Windows® operating systems, Microsoft applications, and adaptive hardware and software. Both of these are addressed in detail elsewhere (e.g., microsoft.com/enable).

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understand how to make anything easier to use. They do not know, what it is that they do not know, and they may not have a clue how to solve the problem. Why? The design logic currently is that PCs will be easier to use when we can develop more natural interfaces such as speech, language, handwriting, gesture, and face recognition. In other words, in the future, when we have more technology or technology has evolved a little more, or a lot more, we'll be able to solve the problem. Is that going to work? Productwise, there are really only two types of problems to solve: it is either a marketing problem or a product problem. A marketing problem can be expanded to include where and to whom the welcome mat is tossed. It is about incremental business revenue. The sound of a cash register can motivate a corporation to do a lot of things. However, you cannot open the door to someone who was not invited to the party in the first place. Product problems, on the other hand, result from the lack of experts who obtain all the necessary information, analyze it correctly, and integrate it. These experts champion usability over technology. In addition, maybe we should not want to satisfy a generic user as much as we should want to delight a single specific person in the target market. Cooper (1998) advocates a design process in which the product is planned out in minute detail before an inch of code is written. Consider a product for a 65—year-old with a touch of arthritis and no experience or interest in computers, who wishes a new career? No doubt some time in the future there will be a knowledge base (think computer animation and simulation and Hollywood wizardry) that will allow testing of a product under development by every segment of a population, along with testing of an unlimited range of functional abilities and limitations. For the here and now, however, what can be done to help us "get it"? It is not an easy thing to sell to engineers and designers. It is not something that is easy to get a hold of. It is more like a story than anything with which they are typically familiar. It necessitates a different level of involvement. It is not reading or following. It is more creative and personal. The bottom line to "getting it" is doing something about it not because you have to (standards and guidelines) or could (technology is capable) but rather because it makes sense at a fundamental level. You act not because it gains market share but because you have clarity and vision about how something is going to work for everyone. What exactly would it mean to "get it" with respect to aging? What are the questions we are not asking? What are the perspectives we are seeing? Where is the magic or the accident that will get us to really address the

58

Overview

design challenge associated with aging? To answer these questions necessitates taking a different approach. Rather than taking the generic industry perspective (e.g., advances, discoveries, patents, inventions, competition) we need to take the customer perspective, and we are. The industry is starting to listen to users and, for the first time in more than a decade, giving them what they want and need. It is a radical departure. It is now a question of how far this perspective will take us. It may certainly lead business to "getting it." Perhaps what is needed to ensure that engineers and designers really "get" the design challenges associated with aging is to create a puzzle for them to solve—a Gordian knot. Something such as the following: 1. 2. 3. 4. 5. 6. 7. 8.

Be 100% customizable Be modular Provide one-finger/single switch access from a telephone keypad Be multi-lingual Support multiple activation Provide multi-sensory feedback Require no ability to read or write Be self-instructing

The preceding may read too much like standards or guidelines, or both. "Getting it" may still feel like universal design think. In the end, how do you really know you have accomplished anything or that the problem has been solved? It is likely that design challenges will always exist; as old ones are met, new ones will arise, ensuring that we make better and better products. It is likely, too, that we will continue to challenge ourselves to do better. Is the essence of "getting it" the feeling of knowing one can do better? That may very well be enough. Recently Anderson (1999) wrote about what might very well be the heart and soul of "getting it." But when all this is said, we are still left with the users' side: how do we protect our own human value as this revolution unfolds? The best answer is: insist on it. Let's consider insisting on instilling more human value in products. Software should be designed so that it is—and is perceived to be—something helpful to people. So what are we to do as individuals with a vested interest in seeing the design challenges addressed (if not solved)? Intuitively and instinctively we

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know what can be done. We need to point to these things often. Our work toward what can be and could be done must be relentless. Consider it all. Today. Given the technology attention focused on the Internet in general, engineering attention to the design challenge associated with aging could not be timelier. In view of the current and anticipated surge in the number of older adults who want to embrace internet technology, it only makes sense to attend to their needs today. It only makes sense to "get it."

REFERENCES Anderson, M. R. (1999a, April). Strategic News Service. Anderson, M. R. (1999b, April 13). Strategic News Service. Anderson, M. R. (1999c, June 8). Strategic News Service. Cloud, D. (1996). The medium and the message: Communicating with older adults. Paper presented at the annual meeting of the American Association of Homes and Services for the Aging, Washington, DC. Cooper, A. (1999). The inmates are running the asylum: Why high tech products drive us crazy and how to restore the sanity. New York: Macmillan. Dychtwald, K. (1999). Age power. New York: Torcher/Putnam. Norman, D. A. (1998). The invisible computer. Cambridge: MIT Press. Peterson, PC. (1999). Gray dawn. New York: Times Books. Remaking Microsoft. (1998, May 17). Business Week, p. 106. Sanford, J. A., et al. (1998). Consumer participation to inform universal design. Technology and Disability, 9, 149—162. Snider, M. (1999, April 7). Tech extra: Remote possibilities. USA Today, p. 4D. Spiezle, C. (2000). Effective Web site design and usability for users of all ages. Clyde Hill, WA: AgeLight.

4

The Internet and Older Adults: Design Challenges and Opportunities Sara J. Czaja and Chin Chin Lee

INTRODUCTION The recent growth of the Internet and the expanding power of computers have made it possible for large numbers of people to have direct access to an increasingly wide array of information sources and services. Network usage is exploding, and new interfaces, search engines, and features are becoming available at an unprecedented rate. Furthermore, technical advances such as high speed transmission of information and affordable computer systems and modems have made Internet access possible to a large number of people. The Internet was created in the 1960s as a government-sponsored computer network for the defense industry. It became popular when education and research and development institutions used it as a means of disseminating and sharing information. Now, commercial access providers such as America Online, Netscape, Microsoft Internet Explorer, and phone companies that provide Internet connections are serving as gateways for home users and small businesses. Originally designed to transmit text and numeric data, the Internet now carries different types of information (e.g., travel, health, business, politics, financial) through graphic, video, and audio representations. Since the creation of the Internet, the population of users has increased, and it will continue to increase. The number of Internet users in the United States alone has reached 79 million, and the number of users worldwide is about 500 million (Quaterman, 1997). Today's computer users, unlike those in the past, include a wide variety of people, many of whom are not technically trained and not 60

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interested in technology per se. Rather, most of today's users consider technology a tool to be used as a means of accomplishing a task. People commonly use computers to search for information and for financial management, shopping and communications. In 1997, approximately, 40% of American households owned a personal computer (PC) and about one half of these households accessed the Internet on a regular basis. The most common reasons adults used the Internet at home include use of e-mail and finding information related to health, education, business, or the government (U.S. Department of Commerce, 1997). In essence, technology has allowed much more information to be available to the average person. Although access to information is generally desirable, the greater availability of information may also result in some unanticipated problems. Using information sources such as the Internet is a nontrivial task, and users may be overcome by the myriad choices and the amount of available information. Users now face difficult problems associated with search, choice, and information integration. As discussed by Marchionini (1995), the general consequences of living in an information society include larger volumes of information, new forms and aggregations of information, and new tools for working with information. We must also learn to manage large amounts and more varied forms of information and to process information more rapidly. Although the topic of information search and navigation has received attention within the human-computer interaction literature, the available data on this topic are limited for older people. The topic of the Internet and older adults is important and needs attention within the research and design communities given the aging of the population and the increased reliance on network technologies such as the Internet for information dissemination and communication. This issue is going to become increasingly important in the future as television, telephone, and other communication media become integrated with computer network resources. More and more functions are likely to depend on computer technology. In this regard, the National Research Council (1997) recently issued a report that stressed the importance of making the Nation's Information Infrastructure (Nil) accessible to as many people as possible, including people of all ages and varying abilities. The report also points out that although the usability of systems has improved substantially, current interfaces still exclude many people, such as those who are older or people with disabilities, from effective Nil access. Given that information technologies are becoming increasingly integral to education, work, and daily living, not being able to successfully interact with these technologies will have increasing negative ramifications for individuals. This implies that people must learn new methods of infor-

62

Overview

mation seeking and to use new systems such as computers. In this regard, researchers (Nickerson & Landauer, 1997) suggest that making information networks easier to use and providing quality information to people as opposed to sheer quantity may be the single greatest challenge facing the discipline of human-computer interaction in the near future.

OLDER ADULTS AND THE INTERNET Although the number of people over the age of 55 who use the Internet is increasing, Internet usage among this age group is low compared with other age groups. Currently, about 30% of people age 55-75 years own a personal computer, an increase of 21% since 1994 (Teel, 1999). Seventeen percent of people over age 50 are Internet users, and although the number of users in this age group is increasing at the same rate as the overall Internet population, Internet users over age 50 are still less than one half of users 16-40 years. There are a number of ways that Internet may be beneficial to older people. For example, the Internet can facilitate linkages between older adults and health care providers and communication with family members and friends, especially those who are long distant. It is quite common within the United States for family members to be dispersed among different geographic regions. In fact, nearly 7 million Americans are long-distance caregivers for older relatives (Family Caregiver Alliance, 1997). Clearly, network linkages can make it easier for family members to communicate, especially those who live in different time zones. The Internet may also be used to help older people communicate with health care providers or other older people. This ability will be more enhanced with future developments in technology such as video conferencing. For example, telemedicine applications may allow direct communication between health care providers and patients. Several studies (e.g., Czaja, Guerrier, Nair, & Laudauer, 1993; Furlong, 1989) have shown that older adults are receptive to using e-mail as a form of communication and that e-mail is effective in increasing social interactions among the elderly. Galliene, Moore, and Brennan (1993) found that access to a computer network "ComputerLink," increased the amount of psychological support provided by nurses to a group of homebound caregivers of Alzheimer's patients. ComputerLink also enabled the caregivers to access a caregiver support network that allowed them to share experiences and fostered the development of new friendships. The Internet can also be used by older people to access information about health care, community services and resources, and continuing education opportunities. Finally, the

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Internet may also be used to facilitate the performance of routine tasks such as financial management or shopping. Access to these resources and services may be particularly beneficial for older people who have mobility restrictions or lack of transportation. According to study conducted by SeniorNet and Charles Schwab & Co. (1998), the top Internet activities performed by older adults are (1) exchanging e-mail with family and friends (72%), (2) researching a particular issue or subject (59%), (3) accessing news or current events (53%), (4) researching vacation or travel destination (47%), and (5) accessing local or regional weather information (43%). The study also indicates that the Web sites visited regularly among older adults are search engine web sites (55%), news or current event-related sites (52%), hobbyspecific sites (41%), health-related sites (39%), and investment sites (38%). Software companies such as Microsoft are beginning to target older consumers. Microsoft recently (1999) published guidelines for effective Web design for seniors. Although these guidelines are a good start, many of them are highly general and difficult to translate into parameters for interface design. Web pages such as http://www.thirdage.com, http://www.aarp.com, and http://www.elderweb.com are also being developed for seniors. Clearly, older adults find information technologies such as the Internet valuable and are receptive to using this type of technology. However, available data (e.g., Czaja & Sharit, 1998; Mead, Spaulding, Sit, Meyer, & Walker, 1997) also indicate that although older people are generally willing and able to use technology such as computers, they typically have more problems than younger adults have. This chapter will discuss issues surrounding Internet use and older adults. The intent is to highlight the potential implications of age-related changes in functional abilities for interface and training design. Before the full benefits of these types of technology can be realized for older people, it is important to understand how to maximize the usefulness and usability of these technologies for this population. It is hoped that this chapter will motivate researchers and system designers to consider older adults as an active and important component of the Nil community.

USING THE INTERNET Overview As discussed, the Internet refers to a vast interconnected system of networks that span the globe. The term Internet is not synonymous with the World Wide Web (WWW). The Internet is the physical medium used to transport

64

Overview

information, whereas the WWW is a collection of protocols used to access the information. Current Web application include communication, information databases, online shopping, online banking, and online travel sevices. Basically, documents on the Web (web pages) reside on a server and are accessed by programs such as Web Browsers. In turn, Web Browsers are either text-based or graphical, which has implications for the users' interaction. In text-based browsers, users interact with a keyboard to select information, whereas in graphic-based browsers information selection is accomplished via a pointing device such as a mouse. Most graphic-based browsers have multimedia capabilities and can include graphics, sound, and video (see Vora & Helander, 1997 for a more complete discussion of these issues). Currently, the Web contains more than 300 million pages of information. One critical issue confronting users of the Internet or WWW is finding desired information without spending large amounts of time. A recent survey of Internet users (Georgia Tech Graphic, Visualization and Usability Center, 1996) found the most common user problems included slow response speed, finding information, and difficulty finding Web pages already visited. Currently, with the explosive growth of the WWW, there are no guidelines that are systematically applied to the design of most Web interfaces. In this regard, Vora and Helander (1997) outlined several usability problem with current Web interfaces, including outdated and incomplete information content, poor use of graphics, slow response time, overcrowding of screen information, and poor navigation support. Although indexes and search engines are helpful with respect to Web navigation, finding information on the Web is often difficult and cumbersome. These problems are likely to become exacerbated with the continued expansion of information on the Web and the increased number of Internet users. Without effective tools to help people deal with the information glut, the new information technologies such as the Internet could hinder rather than help people access information. Electronic Information Seeking Essentially, use of the Internet involves information seeking, a fundamental process people engage in to acquire knowledge or solve problems. It general represents a higher level cognitive activity and as such involves memory, reasoning, attention, learning, and problem solving. Generally, people develop strategies and skills for information seeking according to their abilities, experiences, and available physical resources such as information systems. In this regard, information seeking involves the interaction among six factors:

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the information seeker, task, search system, domain, setting, and search outcomes. The process is both opportunistic and systematic and involves a number of interdependent subprocess or phases: Defining and understanding the problem. Understanding of the problem depends on the knowledge of the task domain and may also be influenced by the setting (e.g., how can I purchase airline stocks?). Choosing a search system. The selection of a search system depends on factors such as the user's previous experience with the task domain, the scope of the existing information structure, and expectations about the answer that may have been formed while defining the problem (e.g., there are web pages for different financial institutions). Formulation of a query. Query formulation involves matching the task and the information system selected. In most cases, the initial query identifies an entry point to the search system and is followed by browsing or query reformulations, or both (e.g., search "financial planning institutions"). Execution of a search. Execution of the physical actions to query an information source is driven by the user's mental model of the search system. Examination of results. The execution of a query leads to a query result that needs to be examined by the user in order to validate the relevance of the results 'with respect to the information seeking task (e.g., results "FDIC non insure," "Merrill Lynch"). Extraction of information. Assessments about relevance initiate information extraction actions. When information is extracted, it is manipulated and integrated into the user's knowledge of the domain. Reflect/iterate/stop. An information search is seldom complete with only a single query and retrieval (e.g., investigate what type of stocks can Merrill Lynch provide, how about airline stocks?). Deciding when and how to stop requires an assessment of the information seeking process. Monitoring the progress of information seeking is crucial to the development of information seeking strategies (Marchionini, 1995). Generally, through practice and experience people develop strategies to guide the information seeking process. This includes strategies for choosing information sources and searching these sources. As discussed by Marchio-

66

Overview

nini (1995), information technologies such as the Internet have a dramatic impact on the information seeking process. For example, instead of using the library and accessing information in hard copy, we now use online databases and access information in electronic form. These technologies require the information seeker to develop specialized knowledge and skills. Specifically, this includes domain expertise, system expertise, and information seeking expertise. Domain expertise involves knowledge and skills related to the problem domain and allows the persons to solve problems or access information quickly and effectively. Generally, experts in a domain have extensive knowledge of the domain and have an organized knowledge base of the general problem area. System expertise refers to knowledge and skills related to the search system and the physical interface to this system. In the case of the Internet, this includes abilities to use a keyboard and mouse and manage menus, windows, and screen information. It also refers to having an understanding of how databases are organized, what information is available, and how documents are structured. Information seeking expertise refers to knowledge and skills related to the process of information seeking. This includes, for example, knowledge of relevant information sources and how these sources are organized. It also includes knowing where to look for information and how to request information. Information seeking is a highly variable process, and individuals develop distinct patterns for searching that involve a variety of strategies and tactics. These strategies vary according to the task, context, and setting. Generally, two broad types of strategies can be distinguished: analytic and browsing. Analytic strategies are goal driven and require planning methods that are precise and systematic. They tend to be methodical and deterministic. Browsing strategies are more data driven and more opportunistic and informal and interactive. People tend to use a combination of analytic and browsing strategies when searching the WWW. However, novice users or people with limited domain or system expertise tend to adopt browsing as opposed to analytic strategies (Marchionini, 1995). Whereas browsing is often the basis for serendipitous discoveries and incidental learning, it can also result in distraction, confusion, frustration, and cognitive overload and general problems associated with being "lost in hyperspace" (Nielsen, 1990). These types of problems may be exacerbated with the recent proliferation of Web sites and the lack of consistency among Web designers. Many users may not have the opportunity to develop the expertise needed to efficiently use current search systems. Essentially, use of the Internet requires learning a new set of skills to locate, access, manipulate, and use information sources. Given that aging is associated with changes in cognitive abilities and that older adults typically have some

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difficulty acquiring new skills, learning to use the Internet for communication and information seeking may be challenging for older adults. The next section will summarize the existing literature on aging and acquisition of computer skills. This will be followed by a discussion of what is known about the ability of older adults to search for information within electronic environments.

OLDER ADULTS AND THE ACQUISITION OF COMPUTER SKILLS As shown in Table 4.1, a number of studies have examined the ability of older adults to learn to use computer technology. These studies span a variety of computer applications and also vary with respect to training strategies such as conceptual versus procedural training (Morrell, Park, Mayhorn, & Echt, 1995) or computer-based or instructor-based versus manual-based training (Czaja, Hammond, Blascovich, & Swede, 1989). In addition, the influence of variables, such as attitude toward computers and computer anxiety, on learning have been examined. Overall, the results of these studies indicate that older adults are, in fact, able to use computers for a variety of tasks. However, older adults often have more difficulty acquiring computer skills than younger people do and require more training and more help during training (Hartley, Hartley, & Johnson, 1984). Also, when compared with younger adults on performance measures such as speed, they often achieve lower levels of performance. For example, Egan and Gomez (1985) conducted a series of experiments in an attempt to identify individual difference variables that predict ability to learn text editing. They found that age and spatial memory were significant predictors of learning difficulty. Both of these variables contributed to the prediction of first-try errors and execution time per successful edit change. In particular, age was associated with difficulty producing the correct sequence of symbols and patterns to accomplish the desired editing change. Elias, Elias, Robbins, and Gage (1987) conducted a study to examine age differences in the acquisition of text editing skills and to identify sources of difficulty encountered by older adults. The training program included an audiotape and a training manual. The results indicated that all participants were able to learn the fundamentals of word processing; however, the older adults required more time to complete the training program and required more help. The older people also performed more poorly on a review examination. Garfein, Schaie, and Willis (1988) examined the ability of older adults to learn a spreadsheet package. They also attempted to identify com-

68

Overview Table 4.1

Computer Training and Older Adults

Study

Age range

Application

Findings

Caplan & Schooler (1990)

18-60

Drawing software

Charness, Schumann, & Boritz (1992)

25-81

Word processing

Czaja, Hammond, Blascovich, & Swede (1989) Czaja, Hammond, & Joyce (1989)

25-70

Word processing

25-70

Word processing

Egan & Gomez (1985)

28-62

Word processing

Elias, Elias, Robbins, & Gage (1987)

18-67

Word processing

Garfein, Schaie, & Willis (1988) Gist, Rosen, & Schwoerer (1988)

49-67

Spreadsheet

Conceptual model detrimental for older adults; older adults had lower performance Older adults took longer to complete training and required more help Older adults took longer to complete task problems and made more errors Older adults took longer to complete task problems and made more errors; goal-oriented training improved performance Age and spatial memory were significant predictors of performance Older adults had longer learning times and required more help No age differences

Mean = 40 Spreadsheet

Older adults performed more poorly on a post training test; modeling improved performance 18-75 Line editor No age differences in Hartley, Hartley, & performance efficiency; Johnson (1984) older adults took longer to complete training and required more help Young-old Electronic bulletin Procedural training superior Morrell, Park, Mayhorn, to conceptual; age effects (X = 68.6) board & Echt (1995) Old-old (X = 79.9) Advanced organizer not Calendar and Zandri & Charness (1989) 20-84 beneficial; age effects for notepad training time and needed more help

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ponent abilities that are predictive for a computer novice to acquire computer skills. The results of their study indicated that all participants were able to operate a computer and use the spreadsheet package after only two 90-minute sessions of training. There were no significant age effects for the performance measures. However, this may be because the age range of the participant was restricted and only included people ranging in age from 49 to 67 years. In terms of other factors affecting computer proficiency, they found that fluid intelligence was an important predictor of performance. Gist, Rosen, and Schwoerer (1988) also examined the influence of age and training method on the acquisition of a spreadsheet program. The training program consisted of two approaches: tutorial or behavioral modeling. The tutorial approach involved a computer-based step-by-step interactive instructional package. The behavioral modeling involved watching a videotape of a middle-aged man demonstrating the use of the software and then practicing the procedure. The results indicated that the modeling approach was superior to the tutorial approach for both younger and older participants. They also found that older adults performed more poorly on a posttraining test. Zandri and Charness (1989) investigated the influence of training method on the ability of older people to use a calendar and notepad system. Specifically, they examined whether providing an advanced organizer would have an impact on the acquisition of computer skills for younger and older adults. They also examined whether learning with a partner would have an influence on learning. The results indicated an age by training method (learning alone or with a peer) by organizer (with or without an organizer) interaction for performance on the final test. For the older adults who received training without a partner, the advanced organizer resulted in better performance. For the other group of older people, there was no performance effect. For the younger subjects, having the advanced organizer resulted in worse performance if they learned alone but it made no difference if they learned in partners. These results suggest that the provision of an advanced organizer may be differentially effective for older people under some learning conditions. Furthermore, the older people were about 2.5 times slower than the younger people were in the training sessions, and they required about 3 times as much as help. In a follow-up study, Charness, Schumann, and Boritz (1992) examined the impact of training techniques and computer anxiety on the acquisition of word processing skills in a sample of younger and older adults. In the first study, 16 computer novices ranging in age from 25-81 years learned word processing skills under a self-paced training program. Half of the participants received the organizer prior to training. Overall, the provision

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Overview

of organizer did not improve performance. The results also indicated that older adults took about 1.2 times longer than younger adults did to complete training, and they required more help. In a second study, the investigator attempted to control the nature of the training session. Thirty computer novices were assigned to either a self-paced learning condition in which they were actively involved in the tutorial or a fixed-paced condition in which they passively observed a predetermined sequence of activities. The results indicated that both the younger and the older adults performed better in the self-paced training condition relative to fixed-paced condition. Again the older adults took about 1.2 times more time than did the younger adults to complete training and required more help. Czaja, Hammond, Blascovich, and Swede (1989) evaluated three training strategies for novice adults in leaning to use a word processing program. The training strategies were instructor based, manual based, and online. The results indicated that younger adults were more successful learning the word processing program. The older adults were slower and made more errors. The results also indicated that the manual-based and instructorbased training were superior to online training for all participants. The investigators also found that there were age differences in performance on the post-training tasks. The older adults took more time to complete the tasks and made more errors. In a more recent study, Czaja, Hammond, and Joyce (1989) attempted to identify a training strategy that would minimize age differences in learning text editing. Two training programs were evaluated: a goal-oriented program and a traditional approach that included a manual and lecture. The goal-oriented approach introduced the elements of text editing in an incremental fashion, moving from the more simple to the more complex task. The training sessions included problem-solving tasks with objectives of discovering and achieving methods for completing the tasks. The manual was written as a series of goal-oriented units. It used simple language, similarities were drawn between computer and familiar concepts, and the amount of necessary reading was minimized. The results indicated that post-training performance was better for participants who were trained using the goal-oriented approach. These participants took less time to complete the tasks and made fewer mistakes. In spite of training manipulation, the performance still was lower for older adults than it was for younger adults. Older adults required more time to complete tasks, completed fewer editing changes, and made more mistakes. Caplan and Schooler (1990) evaluated whether providing the participants with a conceptual model of the software would improve their ability to learn a painting software program. They provided half of the participants

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with an analogical model of a painting software program before training. The results indicated that the model was beneficial for younger adults but detrimental for older adults. Similar results were found in the Morrell et al. (1995) study. They examined the ability of young-old (ages 60-74 years) and old-old (ages 75-89) adults to perform tasks on ELDERCOMM, a bulletin board system. The participants were presented with procedural instructional materials or a combination of conceptual information and procedural instructions. The results indicated that all participants performed better with the procedural instruction material. They also found that the young-old adults had better performance than had the old-old adults; the old-old adults made more performance errors. The investigator concluded that conceptual training may not be beneficial for older adults because they need to translate the model into actions that may increase working memory demands. More recently, Rogers, Fisk, Mead, Walker, and Cabrera (1996) assessed the efficacy of several instructional methods in teaching older adults to use automatic teller machines (ATMs). The results indicated that training method did have an influence on performance such that an online tutorial was superior that provided specific practice on the task components and was superior to written instructions and written instructions accompanied by graphics. The authors discuss the importance of providing older adults with actual training on technologies such as ATM. Sole reliance on instructional materials or self-discovery may not be optimal for this population, especially for more complex technological applications such as the Internet. Identification of training strategies that are efficacious for older adults is especially important given that continual developments in technology that will require developments in technology will require life-long learning for people of all ages. In this regard, Mead and Fisk (1998) examined the impact of the type of information presented during training on the initial and retention performance of younger and older adults learning to use ATM technology. Specifically, they compared two types of training: concept and action. The concept training presented factual information, whereas the action training was procedural in nature. The action training was found to be superior for older adults. They showed superior speed and accuracy immediately after training and superior speed following the retention interval. They concluded that presenting procedural information to older adults was more important than presenting conceptual information. Mead et al. (1997) examined the effects of type of training on efficiency in a WWW search activity. The participants were trained with a "hands-on" Web navigation tutorial or a verbal description of available navigation tools. The hands-on training was found to be especially superior, for older adults. Older adults

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Overview

who received hands-on training increased the use of efficient navigation tools. These findings suggest that type of training strategy does have an impact on the ability of older people to use complex computer technologies. Generally, the data suggest that procedural hands-on training with an action component is superior for older adults. However, more research is needed to identify training strategies that facilitate the ability of older people to acquire computer-based skills. Generally, the literature indicates that older adults are able to use computers for routine tasks and that they are able to learn a wide variety of computer applications. However, they are typically slower to acquire computer skills than are younger adults and generally require more help and hands-on practice. Furthermore, they typically need training in basic computer concepts, such as mouse and windows management, in addition to training on the application area of interest. They may also require information on the types of technologies that are available, the potential benefits associated with using these technologies, and where and how to access these technologies. Finally, greater attention needs to be given to the design of training and instructional materials to accommodate age-related changes in perceptual and cognitive abilities.

OLDER ADULTS AND ELECTRONIC INFORMATION SEEKING As discussed, information seeking is a complex process and places demands on cognitive abilities such as working memory, spatial memory, reasoning, and problem solving. Information seeking within the electronic environment also requires special skills such as knowledge related to the search system. Given that older adults typically experience declines in cognitive abilities such as working memory and are less likely than are younger people to have knowledge of the structure and organization of search systems, a relevant question is the degree to which they will experience difficulty searching for information in electronic environments. Although the topic of electronic information search and retrieval has received considerable attention within the human-computer interaction literature as shown in Table 4.2, the available data on this topic for older people is limited. Westerman, Davies, Glendon, Stammers, and Matthews (1995) examined the relationship between spatial ability, spatial memory, vocabulary skills, and age and the ability to retrieve information from a computer database that varied according to how the database was structured (e.g., hierarchical versus linear). In general, they found that the older subjects

The Internet and Older Adults Table 4.2

Electronic Information Seeking and Older Adults

Investigators

Age range

Westerman, Davies, Glendon, Stammers, & Matthews (1995)

18-27 yrs. Information 45-57 yrs. retrieval/menu search

Mead, Sit, Jamieson, Rousseau, & Rogers (1996)

18-33 yrs. Online library 63-76 yrs. catalog search

Mead, Spaulding, Sit, Meyer, & Walker (1997) Freudenthal (1997)

19-36 yrs. WWW search 64-81 yrs. activity

Czaja & Sharit (1999)

73

Task

18-25 yrs. Information search 60-70 yrs. in a hierarchical menu 20-75 yrs. Information search and retrieval — health insurance database

Findings Older adults performed more slowly especially in initial blocks; no differences in navigation efficacy Older adults less successful than younger adults; more query errors and less-efficient recovery Older adults less "search success"; less search efficiency Older adults were slower and less accurate than younger adults Older adults completed fewer inquiries; no differences in navigational efficiency

were slower in retrieving the information than the younger adults were; however, there were no age-related differences in accuracy. The learning rates also differed for the two groups such that the older people were slower than the younger people were. They found that the slower response on the part of the older adults was more dependent on general processing speed than they were on other cognitive abilities. Freudenthal (1997) examined the degree to which latencies on an information retrieval task were predicted by movement speed and other cognitive variables in a group of younger and older adults. The participants were required to search for answers to questions in a hierarchical menu structure. Results indicated that the older subjects were slower than the younger subjects were on overall latencies for information retrieval and that this slowing increased with each consecutive step in the menu. Similar to Westerman et al. (1995), he found that movement speed was a significant predictor of overall latency. He also found that other cognitive abilities such as reasoning speed, spatial ability, and memory were predictive of response latencies. However, memory and spatial abilities are only predictors for latency on steps further into the menu structure. Freudenthal (1997) suggests that deep menu structures may not be appropriate for older adults because navigation through these types of structures depends on spatial skills that

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tend to decline with age. Vicente, Hayes, and Williges (1987) also found that age, spatial ability, and vocabulary were highly predictive of variance in search latency for a computer-based information retrieval task. They postulated that people with low spatial ability tend to "get lost" in the database. Other investigators such as Gomez, Egan, Wheeler, Sharma, and Gruchacz (1983), Sein and Bostrom (1989), and Czaja and Sharit (1998) have also found spatial ability to be a predictive of ability to perform computerinteractive tasks. Mead, Sit, Jamieson, Rousseau, and Rogers (1996) examined the ability of younger and older adults to use an online library database. Overall, the younger adults achieved more success than did the older adults in performing the searches. They also used more efficient search strategies. The older adults made more errors when formulating search queries and had more difficulty recovering from these errors. A study conducted by Czaja and Sharit (1999) examined age differences in the performance of a database inquiry task. The task was a simulation of customer service representative tasks in the health insurance industry. The participants were required to search through computerized data files to answer "customer" queries regarding their health insurance coverage. The results indicated that the older adults completed fewer queries and were less effective in documenting their responses. However, when controlling for differences in response speed, there were no age differences in navigational efficiency. In addition to age, cognitive abilities such as working memory and spatial skills and prior computer experience influenced performance. The data showed that prior experience with a computer was an important predictor of performance, as were cognitive abilities, such as working memory and processing speed. As expected the older participants had less prior experience than the younger participants had. Czaja and Sharit (1999) suggest that providing older adults with basic training in the use of computers is as important as providing them with training on the particular application. The results also showed that for all participants performance improved with task experience. This finding reinforces the importance of providing people with adequate training and practice. In their study of the WWW, Mead et al. (1997) found that older adults were less successful than the younger adults were in searching the Web for specific information, and they used less efficient search strategies. The older people tended to have difficulty remembering previously followed links and the information on previously searched pages. The data suggest that history markers may be particularly beneficial for older people. Generally, the available literature suggests that older adults are able to search and retrieve information within "electronic environments." However,

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they appear to have more difficulty than do younger adults and tend to use less efficient navigation strategies. The also appear to have problems remembering where and what they searched. In order to maximize the ability of older people to successfully interact with electronic information systems such as the WWW and have access to the "information highway," we need to have an understanding of the source of age-related difficulties. This type of information will allow us to develop interface design and training strategies to accommodate individual differences in performance. Currently, there is very little information on problems experienced by older people when attempting to learn and navigate the Web, especially in real world contexts. This is a fertile area for research.

CONCLUSIONS The "explosion" of the WWW has drastically increased opportunities for gaining access to a wide variety of information. For many people, such as those who are frail or isolated or have some type of mobility restrictions, such as a significant number of older persons, access to the Web holds the promise of enhancing independence by providing linkages to goods and resources, facilitating communication, and enhancing the ability to perform routine tasks such as banking and shopping. The Web can also help older people access information on health and other topics and manage personal finances. As developments in Web technology continue to emerge, users will have faster access to more channels of information in myriad formats. Unfortunately, because of the rapid and expansive growth in Web technology, there have been limited opportunities to develop and test Web interfaces as compared with other human—computer interaction domains. This problem is exacerbated by the fact that many Web developers have limited knowledge with respect to interface concerns (Ratner, Grose, & Forsythe, 1996). In fact, the report by the National Research Council (1997) indicated that current interface structures significantly limit the use of the Web by many users, especially those who have some type of constraint on their abilities, such as older users. To date, there is limited empirical research examining usability issues for the Web, especially for users who are less technically proficient, have physical or cognitive limitations, or are older. To help ensure that the WWW is available to the entire population, research is needed to support effective interface and training for users of all ages and abilities. Currently, although most older people are receptive to using new technologies, they often encounter difficulties when attempting to adopt these

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systems. Barriers to successful adaptation of technology are largely related to a failure on the part of system designers to perceive older adults as "active" users of technical systems. Overcoming these barriers depends on training and design solutions that accommodate age-related declines in perceptual, cognitive, and motor abilities. This might involve, for example, software modifications, alternative input devices, or redesign of instructional manuals. The development of these solutions requires an understanding of the needs, preference, and abilities of older people. In essence, in order to design interfaces for information systems so that they are useful and usable for older people it is important to understand (a) why technology is difficult to use, when it is; (b) how to design technology for easier and effective use; and (c) how to effectively teach people to use and take advantage of technologies that are available.

REFERENCES Caplan, L. J., & Schooler, C. (1990). The effects of analogical training models and age on problem-solving in a new domain. Experimental Aging Research, 16, 151-154. Charness, N., Schumann, C. E., & Boritz, G. A. (1992). Training older adults in word processing: Effects of age, training technique and computer anxiety. International Journal of Aging and Technology, 5, 79—106. Czaja, S. J., Guerrier, J., Nair, S., & Laudauer, T. (1993). Computer communication as an aid to independence for older adults. Behavior and Information Technology, 2, 97-107. Czaja, S. J., Hammond, K., Blascovich, J., & Swede, H. (1989). Age-related differences in learning to use a text-editing system. Behavior and Information Technology, 8, 309-319. Czaja, S. J., Hammond, K., & Joyce, J. B. (1989). Word processing training for older adults (Final report submitted to the National Institute on Aging). (Grant # 5 R4 AGO4647-03). Czaja, S. J., & Sharit, J. (1998). Ability-performance relationships as a function of age and task experience for a data entry task. Journal of Experimental Psychology: Applied, 4, 332-351. Czaja, S. J. & Sharit, J. (1999, August). Age differences in a complex information search and retrieval task. Paper presented at the annual meeting of the American Psychological Association. Boston, MA. Egan, D. E., & Gomez, L. M. (1985). Assaying, isolating, and accommodating individual differences in learning a complex skill. Individual Differences in Cognition, 2, 174-217. Elias, P. K., Elias, M. E, Robbins, M. A., & Gage, P. (1987). Acquisition of wordprocessing skills by younger, middle-aged, and older adults. Psychology and Aging, 2, 340-348.

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Family Caregiver Alliance. (1997). Annual report: California's caregiver resource center system fiscal year 1996-1997. San Francisco, CA: Family Caregiver Alliance. Freudenthal, D. (1997). Learning to use interactive devices; age differences in the reasoning process. Unpublished master's thesis, Eindhoven University of Technology, The Netherlands. Furlong, M. S. (1989). An electronic community for older adults: The SeniorNet network. Journal of Communication, 39, 145-153. Galliene, R. L., Moore, S. M., & Brennan, P. F. (1993). Alzheimer's caregivers: Psychosocial support via computer network. Journal of Gerontological Nursing, 12, 1-22. Garfein, A. J., Schaie, K. W., & Willis, S. L. (1988). Microcomputer proficiency in later-middle-aged adults and older adults: Teaching old dogs new tricks. Social Behavior, 3, 131-148. Georgia Tech's Graphic, Visualization and Usability Center. (1996). GVU's 6th WWW user survey [On-line]. Available: http://www.gvv.gatech.edu/gvv/ user_surveys/survey-10-1996 Gist, M., Rosen, B., & Schwoerer, C. (1988). The influence of training method and trainee age on the acquisition of computer skills. Personal Psychology, 41, 255-265. Gomez, L. M., Egan, D. E., Wheeler, E. A., Sharma, D. K., & Gruchacz, A. M. (1983). How interface design determines who had difficulty learning to use a text editor. Proceedings of the CHI'83 Conferences on Human Factors in Computer Systems (pp. 176—181). Danvers, MA: Association for Computing Machinery. Hartley, A. A., Harley, J. T., & Johnson, S. A. (1984). The older adult as a computer user. In P. K. Robinson, J. Livingston, & J. E. Birren (Eds.), Aging and technological advances (pp. 347-348). New York: Plenum Press. Marchionini, G. (1995). Information seeking in electronic environments. Cambridge: Cambridge University Press. Mead, S. E., & Fisk, A. D. (1998). Measuring skill acquisition and retention with an ATM simulator: The need for age-specific training. Human Factors, 40, 516-523. Mead, S. E., Sit, R. A., Jamieson, B. A., Rousseau, G. K., Rogers, W. A. (1996, August). Online library catalog: Age-related differences in performance for novice users. Paper presented at the Annual Meeting of the American Psychological Association, Toronto, Canada. Mead, S. E., Spaulding, V. A., Sit, R. A., Meyer, B., & Walker, N. (1997). Effects of age and training on World Wide Web navigation strategies. Proceedings of the Human Factors and Ergonomics Society 41st Annual Meeting (pp. 152-156). Santa Monica, CA: Human Factors and Ergonomics Society. Microsoft. (1999). Effective web design considerations for older adults [Online]. Available: http://www.microsoft.com/seniors/default.asp Morrell, R. W, Park, D. C., Mayhorn, C. B., & Echt, K. V. (1995, August). Older

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adults and electronic communication networks: Learning to use ELDERCOMM. Paper presented at the 103rd Annual Convention of the American Psychological Association, New York. National Research Council. (1997). More than screen deep: Toward every-citizen interfaces to the nations information infrastructure. Washington, DC: National Academy Press. Nickerson, R. S., & Landauer, T. K. (1997). Human-computer interaction: Background and issues. In M. G. Helander, T. K., Landauer, and P. V. Prabhu (Eds.), Handbook of human-computer interaction (2nd ed., pp. 3-32). Amsterdam, The Netherlands: Elsevier. Nielsen, J. (1990). Hypertext and hypermedia. Boston: Academic Press. Quaterman, J. S. (1997). 1997 Users and hosts of the Internet and the Matrix. Matrix News, 7 [Online]. Available: http://www.mids.org/press/pr9701.html Ratner, J. A., Grose, E., & Forsythe, C. (1996). Traditional vs. Web style guides: How do they differ? Proceedings of the Human Factors and Ergonomics Society 40th Annual Meeting. Santa Monica, CA: Human Factors and Ergonomics Society. Rogers, W. A., Fisk, A. D., Mead, S. E., Walker, N., & Cabrera, E. F. (1996). Training older adults to use automatic teller machines. Human Factors, 38, 425-433. Sein, M. K., & Bostrom, R. P. (1989). Individual differences in conceptual models in training novice users. Human—computer Interaction, 4, 197-229. SeniorNet & Charles Schwab & Co. (1998). Graying of the Internet [Online]. Available: http://www.headcount.com/globalsource/profile/index.htmPchoi ce=ussenior&id= 190 Teel, D. S. (1999). Technology & senior citizen [Online]. Available: http:// www.sunliving.com/seniortech.html U.S. Department of Commerce. (1997). Computer use in the United States: Population characteristics. Washington, DC: U.S. Census Bureau. Vicente, K. J., Hayes, B. C., & Williges, R. C. (1987). Assaying and isolating individual differences in searching a hierarchical file system. Human Factors, 29, 349-359. Vora, P. R., & Helander, M. G. (1997). Hypertex and its implications for the Internet. In M. G. Helander, T. K. Landauer, and P. V. Prabhu (Eds.), Handbook of human—computer interaction (2nd ed., pp. 877—914). Amsterdam, The Netherlands: Elsevier. Westerman, S. J., Davies, D. R., Glendon, A. I. Stammer, R. B., & Matthews, G. (1995). Age and cognitive ability as predictors of computerized information retrieval. Behavior and Information Technology, 14, 313—326. Zandri, E., & Charness, N. (1989). Training older and younger adults to use software. Educational Gerontology, 15, 615-631.

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5 Culture, Aging, and Cognitive Aspects of Communication Trey Hedden and Denise C. Park

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he study of the impact of culture on cognitive behavior is becoming increasingly important in today's climate of rapid globalization in which ideas and communications occur freely and often cross cultural boundaries. Although the functioning of the human mind is undoubtedly markedly similar across cultural boundaries, it has become apparent that important variation occurs in psychological processing across groups from different cultures. An understanding of how individuals from divergent cultural backgrounds think and process information differently from one another informs our efforts to communicate across cultures. In this chapter, we address the complex topic of how communications are affected by aging, culture, and cognition. We first briefly describe patterns of cognitive aging followed by a discussion of communication, culture, and cognition. We then propose a framework that might be used to guide research on culture, aging, and cognition. Finally, we describe a case in which cultural differences in cognition have been observed and then derive from this example some methodological and conceptual issues relevant to communication studies.

AGING AND COGNITION The process of aging has readily observable effects on the ability to perform a variety of mental operations. As individuals grow older, they often complain about loss of mnemonic ability, and empirical research has produced 81

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a large literature verifying these claims (Park et al., 1996; Smith, 1996). Older adults demonstrate relatively poorer performance than do younger adults on many memory tasks that include short-term memory, working memory span, and episodic memory (Park, 2000; Verhaeghen, Marcoen, & Goossens, 1993). Although the effects of aging on different types of memory compose perhaps the largest part of the cognitive aging literature, other cognitive processes also demonstrate age-related effects. The changes in cognition associated with aging include well-documented declines in speed of performing mental operations, inhibition of irrelevant information, and reasoning (Hasher & Zacks, 1988; Park, 2000; Salthouse, 1987, 1992, 1996). On the other hand, it is important to note that despite these declines, older adults may maintain and, in some cases, improve their ability to perform tasks related to world knowledge, vocabulary, and other semantic abilities (Howard, 1988; Light, 1992). Only in the very oldest of the old do declines in such abilities become evident, and this may be at least partially a reflection of the onset of dementia (Baltes & Smith, 1997). Figure 5.1 shows a typical pattern of changes in cognitive tasks across the life span. The vocabulary measures have an almost flat slope, whereas measures of speed of processing, working memory, and long-term memory show obvious declines as age progresses. The pattern of age-related changes in cognition has been variously interpreted as being caused by a decline in processing resources, often indexed by working memory function (Craik & Byrd, 1982), a loss of inhibitory control (Hasher & Zacks, 1988), or a generalized but unspecified neurological decline that acts as a "common cause" or mediator of age-related changes in cognition (Baltes & Lindenberger, 1997; Baltes & Smith, 1997). A growing corpus of evidence has begun to relate the patterns of cognitive aging described previously to age-related changes in neurophysiology. Apart from the onset of Alzheimer's disease and dementia, even healthy older adults appear to show decreases in the volume of cerebral blood flow (Reuter-Lorenz, 2000; Shaw et al., 1984), changes in evoked potentials (Tecce, 1978), and degeneration of neural tissue (Raz, Millman, & Sarpel, 1990; Raz, Torres, & Acker, 1992, 1995). The frontal lobes, in particular, appear to be especially susceptible to age-related degeneration (Dempster, 1992; Fuster, 1989; West, 1996). Because the frontal lobes appear to be involved in inhibitory control (Chao & Knight, 1997), strategic components of memory (Levine, Stuss, & Milberg, 1997; Schacter, 1998), and other executive control processes (Royall, 1994), such neural deterioration may be a leading cause of the observed pattern of age-related cognitive changes (Dempster, 1992). The neurobiological basis for the cognitive changes that accompany aging provides a broader framework for understanding

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cognitive processing and the effect of age on that processing. By studying the ways in which cognition changes across the life span, we can begin to understand how cognitive processes are related to one another within the neural architecture. Aging also provides a window on how these processes operate together with knowledge structures (which remain relatively constant across adulthood) over the life span. This link to the neuropsychology of aging will become particularly relevant as we investigate the relationships between culture, cognition, and aging. Before exploring those relationships, however, let us first turn to the link between psychology and the study of communication.

COMMUNICATION AND CULTURE The fields of psychology and communication have had overlapping interests for a considerable amount of time, according to a historical review by Delia (1987). Delia traces the development of social psychology and communication studies in the early part of the 20th century. He emphasizes the importance of social psychological investigations that focused on understanding the effects of media on children and studies of propaganda and persuasion to the development of communication research. It was not until the 1940s and 1950s that communication as a social science began to consolidate, influenced by work on attitude change (e.g., Hovland, Janis, & Kelley, 1953) and social-mediation views (e.g., Katz & Lazarsfeld, 1955). Delia (1987) regards as a major influence in this consolidation the "identification of the core concern of communication research as the processes by which communication messages influence audience members" (p. 21). Communication science, then, is the study of interactions among individuals or groups through a medium for transmitting information. That medium can be an individual, a group, or a medium such as newspapers, television, or the Internet. Because the cognitive mechanisms through which messages are interpreted and understood by individuals are an important aspect of communication, cognitive psychology is heavily involved in the study of communication. Indeed, the areas of psycholinguistics, social cognition, and basic cognitive psychology are all integral to the study of communication. In addition, communication researchers have focused a considerable amount of energy on the study of how communication and aging interact. These efforts have included topic areas such as how the elderly are portrayed in the mass media, how familial relationship dynamics change as a parent or grandparent ages, what conversational barriers confront the elderly, and how doctor-

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patient interactions are influenced by aging (Nussbaum, Thompson, & Robinson, 1989), as well as what modalities of communication are most effective for older adults (Frieske & Park, 1999). The study of communication and aging has often relied on a social-environmental perspective. It is important, however, that studies of communication and aging attempt to not only understand how the environment affects individual relationships and relational dynamics but also integrate the role of cognitive aging with the environment. The comprehension of language provides an example of the interplay among cognition, age, and the environment in communication. Kemper and Kemtes (1999), for example, have reported that age-related cognitive changes produce effects on the ability of seniors to comprehend speech and other types of messages. Others have suggested that cognitive factors such as reduced inhibition, working memory declines, general slowing, and sensory loss may contribute to difficulties in comprehension experienced by older adults (Tun & Wingfield, 1997). These effects may then lead to changes in the abilities of older adults to perform a variety of other types of tasks (Tun & Wingfield, 1997). For instance, memory for spoken words or messages is affected by age-related changes in the extraction of information from characteristics of speech such as prosody and linguistic context (Wingfield, Aberdeen, & Stine, 1991; Wingfield, Wayland, & Stine, 1992). Communicative changes related to age may also be important in applied contexts, such as providing information about health services to elderly patients (Halter, 1999) or creating effective instructions for the use of medications (Morrell, Park, & Poon, 1989, 1990; Morrow & Leirer, 1999). Studies in this area have tended to concentrate on the environmental attributes of incoming messages, such as speech rate, sentence length, and use of embedded clauses (e.g., Kemper & Harden, 1999) or the organization of medication labeling instructions. However, communication science and aging studies should also begin to emphasize the relationship of the cultural environment with the communicative abilities of older adults. Research in communication science has begun to integrate cross-cultural perspectives. This research has taken multiple approaches, including separately investigating (a) the effects of one culture's media on another culture, (b) verbal communication among individuals of different cultures, (c) different styles of communication among cultures, and (d) the role of cultural styles of communication on international relations (Gudykunst, 1987). Some of this work has been influenced by traditional research on social cognition but has, in addition, tended to focus on the situational factors that govern how the mechanisms described by social cognition are deployed in the context of communication (Gudykunst, 1987). These factors include sys-

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terns of norms and rules (Argyle, Henderson, Bond, lizuka, & Contarello, 1986), communication networks (Kim, 1986), and language use (Genesee & Bourhis, 1982). Although aging and culture have been separately investigated by communication scientists, the intersection of the two domains has been far less studied (Hill, Long, & Cupach, 1997). Given the general emphasis in the field of communication on the role of environmental factors (see Nussbaum et ah, 1989), it is perhaps surprising that so little research has been conducted on communication and aging across cultures. Cultural context provides perhaps one of the most powerful environmental influences that an individual will encounter throughout life. Based on this realization, in the present chapter we focus on the role of culture and how it affects aging and the fundamental cognitive processes that form the basis of communication. Thus, the remainder of this chapter articulates a perspective that takes into account not only the impact of cognitive aging as it relates to communication but also addresses this topic within the context of cultural variation.

CULTURAL DIFFERENCES IN COGNITION Nisbett, Peng, Choi, and Norenzayan (in press) have postulated a framework for understanding cultural differences in thought and social behavior. This framework categorizes social groups based on their predilections for types or styles of cognitive processing. Nisbett et ah (in press) hypothesize that members of East Asian cultures tend toward holistic processing, a mode of paying attention to relationships rather than to parts, of viewing interactions as more important than individuals, and of attending to the context in which events occur. In contrast, members of Western cultures tend toward an analytic processing style, a mode of viewing objects and individuals apart from their context, of assigning units to categories, and of attending to features rather than to relationships between features (Peng & Nisbett, 1999). It should be made clear that these modes are understood to be tendencies only—each culture can and does employ the other type of processing. However, one type of processing may receive more emphasis within a culture and, as such, may serve as a default or may require less cognitive effort to deploy. Evidence for these tendencies has come from a variety of domains, although most of the research has been conducted by comparing individuals from East Asian countries (China, Japan, and South Korea) to westerners in the United States who are of Northern European descent. For example, East Asians and Americans have been shown to differ on causal attribution tasks

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in that Asians tend to attribute causes to situations whereas Americans attribute causal force to dispositions (Choi, Nisbett, & Norenzayan, 1999; Norenzayan, Choi, & Nisbett, 1999). Americans appear to be more likely than are Asians to use rule-based categories (Norenzayan, Nisbett, Smith, & Kim, 2000) and tend to use categories to group objects; Asians tend to group objects on the basis of relationships (Chiu, 1972). Americans are also more prone to take extreme positions when confronted with a logical contradiction, whereas Asians prefer a dialectical solution (Peng & Nisbett, 1999). Hence, these cultural differences in proclivity for analytic or holistic modes of processing appear to be robust across a variety of cognitive domains, including reasoning, attribution, categorization, and memory processes (Nisbett et al., in press).

A FRAMEWORK FOR UNDERSTANDING AGING, CULTURE, AND COGNITION Park, Nisbett, and Hedden (1999) have extended this cultural framework to the domain of cognitive aging, describing a hypothesis in which the neurobiologic demands associated with the aging process interact with these culturally based cognitive styles. Park et al. (1999) note that, on the one hand, as individuals age their increased exposure to their culture relative to young adults results in elders possessing "cultural expertise." Based on this view, one would predict that cultural differences in cognition observed in young adults from different cultures will magnify with advancing age. On the other hand, Park et al. (1999) note that the aging process has two consequences that might act to minimize intercultural variability. One consequence of aging involves the previously discussed decrements in effortful cognitive processing (as shown in Figure 5.1). These changes in cognition are presumably neurobiologically based and universal in origin. They may act as a biologic "leveling" device across cultures insofar as they limit one's ability to selectively apply cognitively demanding strategies imparted by the culture (Park et al., 1999). The second consequence associated with aging and a range of life experiences is the potential development of wisdom (Baltes & Staudinger, 1993). On wisdom tasks reported by Baltes & Staudinger (1993), young and older adults performed at an equivalent level overall, but older adults did demonstrate greater levels of wisdom on tasks involving life problems specific to their own age group than did younger adults. Although aging in and of itself does not facilitate wisdom, older adults may be more likely to (a) have an accumulation of experience and knowledge that may be necessary to the development of wisdom and (b) be

Culture, Aging, and Communication Processing Speed

Working Memory

Memory

Vocabulary

Age by Decade

Age by Decade

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Figure 5.1 Age-related differences in speed of processing, working memory, recall, and vocabulary measures. (Adapted from Park et al. [1996] and Park [2000].)

considered by others as possessing wisdom (Bakes & Staudinger, 1993). Wisdom may enable an individual to recognize the limitations of one's own cultural cognitive style, resulting in individuals employing other approaches in certain contexts. Both of these mechanisms associated with advancing age (declines in cognitively demanding processes and the potential for increased wisdom) should result in a convergence in performance across cultures on cognitive tasks. The view presented by Park et al. (1999) allows for the possibility that both patterns of convergence and patterns of divergence will be observed across cultures as the populations age. Figure 5.2 displays a hypothetical pattern of divergence and convergence in cultural performance. The left half of Figure 5.2 represents the types of cognitive function in which processing capacity plays a primary role. For such basic mechanisms, Park et al. (1999) predict that the neurological imperatives of aging take precedence and differences observed in young adults across cultures converge in old age. At higher levels of cognition where culturally based

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Cultural Convergence

Young

Elderly

Age Group

Cultur al Divergence

Young

Elderly

Age Group

Figure 5.2 Hypothetical patterns of convergence and divergence of cultural effects across age groups.

knowledge structures are more important (represented in the right half of Figure 5.2), one might expect the saturation of culture that occurs with age to cause greater divergence in these processes during late adulthood compared with early adulthood. In certain cases, one might also expect that wisdom would come into play in some higher cognitive domains, thereby causing a pattern of cultural convergence.

INTEGRATING COMMUNICATION The extent to which cognitive demands and aging interact with and form cultural processing styles may be important in the consideration of both cross-cultural communication and communication within a culture. Within a culture, one might expect that communication modes that rely heavily on processing speed and the ability to integrate large amounts of information in a short period of time will demonstrate age-related declines. Across cultures, such modes will display a pattern of convergence with age. Communication tasks that require the ability to make reasoned judgments based on culturally specified knowledge, on the other hand, should show relatively little change, if not culturally biased increases, with advancing age. Thus, across cultures, such tasks would be candidates for a pattern of divergence with age. The importance of individual differences, a major topic area in the study of cognitive aging, should be particularly salient in the study of aging, communication, and culture. Not only can older adults differ in the rate of

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their cognitive declines and in the manner in which such declines affect their ability to communicate, but they may also differ in their preservation of the semantic and world knowledge that forms the basis of meaningful communication. Individuals within a culture may show more variability than do populations across cultures. By investigating the patterns of variability in communication, we may come to better understand how the processes of cognition operate in conjunction with and mutually determine the knowledge structures and cultural norms that govern both intercultural and interpersonal communication. Finally, the study of communication may inform the study of cognitive differences across cultures because much of cognition is geared toward the domain of communication among individuals and groups.

CULTURE DIFFERENCES IN COGNITIVE PROCESSING "Cognitive Primitives" As an Object of Study Most work on cognitive differences across cultures has focused on so-called "higher-level" cognition, involving such processes as logical reasoning, attribution errors, self-identification, stereotyping, and covariation detection (Fiske, Kitayama, Markus, & Nisbett, 1998; Nisbett et al., in press). Our current research program addresses this view at a more basic level. We argue (Park et al., 1999) that in order to determine the extent to which these cognitive differences are due to cultural effects, we must first understand to what extent such differences are active at lower levels of cognition. We focus on what are often termed "cognitive primitives," those processes that act as building blocks for other functions and are the processes that often show evidence of steep age-related declines (Park, 1999, 2000; Park et al., 1996). These processes include speed of processing, working memory, long-term memory, inhibitory control, attention, and perceptual processes (Hasher & Zacks, 1988; Lindenberger & Bakes, 1994; Salthouse, 1996; Verhaeghen et al., 1993). There are two major reasons for investigating possible cultural influences on such cognitive primitives. First, insofar as cultural influences are evident at these lower levels of cognition, then any other cognitive processes that involve one or more of these mechanisms will also be subject to influences of culture. That is, the cultural differences will "filter up" from basic mechanisms into more complex levels of cognition. Another way of stating this is that such mechanisms will have bottom-up influences on the processing of language, mathematics, and other domains. For example, if we observe differences in working memory on the basis of different linguistic structures

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(e.g., Cheung & Kemper, 1994), we might reasonably assume that this will influence the relative performance on mathematics tasks by speakers of different languages (e.g., Stevenson & Stigler, 1992). Insofar as mathematical ability depends on one's potential for storing and manipulating information about digits in working memory, linguistic or cultural differences that occur at the level of working memory may be active at the level of mathematical performance (Hoosain, 1991). One might also expect that linguistic differences in working memory might lead to differences in the processing of complex syntactic constructions. Insofar as syntactic processing depends on working memory (King & Just, 1991; Norman, Kemper, & Kynette, 1992), when the structural properties of a language reduce an individual's working memory load, one might expect that more complex syntax would be tolerated or more easily comprehended in that language. A second reason for focusing on cognitive primitives is that by studying relatively simple task domains that have been decomposed into their component processes, we may more accurately observe the locus of cultural effects. That is, when a difference between two cultures is observed on a cognitive task, we can potentially determine whether the language, a preferred cultural strategy, or perceptual processes carry the cultural effect. If we observe a similar cultural effect on a more complicated task, it may be difficult, if not impossible, to disentangle potential confounds or interactions among the component processes of the task. The Importance of Task Decomposition: ^forking Memory As a Case Study One very important issue in attempting to interpret cultural differences in cognitive processes is to understand exactly what a task of interest is thought to measure. Only by decomposing a task into its most basic cognitive components can we fully understand the processes measured by the task. Such task decomposition also makes possible an understanding of the relative contributions and interactions between different cognitive processes at work with a task domain. Let us take as an example the case of working memory. Working memory tasks are thought to measure the simultaneous storage and manipulation of information (Baddeley, 1986). Storage is not merely a passive process but, in the case of verbal materials at least, requires continual rehearsal of the information to be maintained (Baddeley, 1996). At the same time, verbal working memory tasks involve what have been termed executive control processes that coordinate multiple requirements of a task by means of task-switching strategies (Baddeley, 1986; Kieras, Meyer, Mueller, & Seymour, 1999). Age differences in such tasks are well-documented and appear to occur both in the storage (Salthouse & Babcock,

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1991) and in the executive processing (Kramer, Hahn, & Gopher, 1999; Van der Linden, Bredart, & Beerten, 1994) components of working memory. Cultural differences in verbal working memory tasks, such as the digit span task, are also well-documented (Ellis & Hennelley, 1980; Chincotta & Hoosain, 1995). The digit span task involves the presentation and immediate recall of a series of digits, either in forward or reverse order. The dependent measure is the maximum length of the series that a participant can correctly recall. The findings of cultural differences include longer digit spans for Chinese individuals than for Americans (Chen & Stevenson, 1988; Stigler, Lee, & Stevenson, 1986). Such culture differences may be explained by the differences in linguistic structure among various languages. For example, Welsh speakers have shorter word and digit spans than do English speakers because of the multisyllabic words common to the Welsh language (Ellis & Hennelley, 1980). Similarly, Chinese speakers have longer digit spans than do English speakers because of differences in syllabic density (Cheung & Kemper, 1993, 1994). The syllabic density for numbers is less in Chinese, allowing an utterance or subvocal rehearsal at a rate of about one and a half times as fast as in English (Chincotta & Hoosain, 1995). Numbers may therefore be more easily rehearsed in Chinese than in English. This is true even when bilingual speakers are used and is further supported by the fact that articulatory suppression mitigates the effects of language on digit span (Chincotta & Hoosain, 1995). With longer words consisting of multiple syllables the differences between Chinese and English spans decrease (Cheung & Kemper, 1993, 1994). From the available evidence, one can infer that the linguistic structure, particularly syllabic density, is a primary determinant of cross-national differences in digit span measures of working memory. This feature of language appears to cause differences through the storage and rehearsal components of working memory tasks, rather than through the executive control processes. Indeed, when one increases the processing requirements to engage executive control components by, for example, adding a digit preload to the task, these linguistic differences fail to emerge (Cheung & Kemper, 1994). Hence, it is important to decompose the task of interest to understand how the functions of the task, namely storage and rehearsal, may be affected by a factor which may differ across cultures or nations—in this case, language structure. Aging and Cultural Effects on Basic Cognitive Processes When structural or cultural differences are found on basic cognitive processes, one may then conduct research to observe how those differences

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change across the adult life span. Why might one be interested in doing so? As discussed before, the process of aging causes neurologically based changes in basic cognitive mechanisms. In addition, the increased experience that accompanies aging may allow an individual to develop highly elaborated knowledge structures, cognitive strategies, and the potential for wisdom about how to approach various problem domains. Because of these multiple influences, age may interact with cultural and structural factors, causing apparent cultural differences to become larger or smaller with age (as shown in Figure 5.2) (Park et al., 1999). By observing the pattern of changes across populations of differing cultural backgrounds and of differing ages, one may be able to infer whether knowledge structures, strategies, and processing power are the important contributors to task performance. Such inferences may then allow us to develop research programs that more accurately determine how a culture influences task performance through a particular cognitive process. Continuing with the previous example of verbal working memory for digits, it is likely that aging will cause convergence in performance across different languages. This pattern is predicted because advancing age causes declines in processing speed and articulation rate, both of which operate in the rehearsal component of the task (Cowan et al., 1998; Hulme, Newton, Cowan, Stuart, & Brown, 1999). Because the cross-national differences are so highly dependent on an advantage of greater syllabic density and length in Chinese over English or in English over Welsh, which allows speakers of one language to rehearse more digits per second, any changes in the rehearsal process will likely affect performance on the digit span task. Because the ability to rapidly articulate decreases as we become older (Amerman & Parnell, 1992), one would therefore expect that the advantage of being able to articulate more digits in one language than in the other would correspondingly decrease. In this particular case, we already have an explanation for the apparent cultural effect, which is that it is due to cross-linguistic differences. By adding aging to the picture, we can learn more about how changes in a relatively narrow cognitive process, namely articulation rate, may affect the ability to store and manipulate information even when linguistic structure appears to provide an advantage for certain speakers. This, in turn, may have implications for how well older adults encode, store, and process information received through communication channels. For example, an English speaker may be traveling in China and find herself at a market attempting to bargain over an item with no set price. The mental challenge of this seemingly simple negotiation is rather immense. The English speaker first has to translate, to the best of her ability, the words of her Chinese counterpart. She must extract from those words the

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numbers relevant to the proposed price and translate those into English words. She may even need to perform a quick currency conversion to know whether the deal is within reason. Holding that number in mind, she must then decide upon a suitable counteroffer, translate that into Chinese, and communicate it to the merchant. These steps must be repeated until an agreement is reached. Even given the handicaps of having to translate, performing currency conversions, and being in an unfamiliar context, the English speaker may be at a disadvantage in terms of her ability to hold prices (as sets of digits) in mind and calculate suitable offers on the basis of those prices. If the Chinese merchant is elderly and experiencing declines in verbal working memory, it is possible that the English speaker may be on a more even playing field with respect to this ability. If both participants are elderly, the negotiation may go more slowly in general, and language may provide less of an advantage to the Chinese merchant than would be the case if both participants were younger. Additionally, if, as we age, our ability to rehearse and store verbal information becomes impaired to the extent that we cannot effectively rely on structural advantages of our language, then that may have ramifications for how we can better structure the messages we wish to communicate to older adults. The implication is that the neurobiological changes that lead to slower processing speed act to impede strategies for understanding languages with higher syllabic density. Therefore, one might reasonably expect that strategies for communication with and among older adults should become more similar across cultures with progressing age. One potential prediction from this is that Elderspeak (Kemper, 1994; Kemper & Kemtes, 1999), a characterization of the slower speech rate, simplified syntactic complexity, and specialized register often adopted when communicating with older adults, may be encountered across cultural and linguistic boundaries. In other tasks in which the mechanisms by which cultural, national, or linguistic differences are less well-understood, the addition of aging into the equation may often provide more clarity than complication. The study of cognitive aging can be considered a window on the understanding of cognition in general. That is, by studying the manner in which cognitive processes change across the life span, one can make inferences about what mechanisms are the primary determinants of performance on a task. These inferences can then aid in the further understanding of how older adults may be able to better adopt coping strategies. In the area of cognitive aging, there is often an interplay between the furthering of basic cognitive research and the agenda of applying knowledge about cognition to assist and inform an aging population. This appears to be particularly true in the case of aging across cultures. By studying what coping strategies and strengthened

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knowledge structures deflect the difficulties of advancing age in one culture, we may be able to apply similar strategies to other cultural populations.

INTERPRETING DIFFERENCES ACROSS CULTURES We have discussed one example of an apparent cultural difference observed in a verbal working memory task: the digit span task. This difference has been explained as a difference in linguistic structure that, when compounded over a rehearsal interval, manifests a performance gap in groups that speak different languages. Already we have encountered two important lessons about methodology in cultural research. The first is that culture is a complex construct with multiple determinants, and it is important to discern what, specifically, causes a task difference. Language and culture effects can often be difficult to disentangle, so that without understanding whether and how the language affects performance on a particular task, it can often be difficult to determine what other aspects of culture operate within the performance domain. The second lesson is that by decomposing tasks and attempting to understand the various processes necessary for performance, we may gain a glimpse of which components are affected and which are unaffected by cultural influences. Such glimpses may then enable the determination of how culture influences a particular cognitive process. As we focus our efforts on determining the mechanisms by which culture influences cognition and communication, we will undoubtedly discover a broad array of interesting task domains that will challenge and enhance our interpretations. Variability Across Tasks In attempting to understand the operation of a cognitive process, it is often advisable to look at the involvement of that process across a variety of tasks and methods (Salthouse, 1981). This is often referred to as the principle of converging evidence (Stanovich, 1996). That is, evidence of a cognitive mechanism's participation in multiple tasks using multiple methods provides stronger evidence of its existence than evidence from a single task or from a few highly similar tasks does (Stanovich, 1996). It is therefore often desirable to collect several measures that are thought to index the same cognitive process. The interrelationships and correlations among the various measures then become an object of study and are often informative as to the nature of the involvement of the process of interest. However, as we investigate multiple measures of the same process in cultural psychological

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research, we are bound to encounter cases in which cultural differences appear in one task but not in the other. This is often viewed as a frustrating predicament in which theoretical constructs and multiple indicators of the construct are inconsistent with one another. We suggest that far from posing an intractable quandary, such situations provide an opportunity to determine how it is, precisely, that cultural variation is expressed. That is, by taking time to decompose and study the ways in which the tasks vary, we can come to understand how the variable "culture" acts as a proxy for understanding differences among indicators of the same process. Possible Interpretative Patterns Let us return to our example of working memory. Imagine a second working memory task in which participants are asked not to remember digit information but instead to rehearse and remember spatial information. We now have two tasks thought to measure working memory. One employs spatial information, whereas the other employs verbal (digit-based) information to measure the working memory construct. For example, the spatial task could fail to show cultural differences, whereas the verbal task demonstrates a cultural difference. In such a situation, one might reasonably assume that the two tasks are not measuring the same construct. This could lead to a research program in which one attempts to trace exactly how the two tasks differ and what mechanisms underlie the nonoverlapping portions of the tasks. This approach is highly valuable, and such task decomposition is likely to lead to a greater understanding of which mechanisms involved in the two tasks actually carry the observed cultural differences. In this particular example, it is likely that task decomposition will lead one to the hypothesis that different storage components, one for verbal information and one for spatial information, are involved in the two tasks. In the Baddeley (1986, 1996) model of working memory, these tasks would be viewed as indicators of the visuospatial sketchpad and the phonological rehearsal loop, both of which act as rather passive storage systems. Linguistic codes used in the verbal storage component allow differences based on syllabic density to emerge, whereas the spatial codes in the visuospatial storage component are unaffected by such linguistic differences. Although this would likely be a large part of the story, it may not be the complete story. For instance, one might also discover that, within each culture, the correlation between these two tasks is relatively large. One might then question the extent to which the tasks truly measure different constructs. It may be that there are multiple determinants of the tasks, such as the two storage components and an executive control component (Bad-

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deley, 1986, 1996). Based on the correlations between the tasks of interest, one might infer that the cultural or linguistic differences are carried by a storage component that differs between the two tasks but that each task also indexes the executive control component. That is, differences are exhibited in the digit span task but not in the spatial span task because only the digit span task is heavily reliant on linguistic codes. Despite this difference, the large correlation between the two tasks within a culture is due to the existence of an executive control component that operates similarly within each task. To the extent that each task involves active manipulation of the information in the relevant storage component, the tasks would be indices of the executive control component. Recent evidence employing structural equation modeling techniques in an American sample indicates that working memory is composed of a structure similar to that proposed by Baddeley (1986) and that the structural relationships among the verbal, visual, and executive control components remain invariant across the adult life span (Park et al., 2000). We are currently investigating whether these relationships are affected by cultural or linguistic influences in a large cross-national sample of young and older East Asians and Americans. It may be that the shared executive control component is relatively culture invariant, but linguistic effects on the verbal storage component obscure this fact with regard to performance on the verbal task. In general, when a situation of differing patterns across tasks is encountered, there are at least two interpretative possibilities. One is that the pattern is self-evident, that is, one task requires processing that the cultures are equivalently facile with; the other task requires processing on which they differ. In our example, the spatial component is relatively equivalent across languages, whereas the verbal component is influenced by linguistic differences. The other possibility is that sampling issues confound the cultural effects. If the populations are not equivalent on all other dimensions except the one of interest (a common problem in cross-cultural research), it remains possible that one or more of those other dimensions is contributing to the observed effect. This is commonly referred to as a cohort effect. Such a cohort effect among populations from different cultures could come about if the groups are drawn from samples of differing ability, for example. This presents a relatively difficult problem in interpretation. Fortunately, the study of cognitive aging has often confronted similar problems when dealing with potential cohort effects. That is, an observed age effect may simply be due to differences in the life experiences, educational systems, or economic conditions encountered by the various cohorts, rather than to differences on the basis of chronological or biological age (Kausler, 1991). The addition of culture into the equation simply adds another potential cohort

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effect and may cause difficult interactions of cohorts because the researcher then must deal with at least four groups (i.e., two cultures and two age groups) for which cohort effects are possible. The lessons learned from the study of cognitive aging potentially may be applied to the study of culture in order to alleviate concerns of cohort effects in a given situation. Methods for Deciding Among Alternatives How, then, can one disentangle culture and cohort effects? One method is to rely on the power of theoretical explanation. If one difference is clearly predicted by theory before the experiment is conducted and that difference is found, it is supportive of that being the true difference. Although post hoc explanations are often easy to generate once one has the data, when a post hoc explanation is pitted against an a priori explanation, the a priori explanation should be preferred. Of course, such conflicting explanations will generate new experiments designed to decide among the alternatives, and new data should always be sought in such situations. A second method, and one that is important in dealing with cohort effects, is to be very careful in selecting samples. Cross-cultural samples should be equivalent on age, health status, and expected mortality, and should be drawn from equivalent ability percentiles across the cultures. In order to be sure that such matching can occur, one needs to collect a variety of measures of general intellectual ability to properly characterize the samples. Measures of general knowledge and semantic information, such as the comprehension and information subscales from the Wechsler Adult Intelligence Scale (WAIS) (which has conveniently been translated into multiple languages), are often preferred because of the known preservation of these skills across most of the adult life span. However, cultures often differ in the types of general or semantic knowledge that an individual can be expected to know, and different questions or items usually appear on similar scales of cross-cultural tests. In these cases, it may be preferable to match samples not on raw scores, because the actual items differ from culture to culture, but on scaled scores (computed from normative data for the task) that place an individual in a percentile relative to normative performance within the culture. One may then sample from equivalent percentiles from each age group within each culture in order to be sure that the ability levels being sampled are equivalently representative of the cultures of interest. In addition, there have been attempts to develop screens for dementia (e.g., Salmon et al., 1989; Chiu et al., 1997) and measures of fluid and crystallized intelligence (Cattell, 1957, 1963; Court, 1991) that are valid cross culturally. When the groups have been rigorously selected and equated on age,

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health, mortality, and ability measures, one can be reasonably certain that differences in the samples are not generating a cohort effect, as described before. (See Park et al. [1999] for further discussion of sampling and other methodological issues.) A third method, and perhaps one of the most powerful, is to actively decompose the tasks into component processes and systematically vary those processes to determine which is the carrier of the cultural differences. This approach requires a thorough knowledge of the task domain and rigorous work at a detailed level to determine precisely what cognitive mechanisms differentiate each task from the other. It is crucial to understand that various tasks will have overlapping, although not identical, mechanisms and that this overlap may result in interactions with a culture effect. Such interactions may be difficult to resolve in a straightforward manner. For this reason, it is important to note that attempts at task decomposition will rarely be successful if careful sampling has not been conducted. Related to this third method, one may also collect multiple measures thought to estimate a variety of cognitive processes. The interrelationships among the various tasks may then be used to determine which processes or subcomponents of processes differ across cultures. By examining the systematic relations among multiple tasks, one may gain a better idea of not only what processes are the primary carriers of a cultural effect but also how those processes fit into the larger context of cognition and communication. This approach may be useful in determining which processes tend to vary together and which processes are likely candidates for interactions involving cultural effects. Additionally, multiple measures may be used in a regression model or in an analysis of covariance to statistically control for the influence of various factors thought to impact performance on a particular task. One may then account for the influence of multiple factors even while observing a culture effect on a measure that may not be a pure index of a particular process of interest. Ideally, all four of the previous methods will be employed in research on culture and aging. In our own work, we are attempting to develop a set of well-understood tasks that can be used as a "gold standard" to compare performance of individuals from different cultural backgrounds on such cognitive abilities as speed of processing and working memory. The hope is that by understanding how such processes display cultural effects, we can begin to approach the problem of how such cultural and linguistic influences may "filter up" into higher cognitive domains. Following this work, we hope to use this knowledge to better understand the basis of the cultural differences in cognitive processing styles (e.g., Nisbett et al., in press). Further, when we are able to discern tasks that appear to be culture-invariant

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measures of a process, those tasks may be employed to more properly equate samples on a variety of processes of interest. The Individual Differences Approach Thus far, we have been focusing largely on differences across age groups and across groups from different cultural backgrounds. The individual differences approach, which has gained popularity in the study of cognitive aging (Park et al., 1996; Park et al., 2000; Verhaeghen & Salthouse, 1997), may also prove highly informative in the study of culture and aging. Although individual differences may be approached through a longitudinal design, this is not required. Longitudinal designs have many appealing aspects and may be the only way in which cohort effects within a culture can be unequivocally ruled out. However, they are often expensive or impractical, and they suffer from the problems of selective attrition, progressive error, and time of measurement effects (Kausler, 1991). Further, a longitudinal design does not provide an answer for cross-cultural comparisons. An individual differences approach may also be applied to cross-sectional samples. In an individual differences study, multiple measures of a variety of processes are collected for every participant. The emphasis in this approach rests on the relationships between the measures rather than on any single measure. Various methods can be employed to examine these relationships, but perhaps one of the most powerful and popular is the use of latent variable or structural equation models. Rather than examining performance on individual tasks, several tasks are employed as indicators of constructs that correspond to cognitive processes of interest. The shared variance between the tasks is taken as a measure of true performance for the process, whereas each individual task is subject to measurement error and contamination from incidental processes (Loehlin, 1998). In addition, the constructs can then be related to one another on the basis of a theoretical framework using confirmatory factor analysis, providing a method for investigating the extent to which variance in one process mediates age-related, or culture-related, effects on another process. This approach may provide a method for examining in more detail the relationships between processes when a cultural difference is found in one domain. For example, when verbal working memory displays a difference among languages, one may be able to show that articulation rate mediates that difference such that the relationship between culture and verbal working memory is no longer evident once the variance explained by articulation rate has been controlled. The individual differences approach does not simply make possible comparisons between the relationship of culture to a group of interrelated vari-

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ables, but also allows the structure of those interrelations to be examined in different groups (e.g., Loehlin, 1998). For example, Park et al. (2000) have presented models demonstrating that the structural relationships governing the mediation of variation in recall measures by speed of processing and verbal and spatial working memory do not change substantially with progressing age. However, the effects of culture on this structure remain unknown at the current time. To resolve this issue, one could construct separate latent variable models for each culture and compare the factor structure (i.e., the existence of similar constructs and mediational paths between those constructs) among the cultural groups. If the factor structure is similar, one can be reasonably certain that the cognitive processes described by the factor structure have the same relationship between the two cultures. When differences in the factor structures emerge, one may be led toward discovering additional constructs that may be active in one culture but not the other, or toward finding relationships between constructs that are evident in one culture and not the other. An important lesson to be learned from the individual differences approach is that the differences among individuals within a culture may be more informative about the types of cognitive processing used by that group than differences between groups. When employed in conjunction with the methods described before, the individual differences approach can help us to understand not only that different processes may be active in different groups but also that the same processes may have different relationships across groups.

CONTRIBUTIONS TO AND FROM COMMUNICATION STUDIES We have been discussing relatively low-level cognitive processing in the preceding sections. At first glance, it might appear that the higher levels of cognition at which the macrofunctions of communication operate have little in common with differences in the rehearsal of digits, the speed of perceptual comparisons, or the ability to recall a list of words. However, the study of communication may be relevant to this work in three respects. First, it is important to understand the science of communication, especially as it relates to psycholinguistics, when attempting to interpret cultural differences on even basic cognitive tasks. This is particularly true when dealing with cultural groups that speak different languages. The impact of language may be crucial to understanding why two groups vary on particular tasks but not on others. Second, basic cognitive processes provide the

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foundation for communication. There may be important aspects of even basic cultural or linguistic differences that filter up into higher cognitive processing. That is to say, cultural effects at the level of basic cognition may become magnified when interactions with other cognitive processes are taken into account. It is also possible that although cultural differences are evident at the level of basic cognition, these differences may become obscured when the complex processes that compose higher cognition are studied. Thus, important cultural differences may not always be evident at the level of communicative processes and other processes of higher cognition. Third, the ways in which we interact with one another as a culture may provide a guiding force that shapes our tendencies toward employing particular cognitive styles. The effects of culture on cognition may not be independent from the effects of cognition on culture. As Fiske et al. (1998) suggested, cultural psychology "aims to describe the processes by which psyches and cultures construct each other, elucidating how cultures create and support psychological processes and how these psychological tendencies in turn support, reproduce, and sometimes change the cultural systems" (p. 916). Culture may be shaped and constrained by cognitive mechanisms, just as cognitive mechanisms may be influenced by the experiences provided by a culture. Moreover, we suggest that the neurological consequences of aging may provide further constraints on the manner in which culture and cognition construct one another. By understanding how cognition and communication jointly affect how individuals transmit information, we can begin to determine what important differences exist among various cultures with respect to the domains of cognition and communication. Culture is an amalgamation of linguistic constraints, social norms, religious practices, institutional structures, and a variety of other factors. Undoubtedly, these factors will have different implications for cognitive tasks and communicative styles, and one would not expect culture to be monolithic in its effects. Our task is to parcel out the factors related to culture that influence cognition and, in turn, investigate how those factors interact with each other and filter up into the large-scale communicative differences that we so readily observe. In addition, the study of cognitive aging will help to shape how we approach the study of culture and communication. As we age, certain neurological imperatives provide constraints on the strategies for communicating and adapting that may be similar across cultures. We may find that cultures differ the most on dimensions that are not as constrained by agerelated changes in neurology. Finally, understanding what works well for older adults in one culture may provide strategies that can be used by the elderly in other cultures.

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ACKNOWLEDGMENTS This research was supported by grant R01 AGO 15047 from the National Institute on Aging Behavioral Research Program to Denise C. Park. This work is a result of support by a conference grant from the German-American Academic Council Foundation. The conference, "Aging and Communication: Opportunities and Challenges of Technology," was held at the University of Michigan, May 23—25, 1999 in Ann Arbor, Michigan. This support is gratefully acknowledged.

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6

Aging, Sensory Loss, and Social Functioning Hans-Werner Wahl and Clemens Tesch-Romer

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iven the patterns of hearing and vision loss over the life span and their dramatic importance in old age, it is surprising how little attention has been paid to the impact of sensory losses on social functioning in later life. It is the aim of this chapter to contribute to research from the field of social and psychological gerontology by suggesting conceptual distinctions that can be used to analyze the connection between sensory loss and social functioning. The theoretical differentiations presented in this paper are buttressed by empirical findings, including some of our own research. Although we predominantly argue as psychologists (which we both are by training), social functioning and communication are presented in a broader social science context in order to address issues such as social rules and interpersonal expectations. We argue that age-related losses in both the visual and the auditory systems negatively affect different strata of communication and social functioning. In other words, we expect differential negative effects of vision and hearing loss that, at least in part, depend on social rules governing different strata of communication and social function. Our argument is divided into five parts. First, we present a simple initial hypothesis derived from the main functions of the visual and auditory systems. Second, we distinguish among three basic functions of these sensory systems and juxtapose them with three strata of social functioning. Third, we integrate both of these views into a discussion of the relation between sensory losses and social functioning; social and communication rule violations play a significant role regarding the three strata of social functioning. Fourth, we present a few unresolved questions concerning the connection of sensory loss and 108

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communication in old age, with special emphasis on cognitive and motivational factors. Finally, we highlight some of the implications of our analysis for applied and social policy fields.

A STARTING HYPOTHESIS AND SOME EMPIRICAL EVIDENCE Sensory impairments are among the most typical lifespan related losses. The average onset of impairment has already begun by one's thirties and increases significantly among the old and very old. Epidemiological data based on subjective as well as objective assessments support the view that about one third of the population over age 60 is suffering from severe hearing deficit, and this proportion increases sharply beyond the age of 85 (Corso, 1992; Davis, 1989; Kline & Scialfa, 1996). With respect to vision loss, recent data from a national representative sample of older persons has found that 20% of those 65 years and older and 25% of those over 75 reported severe functional vision impairment, even when wearing corrective lenses (Lighthouse Research Institute, 1995). Legal blindness, which may occur in conjunction with a variety of eye diseases, predominantly appears in the over 65 age group and increases from about 1% in those 70—74 to about 11% in those 85-89 (Salive et al., 1992). There is general agreement that a strong connection between sensory functioning and communication with the outside world exists (e.g., Fozard, Wolf, Bell, McFarland, & Podolsky, 1977; Kline & Scialfa, 1996). With regard to the precise nature of this relationship, the most common starting hypothesis, found frequently in the research literature as well as in the clinical and rehabilitation field, can be stated as follows: Both hearing and vision are highly relevant for interaction with the environment, but each has a different impact on day-to-day functioning. Hearing is a necessary prerequisite for interacting with the social world, whereas vision is a necessary prerequisite for interacting with the physical and spatial world. Consequently, the loss argument states that hearing impairment predominantly affects the communication with the social world in a negative manner, whereas vision impairment is assumed to have its negative consequences predominantly in the interaction with the physical and spatial environment. This perspective on hearing and vision is probably most pronounced in the areas of rehabilitation and technology (Tesch-Romer & Wahl, 1998). However, empirical research on the psychosocial consequences of both of these sensory losses has also concentrated on domain-specific consequences. On the one hand, a body of empirical literature, developed over the last 10

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A

B

Figure 6.1 Vision loss and day-to-day behavior. Higher scores indicate better functioning. B indicates blindness; V, severaly visually impaired; Ul, unimpaired.

years, has provided support for the assumption that vision loss negatively influences the interaction with the physical and spatial world. The results have repeatedly confirmed that visual capacity is an important predictor of outcomes such as everyday competence, action range outside the home, and social and nonsocial leisure activities, even after controlling for other variables such as comorbidity or cognition (Branch, Horowitz, & Carr, 1989; Heinemann, Colorez, Frank, & Taylor, 1988; Horowitz, 1994; Laforge, Spector, & Sternberg, 1992; Marsiske, Klumb, & Baltes, 1997; Rudberg, Furner, Dunn, & Cassel, 1993). In line with this work, our own research (Wahl, 1997; Wahl, Schilling, Oswald, & Heyl, 1999) has revealed the following (Figure 6.1): (a) The severely visually impaired elderly, compared with their unimpaired counterparts, have lower scores on Activities of Daily Living (ADL) (e.g., self-care)

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Pure tone average (PTA) hearing loss In frequencies 0.5, 1 and 2 kHz in dB HL Figure 6.2 Hearing loss and communication problems. Correlation coefficients: linear, r, = .49; curvilinear, r, = .62. Illl

log

and the more complex Instrumental Activities of Daily Living (IADL) (e.g., meal preparation) assumed as particularly prone to environmental influences (Lawton & Brody, 1969) (Figure 6.1 A); the blind elderly have even lower scores than the severely visually impaired elderly, (b) Visual impairment has a negative impact on leisure activity level (Figure 6.1 A), (c) The negative impact of visual impairment on both the ADL and IADL as well as the leisure domain cannot be compensated for in the long run (5-year observation period). In fact, functioning for the visually impaired compared with the unimpaired elderly remains significantly lower over 5 years and even decreases further in the leisure activity domain (Figure 6.IB). On the other hand, with respect to the consequences of hearing, as one might expect, negative correlations with communication ability are welldocumented (Garstecki, 1987; Lichtenstein, Bess, & Logan, 1988; Mulrow, Aguilar, Endicott, Velez, Tuley, Charlie, & Hill, 1990; Pedersen & Rosenhall, 1991; Sever, Harry, & Rittenhouse, 1989; Weinstein & Ventry, 1983), although this relationship is far from simple. One example from our own research is presented in Figure 6.2: We found a curvilinear relationship

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between degree of hearing loss and subjective hearing handicap (TeschRomer, 1997). The increase in subjective hearing handicap is thus not linear but exponential, although one should note the high interindividual variability. Moreover, there are findings regarding the relationship between hearing loss and emotional well-being, especially loneliness and depressive symptoms (Carabellese, Appolinio, Rozzini, Bianchetti, Frisoni, Frattola, & Trabucchi, 1993; Herbst, 1983; Jones, Victor, & Vetter, 1984). No substantial correlations between everyday competence (ADL) and hearing capacity have been reported, however (Marsiske, Delius, Maas, Lindenberger, Scherer, & Tesch-Romer, 1999; Rudberg et al., 1993). So far, the empirical results suggest that hearing has a profound negative impact on social interaction and thus on communication, whereas vision impairment seems to predominantly impede the day-to-day action regulation within physical and spatial opportunities and constraints. Our aim in this chapter is to add some necessary complexity to the hypothesis of domain-specific effects of hearing and vision loss. We start with the insight (based on the work outlined earlier) that research on the psychosocial consequences of vision loss has largely disregarded its consequences on social functioning and communication. Conversely, research on the psychosocial consequences of hearing loss tends to exaggerate its negative impact on social functioning and virtually ignored its other consequences for functioning outside of the social context. In the next step of our analysis, we describe the functions of the visual and auditory systems in more detail and relate these to different strata of social functioning.

FUNCTIONS OF VISION AND HEARING AND STRATA OF SOCIAL FUNCTIONING Three Functions of Vision and Hearing: Orientation, Action Regulation, and Communication Sensory systems serve several functions in the everyday world of persons, regardless of their age. Although these functions differ for the auditory and the visual systems, as is commonly emphasized in the literature, we underscore the similarities of these functions in order to provide a more holistic analysis. According to our view, vision and hearing have three important functions in most everyday situations, namely (a) orientation, (b) action regulation, and (c) communication. Naturally, these sensory systems are used in an integrative fashion; hence, we assume the bimodality of sensory functioning in a higher-order sense.

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Orientation entails the process of finding direction or getting around in the physical and spatial world. Vision enables the localization of objects and one's own body in spatial networks. Hearing provides orientation-relevant information by means of acoustic feedback from spaces (e.g., the reverberation of sound in large halls or churches). In a broader understanding of orientation, recognition may be subsumed under orientation as well. A typical example with respect to vision would be the detection of a car driving past from the vantage of a sidewalk, whereas hearing may help detect a car approaching from behind (alarm function). Action regulation means the process of planning, executing, and monitoring goal-directed behavior. Hence, recognizing action possibilities, carrying out an action, and monitoring the action all rely heavily on both senses. Vision is of particular importance in recognizing action opportunities and alternatives inherent in the outside everyday world, including what Gibson has called "affordances" (Gibson, 1979). Hearing further supports the onset, performance, surveillance, and termination of actions, for example, by use of the acoustic feedback that occurs when one closes the door of a refrigerator or starts a car engine. Finally, communication—according to its classic definition—entails a process by which information is exchanged between individuals through a system of symbols, signs, or behavior. This interpersonal exchange of information is achieved using speech, facial expressions, and gestures. Whereas vision is predominantly involved in the recognition of facial expressions and gestures, hearing is the basic mode for listening to and understanding speech. Our argument, which is further developed later, is that these three functions—orientation, action regulation, and communication—all influence social functioning. Before proceeding, however, clarification is needed on what we mean by social functioning. Three Strata of Social Functioning and Communication: Face-to-Face Interaction, Maintaining Social Relations, and Striving for Social Integration The term "social functioning" could conceivably encompass a huge variety of different phenomena. This is reflected in the topics covered in this book. There is communication, on the one hand, including everyday discourse, the mass media, and new technologies. On the other hand, social functioning could be taken to mean the whole range of everyday encounters to social adaptation in society in the broadest sense. In the following, we suggest a distinction between three levels of social functioning as a means for developing our argument: (a) face-to-face interaction, (b) social relations, and (c) feelings of social integration.

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Face-to-face interactions refer to basic communication situations in which people exchange information and influence each other's actions using speech (i.e., spoken language). Although the term "face to face" does not imply it, we include telephone conversations in our understanding of this construct. However, we exclude other interesting and important communication situations (such as using the Internet) because they are still rare forms of social exchange among the elderly and have not yet produced, as far as we can see, (new) social rules or regulations. With the term social relations, we mean long-lasting connections between people based on social interactions or the exchange of information, instrumental or emotional support, or material goods. We are excluding here relations that might be based predominantly on definitional criteria, such as family relations (e.g., merely being someone's relative) or relation to one's fellow human. Social relations, in this sense, entail a strong history of interpersonal development that leads to a considerable degree of intimacy and mutual responsibility in day-to-day interchange. By social integration, we mean the integration of a person within a network of social relations. Moreover, "social integration" refers to the subjective feeling of being in an intimate and close relationship with persons or belonging to a broader social network that benefits from one's own input and simultaneously gives something back to the individual. Well-functioning auditory and visual sensory systems are an important requirement for partaking in face-to-face communication, maintaining social relations, and striving for social integration. Losses in these sensory systems obviously lead to chronic disturbances in face-to-face interactions that might also affect social relations and social integration. The question is, however, to what degree and with what differential impact? In the next step of our analysis, we will combine our proposal to consider these three strata of social functioning with the psychosocial consequences of vision and hearing loss.

VISION, HEARING, AND SOCIAL FUNCTIONING Regulation of Face-to-Face Interactions Face-to-face interactions are regulated by a large set of basic rules and conventions. To conduct a conversation effectively, one has to be able to detect subtle signals such as prosody and facial cues in order to alternate smoothly as listener and speaker. If one violates conversational rules, unsatisfactory interaction may ensue. In the long run, negative consequences in the emotional and behavioral domain may also follow.

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Vision Technically, a person suffering from vision impairment is not handicapped in listening to and understanding speech. However, taking communication from an action perspective, vision impairment may negatively impact on conversational performance. For example, very severe visual deficit impairs one's ability to recognize when the "right" point in time has come to begin talking to another person, whose nearness or distance can only be inferred based on nonverbal cues or may even require touching. Vision loss further undermines the capability of detecting facial expressions, which can be important in interpreting the meaning of a speaker's contribution to the discourse. Unfortunately, the loss of vision has not found very much attention in verbal and nonverbal communication research in gerontology. Thus, no clear empirical answer on the influence of vision loss on face-to-face communication is available today. However, clinical evidence may at least be cited to support our point (e.g., Ainlay, 1988). Hearing With respect to hearing, it should be mentioned that a functioning auditory system is a necessary, albeit insufficient condition for understanding what is said (and meant) in a conversation. Individuals suffering from hearing loss have difficulties decoding phonological information. Hence, hearing loss regularly leads to situations in which people either have to infer what has to be said or ask for repetition and explanation. In both cases the person very likely violates basic conversational rules or maxims (Grice, 1975; Tesch-Romer, 1999). Quite often, hearing-impaired persons do not correctly infer the meaning intended by a speaker and make, as a consequence, an "irrelevant" or "unrelated" contribution to the conversation; if a person makes a mistake like this, she or he quite likely violates the rule of conversational relevance. This might lead to a "conversational disturbance," for instance, when the other participants in the social interaction react with amusement or irritation. If the hearing-impaired person, on the other hand, decides to ask his or her partner to repeat an utterance, the conversation slows down, and the hearing-impaired person violates the rule of conversational parsimony. In this case, the participants of a social interaction might become bored or annoyed. That is, a hearing-impaired person faces a dilemma, because she or he very likely violates one of these basic conversational maxims. Hence, regarding the communication stratum of face-to-face social interactions, we would argue that the hearing impaired clearly have a higher risk for communication failures because of to their proclivity to violate basic

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communication rules. However, visually impaired persons, particularly those not identifiable as being impaired (which probably represent the majority of visually impaired elderly), may also experience negative consequences in the social domain for the very same reasons. Maintaining Social Relations Most (but not all) social relations are based and maintained via regularly performed social interactions and shared activities. If a person experiences difficulties in social interactions because of rule violations caused by sensory loss, the person might tend to withdraw from social activities. As a consequence, the maintenance of established social relations might be endangered and the establishing of new social relations may become difficult or even impossible. Vision As is also supported by our own data (Wahl, Oswald, & Zimprich, 1999; Wahl et al., 1999), vision loss shrinks one's action radius and decreases one's ability to perform ADL/IADL and leisure activities. Such declines in competence, however, are not the only kinds of loss incurred by the visually impaired elderly individual: the activities themselves have symbolic relevance and are, at the very least, critical prerequisites for social interactions. Consider shopping, banking, going out for a stroll, visiting a senior club by use of public transportation, or driving one's own car. In American culture (and to a lesser extent in certain west European countries, including Germany), giving up driving because of visual loss appears to be a new "rite of passage," one that not only erodes feelings of autonomy but also blocks the maintenance of social relations (Cobb & Coughlin, 1998). Hearing Although hearing problems in old age might disturb some social interactions, they probably do not jeopardize all social relations, as was also found in our own work (Tesch-Romer, 1999). Hearing problems might hinder "formal interactions" with professionals (such as doctors) or strangers (somebody asking for directions). However, communication behavior and communication problems in "formal interactions" might be quite different from communication in "informal interactions" (e.g., among family members). It is worth noting that in this context intimate relationships are governed by a set of rules that allow for peculiar, non-normative exchanges. In this regard, long-lasting social relationships—which are more the rule than the exception in old age—may have the power to overwrite rule violations in

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the domain of relevance and parsimony. This is quite different from interactions with unfamiliar persons, in which strict conversational rules are predominant. However, the degree of hearing loss is decisive. Even in intimate, long-lasting relationships, severe hearing loss (close to deafness) might create tremendous difficulties (Nowak, 1998). Thus, it seems plausible to assert that mild to moderate hearing loss (the typical condition in old age) tends to have little or no effect on intimate social relations, whereas severe hearing loss tends to negatively influence not only formal but also informal relationships. Hence, regarding the communication stratum of the maintenance of social relations, we would argue that a visually impaired person runs a risk of experiencing negative consequences comparable to that of a person suffering from a hearing loss. Although the direct negative effects of hearing on social relations may be buffered in the long run by the power of existing intimate relations, the more indirect effects of vision loss on social functioning, such as the shrinkage in the daily range and scope of actions, requires the social environment to play a more active role (e.g., significant others may have to pay more home visits to the elderly individual after the onset of vision loss; see also Reinhardt, 1996). Striving for Social Integration Aside from disengagement and activity theory, we feel that there is a consensus in the current literature on social relations and networks in old age that striving for social integration is and will continue to be an important personal goal for most elderly persons. Let us explore the impact of sensory loss on this third stratum of social functioning. Vision With respect to vision, the literature (e.g., Branch et al., 1989; Horowitz 1995), as well as our own research (e.g., Wahl, 1997; Wahl, Schilling, et al., 1999), supports the view that a severe loss of vision has negative consequences on well-being and future orientation (at least in the long run). As can be seen in Figure 6.3A, well-being was significantly lower in both groups of blind and severely visually impaired elderly compared with the unimpaired elderly, whereas no difference at our first measurement point in regard to future orientation was observed. Five years later, well-being went down in both the visually impaired and the unimpaired elderly, with a continuing sharp difference in the means between both groups. Conversely, future orientation became significantly more negative only in the visually impaired group (Figure 6.3B). Conceivably, the more negative future orien-

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A

B

Figure 6.3 Well-being and future orientation in short-term and long-term perspective in age-related vision impairment. Higher scores indicate higher wellbeing and a more positive future orientation. B indicates blindness; V, severely visually impaired; UI, unimpaired. tation that results from chronic visual impairment compounds the problem of social integration. In particular, a general feeling of no longer being "really" involved in the world, which one might generally associate with very advanced age, may be strongly reinforced by age-related vision loss. Our qualitatively oriented research (Wahl, 1997), as well as the empirical research of others (e.g., Ainlay, 1988), generally supports this claim. However, our data also illustrate a certain paradox regarding the issue of vision loss and social integration: Social support and help from social partners may heighten well-being on the one hand and simultaneously strengthen dependent behaviors on the other (Wahl, 1997). Vision loss is a particularly strong trigger for a "helping impulse." The average person feels morally obligated to help and support the visually impaired individual, who

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often perceives such aid as being emotionally supportive. At the same time, helping behavior increases the risk of becoming, to use the term coined by Baltes (Baltes, 1996; Bakes & Wahl, 1996), a pawn of the dependencesupport script. Such scripts may, in the long run, undermine action potentials through overprotection and oversupport in everyday life, allowing the elderly individual's abilities to fall into disuse. Hearing Because hearing loss in old age negatively affects face-to-face interactions and, when severe, can strain social relations, one could expect hearing impairment to threaten social integration. In our own research, we approached this question somewhat indirectly from a rehabilitation point of view; we examined whether hearing aids have a positive impact on communication and social functioning (Tesch-Romer, 1997, 1999). Interestingly enough, although communication problems in face-to-face interactions could be alleviated through the use of a hearing aid, it had no effect on social activities, which is regarded as an indicator of social integration (Figure 6.4). Hence, although even mild to moderate hearing impairment might heavily disturb social interactions, it seems that many social activities performed by older adults take place in a social convoy that has developed over the life span (Antonucci, 1990). Because the existence of the convoy has been firmly established over the course of development, it might be rather unaffected by mild to moderate hearing loss in one of its members. Nevertheless, decline in hearing ability might slowly alter social habits without affecting the social convoy as a whole. It may take some time before the elderly individual becomes aware of subjective communication problems, that is, a qualitatively changed "social world" within the same social convoy. We would like to emphasize, however, that this situation is quite different for younger hearing-impaired persons, for whom hearing impairment is strongly related to social isolation and loneliness (Richtberg, 1990). Regarding the communication stratum of social integration, we would argue that a visually impaired person is confronted with an even greater risk of experiencing negative consequences (in part, combined with ambivalent consequences as in the case of a dependence-support interaction script) compared with an older person suffering from chronic hearing loss. Although vision loss has a weaker negative impact on direct face-to-face communication than hearing loss and vision loss and hearing loss produce more or less comparable negative effects in terms of social relations, visual impairment may reveal more severe negative communicative consequences in the long run because of its impact on subjective and objective social integration.

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Hearing handicap -> subjective communication problems: Strong rehabilitation effect of hearing aids

Social activities -> objective social integration: No rehabilitation effect of hearing aids

Figure 6.4

Striving for social integration: Role of hearing aids.

Conclusion and Further Implications In agreement with default expectations, we can conclude on the basis of our analysis that vision, as well as hearing, has profound negative effects on social communication and the feeling of social involvement in the "world." (Admittedly, the effects of vision loss are more indirect.) We should, however, mention that hearing losses not only hinder communication with the social environment but also handicap the interchange with the physical context. Accordingly, we propose considering communication and social functioning in a broader sense: Communication can occur with the physical and spatial world as well as with the social world. This proposal is supported by theoretical arguments (i.e., it is generally very hard to make a sharp differentiation between social and physical types of person-environ-

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ment interaction) as well as empirical data (e.g., the incapacity to visually "communicate" with traffic lights will hinder the visit to a friend just three streets away, the incapacity to understand a social partner may result in taking the wrong train). Under this broad perspective of person-environment interaction, our basic conclusion is that both hearing and vision loss negatively affect communication. Although vision loss has a stronger influence on one's interaction with the physical and spatial environment, hearing loss has some influence as well. Furthermore, we tried to provide some good reasons why the evidence is very mixed regarding the social environment. Although hearing loss obviously impacts more strongly on the "surfacestructure" of social functioning in day-to-day interactions, we ended up with the insight that vision loss may also have a strong and negative impact on social functioning, especially on social integration and feeling involved in the "world."

OPEN QUESTIONS Obviously, many different kinds of open questions remain. For example, at the microlevel of analysis, one question not addressed in this chapter is whether further differentiation is needed, in other words, whether different kinds of sensory impairment should be considered separately. To take the example of vision loss, one may ask whether the shrinkage of the visual field (with no loss in visual acuity in the narrowed visual field) has different communicative impact compared with reduction in visual acuity. We know that spatial orientation is more closely linked to visual field deficits compared with visual acuity (Matron & Bailey, 1982), but we know practically nothing with respect to the differential social implications posed by these two different kinds of visual impairment. On a more general level of analysis, what roles do cognition and motivation play in the context of sensory loss, social functioning, and communication? Intact cognitive functioning is critical to effective communication and social functioning, and there is a strong correlation between sensory and cognitive capacity (Wahl, Tesch-Romer, & Rott, 2000). Two hypotheses have been used to explain the substantial correlation between sensory ability and cognitive capacity in old age. The "cascade hypothesis," on the one hand, claims that decreases in sensory ability over the years affect cognitive functioning because of sensory underload (Sekuler & Blake, 1987). The "common cause hypothesis" argues, on the other hand, that decreases in central cognitive processing simultaneously affect sensory and cognitive functioning (Lindenberger & Baltes, 1994). If the impairment not only

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extends to the sensory systems but also affects cognitive functioning, then this might affect social functioning and communication in an additive or, more probably, interactive manner and is thus qualitatively different at higher levels of functioning (e.g., regarding discourse processing) (Kemper, 1992). Finally, one could speculate regarding motivational issues in social functioning and communication. Because the motivation for social interactions might change with old age, as is suggested by socioemotional selectivity theory (Carstensen, 1993), this motivation could also affect the negative impact of sensory loss on communication in old age. For example, if the motivation to interact with new social partners as well as the need for information exchange decreases with old age, then communication problems with unfamiliar persons or communication disturbances in information-oriented discourses might become less relevant.

APPLIED IMPLICATIONS There is general agreement that more effort could be made to rehabilitate sensory losses in old age, to use the full potential of existing interventions in order to reestablish "normal" life-quality (Tesch-Romer & Wahl, 1998). Technology has become more and more important in the rehabilitation of both hearing and vision impairment, although fundamental behavioral and environmental interventions are critical as well. Behavioral strategies, such as learning how to hear effectively, or environmental strategies, such as improving the legibility of the physical surroundings, can be very important tools in the rehabilitation of sensory deficit. We would suggest that intervention strategies take different strata of social functioning and communication into account and view communication in terms of both the social and the physical or spatial environment. The two obvious implications of these suggestions are that (1) the rehabilitation of vision loss should place more emphasis on social integration (where we would expect pronounced losses) and (2) the rehabilitation of hearing loss should place more emphasis on optimizing communication with the physical world (which has been generally disregarded in the psychosocial research on hearing impairment). Another point can be made regarding the so-called new information and communication media such as the Internet. There has been a lot of ongoing discussion addressing whether new media present pure potential or also involves constraints and risks for elderly people. One of the most interesting questions within this new field, challenging the elderly themselves as well as

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social policy, is how new modes of communication will interact with communication habits and whether they will be embraced by new cohorts of elderly. Will new modes of social exchange evolve based on these new technologies, these new opportunities for face-to-face interactions? If so, will these technologies enhance or simply change the social integration of the elderly within the scope of their broader social network or even within society as a whole? Because the main theme of this chapter is the relation among sensory losses, social functioning, and communication, we would like to comment on these questions. First, it is an absolute necessity that sensory-impaired elderly persons, who are certainly a substantial part of the elderly population (see again the epidemiological data cited at the beginning of the chapter), are not deprived from the latest developments. Social policy should ensure that this issue receives high priority. In the past, technological devices were designed and developed without concern for whether or not the technology was barrier free, and perhaps even with a deficit image of old age in mind. However, facing the demographic changes in the future, industry would be well-advised to put more emphasis on the development of technologies usable by all members of the society. In terms of our conception of the different strata of social functioning and communication, one should note that "face-to-face" interactions over the Internet are not as prone to the rule violations that often occur in natural face-to-face interactions. Second, new communication tools, such as the Internet, may even have the potential to counteract negative consequences resulting from sensory losses. For example, intensive use of the Internet by visually impaired elderly may strengthen their feeling of still being involved in the "world"; it affords one the opportunity of communicating and having interpersonal interchanges with persons living in all corners of the earth. The hearingimpaired elderly may, for instance, use the Internet to compensate for losses in natural social relations. We are not aware of any ongoing research efforts on these issues, although we know that visually and hearing-impaired elderly have been users of the new media for many years now. To conclude, many research questions remain untouched in the field of hearing and vision losses and communication. This area of inquiry deserves new combinations of scientific disciplines, a genuine interdisciplinary approach including psychology, sociology, psycholinguistics, and geriatrics. Combining such research with a communication technology perspective (rehabilitation, new media) would be, in our view, a particularly promising and intellectually stimulating enterprise.

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REFERENCES Ainlay, S. C. (1988). Aging and new vision loss: Disruptions of the here and now. Journal of Social hues, 44, 79-94. Antonucci, T. C. (1990). Social supports and social relationships. In R.H. Bin stock & L.K. George (Eds.), Handbook of aging and the social sciences (3rd ed pp. 205-226). San Diego, CA: Academic Press. Baltes, M. M. (1996). The many faces of dependency in old age. Cambridge: Cambridge University Press. Baltes, M. M., & Wahl, H-W. (1996). Patterns of communication in old age: The dependence-support and independence-ignore script. Health Communication, 8, 217-231. Branch, L. G., Horowitz, A., & Carr, C. (1989). The implications for everyday life of incident self-reported visual decline among people over age 65 living in the community. Gerontologist, 29, 359—365. Carabellese, C., Appolonio, L, Rozzini, R., Bianchetti, A., Frisoni, G.B., Frattola, L., & Trabucchi, M. (1993). Sensory impairment and quality of life in a community elderly population. Journal of the American Geriatrics Society, 41, 401-407. Carstensen, L. L. (1993). Motivation for social contact across the life-span: A theory of socioemotional selectivity. In J. Jacobs (Ed.), Nebraska Symposium on Motivation (Vol. 40, pp. 209-254). Lincoln: University of Nebraska Press. Cobb, R. W., & Coughlin, J. F. (1998) Are elderly drivers a road hazard? Problem definition and political impact. Journal of Aging Studies, 12, 411—427. Corso, J. F. (1992). The functionality of aging sensory systems. In H. Bouma & J. A. M. Graafs (Eds.), Gerontechnology (pp. 51-78). Amsterdam: IOS Press. Davis, A.C. (1989). The prevalence of hearing impairment and reported hearing disability among adults in Great Britain. International Journal of Epidemiology, 18, 911-917. Fozard, J. L., Wolf, E., Bell, B., McFarland, R. A., & Podolsky, S. (1977). Visual perception and communication. In J. E. Birren & K. W. Schaie (Eds.), Handbook of the psychology of aging (pp. 497-534). New York: Van Nostrand Reinhold. Garstecki, D. C. (1987). Self-perceived hearing difficulty in aging adults with acquired hearing loss. Journal of the Academy of Rehabilitative Audiology, 20, 49-60. Gibson, J. J. (1979). The ecological approach to visual perception. Boston: Houghton Mifflin. Grice, H. P. (1975). Logic and conversation. In P. Cole & J. L. Morgan (Eds.), Syntax and semantics. Vol. 3: Indirect speech acts (pp. 41-58). New York: Academic Press. Heinemann, A. W., Colorez, A., Frank, S., & Taylor, D. (1988). Leisure activity participation of elderly individuals with low vision. Gerontologist, 28, 181—184. Herbst, K. G. (1983). Psycho-social consequences of disorders of hearing in the

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elderly. In R. Hinchcliffe (Ed.), Hearing and balance in the elderly (pp. 174200). Edinburgh: Churchill Livingstone. Horowitz, A. (1994). Vision impairment and functional disability among nursing home residents. Gerontologist, 34, 316-323. Horowitz, A. (1995). Aging, vision loss and depression: A review of the research. Aging & Vision News, 7, 1,6,7. Jones, D. A., Victor, C. R., & Vetter, N. J. (1984). Hearing difficulty and its psychological implications for the elderly. Journal of Epidemiology and Community Health, 38, 75-78. Kemper, S. (1992). Language and aging. In E I. M. Craik & T. A. Salthouse (Eds.), Handbook of aging and cognition (pp. 213-270). Hillsdale, NJ: ErIbaum. Kline, D. W., & Scialfa, C. T. (1996). Visual and auditory aging. In J. E. Birren & K. W. Schaie (Eds.), Handbook of the psychology of aging (pp. 181—203). San Diego: Academic Press. Laforge, R. G., Spector, W. D., & Sternberg, J. (1992). The relationship of vision and hearing impairment to one-year mortality and functional decline. Journal of Aging and Health, 4, 126-148. Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179-186. Lichtenstein, M. J., Bess, E H., & Logan, S. A. (1988). Validation of screening tools for identifying hearing-impaired elderly in primary care. Journal of the American Medical Association, 259, 2875-2878. Lighthouse Research Institute. (1995). The Lighthouse National Survey on Vision Loss: The experiences, attitudes and knowledge of middle-aged and older American. New York: The Lighthouse Inc. Lindenberger, U., & Bakes, P. B. (1994). Sensory functioning and intelligence in old age: A strong connection. Psychology and Aging, 9, 339—355. Marron, J. A., & Bailey, I. L. (1982). Visual factors and orientation-mobility performance. American Journal of Optometry and Physiological Optics, 59, 413-426. Marsiske, M., Delius, J., Maas, I., Lindenberger, U., Scherer, H., & Tesch-Romer, C. (1999). Sensory systems in old age. In P.B. Bakes & K.U. Mayer (Eds.), The Berlin Aging Study: Aging from 70 to 100 (pp. 360-383). Cambridge: Cambridge University Press. Marsiske, M., Klumb, P., & Bakes, M. M. (1997). Everyday activity patterns and sensory functioning in old age. Psychology and Aging, 12, 444—457. Mulrow, C. D., Aguilar, C., Endicott, J. E., Velez, R., Tuley, M. R., Charlip, W. S., & Hill, J. A. (1990). Association between hearing impairment and the quality of life of elderly individuals. Journal of the American Geriatrics Society, 38, 45-50. Nowak, M. (1998). Schwerhorigkeit im Alter: Die Unterstiitzung durch den Partner bei Hb'r-und Verstdndnisproblemen [Hearing loss in old age: Partner support in hearing and understanding problems]. Unpublished dissertation, Berlin: Freie Universitat Berlin.

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Pedersen, K., & Rosenhall, U. (1991). Correlations between self-assessed hearing handicap and standard audiometric tests in elderly persons. Scandinavian Audiology, 20, 109-116. Reinhardt, J. P. (1996). The importance of friendship and family support in adapt impairment. Journal of Gerontology: Psychological Sciences. 5IB, 268—278. Richtberg, W. (1990). Was schwerhorig sein bedeutet [The everyday implications of hearing impairment]. GroEburgwedel: Kind. Rudberg, M. A., Furner, S. E., Dunn, J. E., & Cassel, C. K. (1993). The relationship of visual and hearig impairments to disability: An analysis using the Longitudinal Study of Aging. Journal of Gerontology: Medical Sciences, 48, M261-265. Salive, M. E., Guralnik, J., Christen, W., Glynn, R. J., Colsher, P., & Ostfeld, A. M. (1992). Functional blindness and visual impairment in older adults from three communities. Ophthalmology, 99, 1840-1847. Sekuler, R., & Blake, R. (1987). Sensory underload. Psychology Today, 21, 48-51. Sever, J. C., Harry, D. A., & Rittenhouse, T. S. (1989). Using a self-assessment questionaire to identify probable hearing loss among older adults. Perceptual and Motor Skills, 69, 511-514. Tesch-Romer, C., & Wahl, H-W. (1998). Rehabilitation in old age: Psychosocial issues. In A. Hersen & M. Bellack (Series Eds.) and B. Edelstein (Series Ed.), Comprehensive clinical psychology: Vol. 7. Clinical geropsychology (pp. 525—550). Oxford: Elsevier. Tesch-Romer, C. (1997). Psychological effects of hearing aid use in older adults. Journal of Gerontology: Psychological Sciences, 52 B, P127—P138. Tesch-Romer, C. (1999). Schwerhorigkeit im Alter: Belastung, Bewdltigung und Rehabilitation [Hearing loss in old age: stress, coping, and rehabilitation]. Heidelberg: Median. Wahl, H-W. (1997). Altere Menschen mit Sehbeeintrdchtigung: Eine empirische Untersuchung zur Person-Umwelt-Transaktion [Visual impairment in old age: An empirical study of person-environment transaction]. Frankfurt: Peter Lang. Wahl, H-W, Oswald, E, & Zimprich, D. (1999). Everyday competence in visually impaired older adults: A case for person-environment perspectives. Gerontologist, 39, 140-149. Wahl, H-W, Schilling, O., Oswald, E, & Heyl, V. (1999). Psychosocial consequences of age-related visual impairment: Comparison with mobility impaired older adults and long-term outcome. Journal of Gerontology: Psychological Sciences, 54B, P304-P316. Wahl, H-W, Tesch-Romer, C., & Rott, C. (2000). Vision and cognitive functioning in old age. In B. Silverstone, M. A. Lang, B. Rosenthal, & E. Faye (Eds.), The Lighthouse handbook of vision and rehabilitation (pp. 431-439). New York: Oxford University Press. Weinstein, B., & Ventry, I. M. (1983). Audiologic correlates of hearing handicap in the elderly. Journal of Speech and Hearing Research, 26, 148-151.

7

The Impact of Internet Use Over Time on Older Adults: A Field Experiment Karra L. Bikson and Tom K. Bikson

D

o you remember the computer program you were using for e-mail in the 1980s? The pre-Windows text-based interface was not like what most Internet interfaces look like today. In fact, by 1989—when the longitudinal study discussed here ended—fewer than 1% of U.S. adults age 60 and older were using e-mail (Neu, Anderson, & Bikson 1999). The graphic interface, commonplace now, presents a very different environment from the electronic communication medium mastered by older adults in this first longitudinal field experiment on aging and electronic communication. Even though the experiment is more than a decade old, it still provides valuable lessons for older adults and the use of contemporary network media. The field experiment by Bikson, Goodchilds, Huddy, Eveland, and Schneider (1991), funded by the Markle Foundation, addressed three questions about older adults, retirement, and networked information technology: Can increased interaction between retirees and employees nearing retirement improve the transition for role incumbents on both sides? Will access to networked computer systems provide a viable avenue for between-group interaction and information exchange? How do these new technologies function as personal or social media? The research demonstrates that Internet communication can have a powerful impact upon the communication patterns of retired older adults.

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CONTEMPORARY RESEARCH CONTEXT Subsequent research on Internet and computer usage and older adults corroborates the conclusions of Bikson et al. in their 1991 research. Studies continue to indicate a willingness and ability to learn to use computers in older adults, even when computer confidence is low and anxiety is high (e.g., Charness, Schumann, & Boritz, 1992; Kautzmann, 1990; McNeely, 1991; Rousseau & Rogers, 1998; Sherer, 1996; Temple & Gavillet, 1990). For a recent example, Kelley, Morrell, Park, and Mayhorn (1999) found that the most important predictor of continued use of an electronic bulletin board was success at initial training; age, education, and income were not predictors of electronic bulletin board use. Many research studies in the last decade have examined attitudes and anxiety about computers and the age of users (e.g., Charness et al., 1992; Czaja & Sharit, 1998; Dyck & Smither, 1994; Laguna & Babcock, 1997; McNeely, 1991; Marquie, Thon, & Baracat, 1994; Pope-Davis & Twing, 1991; Rousseau & Rogers, 1998; Ryan, Szechtman, & Bodkin, 1992; Sherer, 1996; Temple & Gavillet, 1990). Common stereotypes of the older adult as avoidant of new technology have not been substantiated. Computer anxiety appears to be unrelated to performance and modifiable for people of all age groups with adequate training and support. Current research on training formats and user interfaces for older adults may yield even more successful computing experiences for this population in the future (Echt, Morrell, & Park, 1998; Hutchison, Eastman, & Tirrito, 1997; Moore & Zabrucky, 1995; Zandri & Charness, 1989). It is in this contemporary research context then, that we revisit the field experiment conducted in the late 1980s by Bikson et al. (1991).

AN EXPERIMENTAL COMMUNICATIONS PROJECT What had been really lacking in previous research was experimental design. In past studies of computers and older adults, problems of subject selfselection produced data that had limited generalizability. How different are older adults who choose to use computers and participate in a computer behavior study from the general population at large? A field experiment would allow for random assignment of group members to computer-based versus traditional support in the completion of identical activities. An effective design should also have the following characteristics. If individuals are expected to become familiar with new information technology, accomplish a meaningful goal, and in the process have an op-

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portunity to form or reform group structures and social relations, it would require an intervention of at least 1 year's time. Further, if individuals in both "electronic" and "standard" conditions were to participate in a year-long effort, a strong mission focus was essential; the goal for group activity and the role of communication would have to be highly motivating. In addition, for noncolocated individuals to agree to take part (and to continue to participate) in randomly assigned groups, they should be selected from a common "community"; that is, they should come from a common social environment, share some concerns, and have some reason to think they might want to work with one another (see also Bikson, 1980; Markus, 1987). Last—and definitely not least—a funding source willing to support a rather costly experiment of this sort was needed! Given these constraints, the experiment took as its basis a task force on the transition to retirement, funded by a nonprofit organization whose two programmatic interests were aging and adult development and social uses of media.

FIELD PROCEDURES Volunteers from one of the older and larger corporations in the greater Los Angeles (California) area were recruited to take part in a year-long effort focused on the transition to retirement: thinking about it, planning for it, and adjusting to it in a time when U.S. policies and organizational practices were also undergoing change. The letter of solicitation told prospective participants, in part The unusual and, we hope, exciting aspect of the study is that we are looking to you as someone directly involved to provide the issues and explore their implications. What do you envision as the goods and bads, the major unknowns, the unexpected pitfalls and delights, in retirement planning today? We ask you to consider joining us and other . . . colleagues in this effort. We are forming two retirement Task Forces, and the charge to each is straightforward. Members, half retired and half actively employed, will work together over the course of a year. Their task will be to consider, deliberate, probe, and develop a set of recommendations about preretirement planning—recommendations that can be addressed to persons nearing retirement, to organizations (including but not limited to [yours]), and to professionals involved in preretirement planning. To realize this goal, the

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Table 7.1

Field Experiment: Electronic versus Standard Task Groups

Electronic group

Standard group

40 Members 20 Retired 20 Employed

40 Members 20 Retired 20 Employed

Average age of employees was 60.1 and of retirees was 62.8.

Task Force participants may meet, form subgroups, correspond, work hard, play a little, or whatever you decide will best accomplish our joint purpose. Additionally, members of one of the two Task Forces will have the option of communicating with each other and conducting their business with the aid of computers. Each member of this electronic group will have access to a microcomputer. Because we are interested in the possible advantages and disadvantages of ELECTRONIC communication compared with more STANDARD media, we will randomly appoint Task Force volunteers to either group. We want you to consider participating whether or not you have used a computer before. (Provided from the archives of the Bikson et al. [1991] project by the principal investigator.) The project enrolled 80 members, all of them middle-to upper-level professionals or managers with prior problem-solving or decision-making responsibility on the job (all men). Those who were retired had done so in the past 4 years, and those who were employed were all currently eligible to retire. Conditions were assigned after recruitment, with subjects distributed into the 4 cells of the design as illustrated in Table 7.1. Those in the electronic group were provided with networked microcomputers, communications software adapted from the interface to the unix mail handling system (mh/unix), built-in modems, hard disks, and local printers. Limited additional software was supplied, including text editing and formatting capabilities, a spreadsheet, a database management system, games, and Basic (a more complete description is available in Bikson, Eden, Gillogly, Hahm, Payne, & Shapiro (1987). Meeting support, phone calls, duplication, postage, and other supplies and services were provided for both groups. Highly structured individual interviews were administered to all subjects at the beginning of the project and three times thereafter. Interviews gathered detailed sociometric data about interactions among group members in addition to information about other aspects of subjects' work and social lives and their evaluations of task force activity. In addition, for the elec-

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tronic group, automated usage logs, user experiences and assessments, and detailed electronic network data were collected.

BASELINE INFORMATION Examination of the baseline data indicated that random assignment had in fact produced two quite similar work groups. In both the electronic and the standard task forces, for instance, mean age was 61 (ages ranged from 55 to 71). Prior computer experience was also much the same across conditions. About half in each task force had had some sort of contact with outputs from batch-processing mainframe computers at work, and about one quarter had tried using a small home computer (typically for games). None had ever used computer-based communications. An open-ended item at the end of the initial interview asked subjects why they had agreed to participate in the project (Table 7.2). In both conditions a similar pattern emerged: retirees were interested in giving information and employees were interested in getting information about the transition to retirement; the task force topic itself was a strong incentive. The other often-mentioned motivation was curiosity about research procedures. Access to the technology was infrequently cited as an incentive; only 10% of the standard group and 5% of the electronic group mentioned they were interested in computers. To enable these groups to get underway, two start-up meetings for each task force were scheduled and held about a month apart. Each of these gatherings was chaired by a professional facilitator. The first meeting provided an opportunity for announcing the assignment to experimental conTable 7.2

Reasons for Participation Percentage

Reason Want to get retirement information Want to give retirement information Want to improve DWP program Interested in social contact Interested in RAND/research Want a computer to use

Retired

Employed

10

64

37 7 5 66 12

15 5 0 33 3

Note: Responses sum to more than 100% because people may have mentioned several reasons for their participation.

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Issue Categories Devised to Organize Task Force Work

Health Finances Use of time Family and social adjustment Self-esteem Retirement planning processes

dition and for brainstorming about retirement issues that the task force might address. At the second meeting, these issues were prioritized and grouped. Then the general charge to the task force was discussed in more detail, and the membership devised organizational arrangements and procedures for fulfilling it. Table 7.3 gives the major categories into which the issues were classified. Initially, the structure of the two task forces was much the same. Each divided the basic mission into smaller issue areas suitable for attention by subgroups. Although the names of the subdomains differed somewhat between the two task forces, their orientations were quite congruent; each eventually settled on six (as shown in Table 7.3). The subgroups in turn elected chairs, with the set of six chairs forming a task force steering committee. Once a structure was in place, the participants were on their own. Subgroup membership was by self-selection in both task forces. In both task forces as well, each subgroup's membership was roughly constituted half and half of workers and retirees—in the standard task force by design, in the other by happy accident. That is, the standard group spent considerable effort getting the "right" balance of employees and retirees in each subgroup while making sure that everyone's preferences were accommodated. Each subgroup enrolled about six or seven people. In the electronic task force, by contrast, about half the participants chose to participate in more than one subgroup; the size of the groups varied from 6 to 15, averaging more than 10 members. Apparently the members of the electronic task force thought that their technology would allow them to work on as many topics as interested them. To be sure, not every member participated in all subgroups to the same extent, but there was a much broader range of involvement than in the standard group. Succeeding sections of this chapter compare social structures and processes over time for the two groups, describe the pattern of electronic interaction that emerged within the electronic condition, and discuss participant assessments of task force activity.

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WORK GROUP STRUCTURES AND PROCESSES A general theme of the hypotheses motivating this research was that the processes, patterns, and structures of interaction among participants would be significantly affected over the life of the project by the nature of the technology available. That is, the social system created and maintained by the interplay between the electronic task force and its computer network would evolve differently from that created and maintained by the interplay between the standard task force and its more conventional work technology (meeting rooms, blackboards, telephones, and paper mail). To permit a detailed mapping of the "social space" of each task force as well as the patterns developing within it, a portion of every interview addressed the nature and extent of relationships among respondents. These standardized inquiries used as stimulus materials a set of participant identification (ID) cards: laminated photos with names for each task force member. Respondents sorted the ID cards and answered a number of questions about each familiar name or face. From such items, three measures were constructed reflecting varying degrees of interpersonal attachment: 1. Recognition, reflecting other task force members with which a subject is familiar at least by recognizing the name or face 2. Knowing, or reciprocal acknowledgement between pairs of subjects in the task force that they know each other somewhat or very well 3. Contact, or having been in touch with any of the other task force members (in person, by phone, by memo, by computer, or by a combination of these) in the past 2 weeks. At baseline (i.e., prior to the experiment) subjects on average "recognized" more than one third of the other members of their task force, but "knew" only about 10% of them. Very few instances of actual contact were reported. Virtually no differences between the two experimental groups on these measures were found. Much stronger differences, however, were observed as a function of work situation (employed versus retired) across the two task forces; measures of recognition and knowing, and especially of contact, were significantly lower for retirees than they were for those still employed. These initial differences had been expected, in part because retirees are no longer a part of the official social structure of work and in part because they are geographically distant from their former work colleagues as well as from one another. As the experiment progressed, the percentage of

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Contact Density

Figure 7.1

"Social contact space," by time period.

potential social relations represented by actual social relations, or the "density" of the social space, increased for both task forces. Figure 7.1, for instance, shows increasing contact over time, and the most marked increase occurs among electronic group retirees. Quite similar patterns of effect emerged for all three measures of social space. For contact density, both experimental condition (F = 3.9, p < 0.05) and the retiree versus employee difference (F = 18.9, p < 0.001) are sources of main effects; the condition by status interaction term is also significant (F = 15.6, p < 0.001). The findings provide striking evidence that interactive information media can help reduce barriers to social interaction in distributed groups of older adults. These results illustrate a theme that characterizes much of the rest of the study. The standard task force remained predominantly the preserve of the employees during the period of the experiment, whereas interactions in the electronic task force, starting from the same point, became increasingly the domain of the retirees. Besides differences in level of contact, the experimental conditions appear to have supported other differences in social roles and processes. For example, the two task forces varied in the degree of centralization that characterized their communication networks. (Centralization is the extent to which group communications are concentrated in relatively fewer group members.) Overall, the study found a trend of decreasing centralization over time for the electronic group. In both groups, employee members' interactions show a slight tendency toward increased centralization over

Impact of Internet Use Table 7.4

Time 1 to Time 2 Time 2 to Time 3 Time 3 to Time 4

135

Continuity of Leadership Structure Standard

Electronic

0.47

0.19 0.28 0.21

0.69 0.57

Pearson correlations.

time. High centralization scores for retirees in the standard condition reflect their overall lower level of participation as well as the role of a small number of key individuals in this task force. Retirees in the electronic task force, by contrast, finished the project in a significantly less centralized position than when they began. In general, centralization reflects both participation and distribution of control; it is clear that the electronic task force completed its work in a considerably more participative mode than did the standard group. Likewise, the standard task force experienced significantly greater stability of leadership roles during the experiment than did the electronic group. For heuristic purposes, "leaders" were defined as the five most central individuals in each task force at each period in time. Summing over the four time periods, then, there are a total of 20 possible leadership slots for each task force. In the standard group, 13 people fill those 20 leader positions, with 7 repeating the role at more than one time period; all but 1 are employees. In the electronic group, there are 16 leaders, 4 of whom are repeaters; 7 are employees, 9 retirees. Table 7.4 shows the correlations of leadership structure over time. These analyses confirm that in the computer-supported task force, leadership roles are more broadly shared over time, and they are much less dominated by employees than are leadership roles in the standard condition. In general, then, we see an emergent pattern characterized by initial similarity of task force social structures and group processes, followed by increasing differentiation. The standard group shifts toward less participation (particularly by retirees), greater centralization, and more stable leadership; the electronic group shows broadening participation, with retirees holding a majority of leadership roles and a fluctuating leadership pattern related to functional needs. It seems clear that the technology supplied to the electronic group enabled a much richer and more dense interaction structure than could be supported by the technology available to the standard group. This finding supports prior research that finds that interactive technologies permit rapid and widespread exchange, overcoming barriers to

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Table 7.5

Reported Contact: Types of Media and Correlations Between them

Scheduled meetings Unscheduled meetings Telephone Letters/memos

Standard (N= 178)

Electronic (N = 408)

N=36

N = 220 0.80 N= 84 0.47 N= 41 0.32 7V= 8 0.14 N= 55 0.38

0.45 7V= 116 0.83 N = 23 0.36 N =2 0.11

Electronic mail

Pearson correlations.

group participation and promoting more egalitarian task processes (e.g., Hiltz, 1985; Kiesler, Siegal, & McGuire, 1984). The technology was also presumably useful for helping the electronic task force overcome physical barriers to group interactions (see Eveland and Bikson, 1987). In particular, members of the standard task force conducted a relatively high percentage of their business via communication routes that relied on proximity and chance, making it difficult for retirees to participate; electronic task force members, by contrast, used modes that encouraged or at least enabled retiree participation. Both task forces had access to a full range of meeting, correspondence and telephone capabilities, with computer-based communication provided in addition to the electronic group. In the last interview, sociometric questions were modified to include, after each reported contact, an item tapping the manner of contact. Table 7.5 shows the number of contacts reported in the 2 weeks prior to the last interview as a function of contact medium. The maximum possible number of contacts in any one cell is (N(N-l)/2), or 780 for the 40 individuals in each group. For the standard group, in the last period surveyed, contacts most often took the form of unscheduled meetings; not surprisingly, retirees tended to be out of the unscheduled meeting loop, because these almost always occurred at the workplace. Retirees participated in only 12% of the unscheduled meetings reported by standard task force members (versus 25% of those reported by the electronic group). For electronic task force members, by contrast, contacts tended to be primarily in the form of scheduled meetings, with less reliance on unscheduled meetings and relatively heavy use of electronic mail. Retirees took part in 75% of the scheduled meetings re-

Impact of Internet Use Table 7.6 Task Force: Standard Electronic

137

Percentage of Contacts Attributed to "Chance" Time 1

Time 2

Time 3

Time 4

41 53

32 24

33 26

55 12

ported by electronic task force members, whereas their counterparts in the standard group participated in 19% of the scheduled meetings reported. Moreover, in the electronic group, retirees accounted for about 80% of the electronic mail that was sent. Table 7.6 shows the percentage of contacts in each task force at each time period that were reported as being "chance" contacts (rather than scheduled). For both task forces, chance contacts were almost exclusively a mode available to employees; anywhere from 92% to 100% of chance contacts involved employees, depending on the time period. These data indicate that throughout the field experiment the standard task force was characterized by significantly higher levels of chance contact. On the other hand, although the electronic task force started out with approximately the same levels of chance contacts, it quickly came to rely on methods other than chance to carry out its work; by Time 4, it reported less than one-fourth the percentage of chance contacts of the standard task force. If, as these data suggest, electronic communication media effectively alleviate the otherwise centrifugal effects of physical distance on social network participation, one should expect to see quite different patterns of relationships between distance and interaction for members of the two task forces. In fact, the differences observed were rather striking. Participation is strongly and negatively correlated with distance for the standard retirees; that is, the farther away they live, the less they take part. For the electronic retirees, participation is somewhat negatively correlated with distance at Time 1 (before most of them were online). Subsequent time periods are characterized by a somewhat positive or at least neutral relationship between distance and participation. It is evident that, whatever else electronic tools did for this task force, they permitted retirees who were physically distant from the workplace to be centrally involved with each other and with group activity. Evidence about electronic tools and temporal barriers to interaction can be examined only within the electronic condition. For members of the electronic task force, the logging of message header data provided a way to determine when different types of people preferred to do online work.

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Retirees in general and steering committee members in particular differ notably from employees (it should be recalled that the subgroup chairs in this task force were all retirees). The employees tend to come into the office early and log on (the 7 to 8 AM, peak) and then to check in again just after lunch. They do not stay in the office after 5 PM, at least not to do computing. (It is worth noting that the computers for employees were all located at the office, whereas those for the retirees were in the retirees' homes. Whether the employees would have exhibited retiree-like work patterns if their machines had been differently located is an open question.) The retirees, by contrast, rise later, eat a later lunch, and often sign on again after dinner for an evening session. The chairs, in fact, did a great deal of their work in the evenings. These differences, although not intrinsically surprising, confirm that people use electronic communications in ways that suit their own schedules, potentially overcoming temporal as well as spatial barriers to group participation.

THE STRUCTURE OF THE ELECTRONIC NETWORK As previously explained, the research project retained a log of the headers of all network messages exchanged among electronic task force participants over the project year. This log included the sender's ID, the receivers ID, the message date and time, and—if the message was a reply—the date and time of the original message. Topic lines were not retained to protect the confidentiality of communications. These data comprise a rich source of information about the structure of the electronic network and the online behavior of its participants. During the project year, 4091 messages were sent by the 40 people taking part in the electronic network. These messages were not evenly distributed across task force members. As several other studies have reported (see Eveland and Bikson, 1987), approximately 25% of the people accounted for about 75% of the messages sent. The 10 "high senders" in this case included the 6 subcommittee chairs (all retirees); and only 1 employee emerged as a heavy sender. On average, chairs sent four to five times as many messages per month as other participants. Of course, chairs also received considerably more messages than did other people; much of this information was apparently exchanged among themselves. Although retirees tended to send more messages than employees, they tended to receive just about the same number. Operating an electronic network is labor intensive and adequate "humanware" is crucial to its performance. Messages to project staff were also logged by month. After an initially high level of sending during the training

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139

and early learning period (March and April), messages fell off—only to rise again as the due date for an interim report approached (June). Staff messages rose again in October and November as task force members were learning to use their database program to analyze some survey data they had collected from a larger pool of retirees. Not surprisingly, subcommittee chairs were the predominant generators of staff inquiries, although those who took on the main burden of data analysis made their share of inquiries as well. The low level of employee inquiries is probably attributable to the fact that relatively few of them undertook anything particularly unusual or risky with the system, and also to the availability of within group expertise. Toward the end of the project year, a number of members of the electronic task force had become highly proficient users of the system and its documentation and were able to extend help to others who needed it.

OUTCOMES Besides wanting to understand how access to a networked computer system might influence group structures and interactions, the field study also sought to learn what effects it might have on participants' perceptions and evaluations of task force activity. In the following we examine a number of outcome measures.

THE COMPUTER EXPERIENCE Electronic task force members were asked at three points in time, starting with the second interview, to give their "impressions" of the task force computer using 5-point rating scales. Responses to six adjectival scales are summarized in Table 7.7 (where 1 = not very and 5 = very); they were treated as outcomes in repeated measures analyses of variance with employment status serving as the independent factor. The two positive adjectives, Fun and Gratifying, show similar patterns (not surprisingly, because their average correlation for the three periods is 0.71). Retirees' ratings start out and remain very positive; employees' subjective reactions are less positive initially and improve over time. These data suggest that, for this sample, the computers were not experienced as novelties or gadgets whose interest value would diminish over the year. Neither did their capacity to challenge or intimidate wear off; rather, both dependent measures exhibit a significant effect for time. Mean ratings are higher among retirees (significantly so for the Challenging scale), who were the

140

Communication and Sociocultural Issues Table 7.7

Impression Fun:a Retirees Employees Gratifying Retirees Employees Challenging Retirees Employees Intimidating Retirees Employees Frustrating Retirees Employees Disappointing Retirees Employees

Impressions of Computer Use Means Time 3

F

F

Time 2

Time 4

(status)

(time)

4.4

4.5

4.4

5.0*

n.s.

3.7

3.5

4.0

4.6 3.4

4.3 3.6

4.4 3.7

9.4**

n.s.

4.5 3.9

4.5 3.8

4.8 4.4

8.0**

4.8**

2.3 2.4

2.9 2.7

3.15 2.6

n.s.

3.76*

3.1 2.8

3.2 2.8

3.3 2.7

n.s.

n.s.

1.7

1.9

n.s.

2.3

1.9 2.0

n.s.

2.1

Note: All ratings were made on 5—point scales, where 1 = not very and 5 = very for each adjective; n.s. = not significant. "Time x status, the interaction term, yields a value of F = 3.2, p < 0.05. No other interactions in the analyses summarized were statistically significant. *p < 0.05 **/> < 0.01

most vigorous users, and increase as use increases for both groups. One may conclude that the more the task force tried to do with its computers, the more impressive it found them. Happily, the members were not in the main disappointed by their efforts, although they were accompanied by an intermediate and consistent level of frustration throughout.

THE TASK EXPERIENCE To explore the comparative effectiveness of computer-based and conventional media for carrying out group activities, members of both task forces were asked to evaluate their efforts. After a series of items about specific activities, two general questions were raised: How well has your study group(s) done its task, and how well has your task force done its work? As before, responses were obtained using 5-point scales and subsequently examined in

Impact of Internet Use Table 7.8 Task force Retirees Electronic Standard Employees Electronic Standard

141

How Well Has Your Task Force Done Its Work? Time 2

Means Time 3

Time 4

2.8 3.5

3.2

3.4

3.7 3.3

2.8

2.9 3.6

3.8 3.4

3.7

Note: Higher numbers mean better performance ratings (1 = not very well; 5 = very well). Condition: F = 2.99, 0.05 < p < 0.10. Time: F= 5.53,^ < 0.01. Condition x time: F = 13.7, p < 0.001.

repeated measures analyses of variance. Results for the two analyses yielded quite similar patterns. Table 7.8 summarizes assessments of how well the task force did its work. After 3 months, members of the standard task force gave their work higher performance ratings whether the evaluation targeted subgroups (F = 11.9, p < 0.001) or the group as a whole (F = 20.4, p < 0.001). By the end of the project year, however, the situation was reversed; electronic group members gave higher evaluations to their subgroups (F = 2.84, 0.05 < p < 0.10) and their task force (F - 3.89, p < 0.05). The net effect is a very strong time-by-condition interaction, a function of increasingly positive accomplishment judgments on the part of the electronic group. The pattern is not difficult to interpret. Standard task force members tackled their shared charge immediately, whereas their counterparts in the electronic condition put most of their energy into learning to use the computer system and initially made little headway toward their substantive goal. After mastering the basics, however, they turned more of their efforts to the task itself and, with the electronic tools at their disposal, were able to make great progress. Early in the process, several participants in both task forces suspected that electronic information media might be as much a hindrance as a help, especially for employees whose job commitments made it difficult to set aside time for both learning and task force work. Informal comments to this effect led the research team to include in interview protocols a direct question about the influence of experimental condition on task force performance (Table 7.9). These judgments, like the evaluations of task force work, show a significant time by condition effect. Over time, members of the electronic task

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Communication and Sociocultural Issues

Table 7.9 Task force Retirees Electronic Standard Employees Electronic Standard

How Much Did Your Experimental Condition Help or Hinder? Means Time 3

Time 4

3.1

4.0 2.9

4.6 2.7

3.3 3.8

3.5 4.1

3.9 3.7

Time 2

3.9

Note: Higher numbers mean the condition is perceived as more helpful. Condition: F = 7.58, p < 0.001. Condition x status: F = 16.51, p < 0.001. Condition x time: F = 10.32, p < 0.001.

force become increasingly convinced that their experimental assignment helped them accomplish their work, whereas standard task force members become less certain that their assignment was advantageous. More illuminating, however, is the very strong interaction of experimental condition with work status. Retirees in the electronic condition and employees in the standard condition give their experimental assignments relatively high marks. Assignments were just the opposite initially for employees in the electronic condition and retirees in the standard condition; with time, however, condition assessments by electronic group employees show substantial improvement, whereas standard retirees judge themselves by far the most disadvantaged.

THE RETIREMENT EXPERIENCE A basic requirement for this field experiment was to design the research around a real purpose for bringing into interaction a collection of individuals who are not colocated and who may not know one another but who could probably benefit by being in communication. In particular, people who have retired might suffer from the loss of contact with colleagues with whom they had developed meaningful social relationships. If so, having access to an avenue for staying in touch with work friends could be an interesting and positive experience. Concomitantly, those still employed but nearing retirement might benefit from involvement with already-retired peers. Research literature suggests that those nearing retirement are worried about the transition and are uncertain about what it entails. These hypotheses

Impact of Internet Use Table 7.10

143

Are There People You Will Continue to See? People You Didn't Know Before?

Task force Retirees Electronic Standard Employees Electronic Standard

Mean number named

2.9 0.2 0.9 0.4

Condition: F = 33.12, p < 0.001. Status: F = 6.91, f < 0.01. Condition x status: F = 3.21, 0.05 < p < 0.10.

assume that interaction among role incumbents on either side of the retirement transition will have positive effects for both. To address the first question—will task force interactions create social ties among retirees and between them and their still-employed counterparts—subjects were asked during the exit interview to tell whom, among people they met on the task force, they think they will continue to see socially. Responses were coded for employment status and counted; the results are summarized in Table 7.10. Between-conditions comparison yielded a strong effect, with those in the electronic task force significantly more likely to stay in contact with retirees (F = 20.49, p < 0.001). Although the dependent measure represents expectation and not necessarily reality, the strength and direction of effect suggests electronic communication will support social ties between retirees and their colleagues. To address the second question—whether task force interactions will ameliorate employees' views of retirement—subjects were asked during both the first and last interviews whether or not they looked forward to retirement. Responses, gathered on a 5—point scale (1 = not very much, 5 = very much), yielded a positive effect for time (F = 4.48, p < 0.05); the data are summarized in Table 7.11. These findings are interpreted to mean that communication with retirees had improved employee attitudes toward retirement. (The constancy of retirees' responses to the same question helps rule out history and other potential confounds.) Moreover, the effect interacted with experimental condition, being strongest for those in the electronic task force (F = 3.23, 0.05 < p < 0.10). Computer-based interactions, then, seem a viable avenue for the communication of attitudes and values.

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Communication and Sociocultural Issues Table 7.11

Do/Did You Look Forward to Retirement? Me ans

Task force Retirees Electronic Standard Employees Electronic Standard

Time 1

Time 4

3.6 3.9

3.6 3.9

3.6 3.2

4.2 3.5

Note: The higher the number, the more the respondent looks forward to retirement. Time: F = 4.48, p < 0.05. Time x status: F = 5.57, p < 0.05. Condition x status: F = 3.23, 0.05 p < 0.10.

DISCUSSION Experience with the field experiment, both informal and analytic, reinforces the value of treating the interacting group as a critical unit of study, employing embedded levels of analysis. For some questions (e.g., effects of communication medium on attitudes), the individual is the required analytic unit. Individual behavior is, of course, influenced by group membership, and for other analyses the primary group is an appropriate focus of study (e.g., questions about relative amounts of within-group and betweengroup communication). The behavior of primary groups (such as the issueoriented subcommittees), however, can be interpreted only in the context of the larger social space in which they are embedded. Using a research design that embeds individuals within complex groups located in a larger social space for purposes of collaborative activity over a period of time also permits observing how leadership roles, group structures and interaction patterns evolve and change. Next, the strikingly divergent courses taken by two initially similar groups provided with different technologies to support their activity illustrate the intimate interplay over time of communication tools, task definitions, and group procedures and practices. The computer-based network quickly became not an exogenous force acting on a group but rather part of the web of interpersonal and task interactions. The consequences for group processes and structures are dramatic and begin to appear almost immediately. Electronically supported groups develop a richer communication structure with less hierarchical differentiation, broader participation, and more fluctuating and situational leadership structures. This appears in turn to be associated with greater feelings of involvement in the task and greater sat-

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isfaction and identification with group products. The electronic technology substantially weakens the constraints posed by time and space that accompany conventional group interaction tools. Employees and retirees tend to use the computer on different time schedules, apparently reflecting lifestyle differences, and can interact through the asynchronous medium without having to be on the same schedules. Conventional media (particularly informal or unscheduled meetings) tend to disadvantage those physically distant from the central locus of the activity; by contrast, electronic media allow direct access to that locus irrespective of physical distance. In any case, it is evident that the Internet infrastructure is not a simple substitute for in-person contact, telephone calls, print correspondence, or any other more conventional medium. Rather, as this experiment illustrates, messaging establishes a quite distinct avenue for exchange whose nature is still unclear and evolving. The Internet environment is a rich context in which doing activities and sharing activities become virtually indistinguishable, and the frequency and spontaneity of interactions equally facilitate task and social exchange. In fact, far from replacing other media, electronic media add a new dimension to their usability by improving the efficiency of direct contacts, providing easy access to shared data, and allowing more efficient production of print documents. As the functionality of computerbased tools improves and they become increasingly integrated with adjuncts such as voice messaging, fax, and related technologies, we expect to see this trend toward multimedia interaction through a common infrastructure expand and improve in effectiveness. In the meantime, the use of even relatively low-technology systems of the sort studied here seems promising not only for group task support but also for the communication of affect and the establishment and maintenance of both weak and durable social ties. However, humanware requirements are substantial. Networked technology to support group activity is not self-enacting but rather requires significant investments of time and energy in learning how to use the tools to best advantage, on the part of both individuals and groups. The bounds of participation in group activity are set less by preexisting position and status and more by capacity to master and leverage the tools. Creating and maintaining an Internet-supported group requires the willingness of the participants to invest resources in a learning period characterized by relatively low output and relatively high consumption of outside assistance. However, as mastery of the tools is gained, progress happens quickly and makes up for—and may surpass—the learning period lag. Each new tool probably initiates similar phases. Thus, willingness to tolerate an uneven pace of activity appears to be necessary for taking advantage of continuing technological advances.

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IMPLICATIONS Between the time when the field experiment was conducted and now, great technical leaps forward have occurred. Costs of processing power have decreased while interfaces have improved dramatically. Assistive technologies are extending Internet access to individuals with a range of disabilities regardless of age (National Research Council, 1997). Electronic communication is no longer an alien medium—we hear about it everyday. However, with respect to Internet access, people over 60 years of age are lagging further behind than ever, even when socioeconomic status and other demographic variables are controlled (Bikson & Panis, 1999). The digital divide, then, is also an age divide. The findings of the study reported here indicate that the substantial and growing Internet age gap is not a function of change resistance or diminished cognitive ability. Instead, social and contextual factors are more likely to explain whether or not older adults will adopt the Internet as a mode of communication. As we have seen, given a meaningful reason to communicate, some training, access to help, and a networked computer, older adults can be a formidable presence on the Internet. What conclusions can be drawn, then, from recent census data that show that, although all age groups are making more use of the Internet today, the over-60 group has fallen further behind, relatively speaking, in the past decade? Given the success of the retirees in the electronic group in adopting and adapting to a 1987-era Internet interface, the findings rule out user unfriendliness of the technology as the reason. It is better explained by a social policy environment that has yet to address issues of access for older adults and others. Personal computers and the Internet are not yet a plug and play medium; starting up and maintaining usage requires considerable technical support. Further, financial support is probably requisite to create access to the Internet for low income people of all ages (Anderson, Bikson, Law, & Mitchell, 1995). Policies to ensure universal access to telephony and utilities have been successful. Now it is time to consider similar policies for Internet access. The benefits should be numerous. Older adults would have an important means for retaining or developing (or both) connections with social support networks, government services, and health services. This type of connectivity is multipurpose, providing both interpersonal communication and instrumental support. Further, it can create a form of mobility for people with disabilities to "get around" virtually. In general, the more people are able to retain independent living arrangements, the greater the benefits to individuals, the government, and society.

Impact of Internet Use 147

Moreover, the study findings suggest that nonworking older adults may be a particularly prime population for network activity. With typically greater access to free time, decreased employment-related social interaction, and reasonable discretionary income in a period when the Internet is expanding, the user interface is vastly improved, and there are important aging-related online services available, older adults could in principle become the fastestgrowing population on the Internet. Senior Policy Advisor and Director of the National Partnership for Reinventing Government, Morley Winograd, said recently, "By 2004, ...services to individuals, such as Social Security, will be delivered through the Internet" (Business of Government, 1999, p. 14). It is time to do the experiment again, calling attention to the policy implications and broadening the range of participants and interactions. To our knowledge, this experiment has not been replicated, and it would be well worth doing now, given more flexible user interfaces and vastly more online resources.

ACKNOWLEDGMENTS this chapter describes research activities and results from a field experiment supported by a grant from The Markle Foundation. The research was carried out within RAND's Domestic Research Division. RAND also shared in the costs of computer equipment used in the field experiment. We are grateful to the Los Angeles Department of Water and Power for providing the organizational context for the field experiment and for giving the research effort its continuous, willing and able cooperation. We thank Steven Moga and Thomas Bikson for their technical assistance.

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Moore, D., & Zabrucky, K. (1995). Adult age differences in comprehension and memory for computer-displayed and printed text. Educational Gerontology, 21, 139-150. National Research Council, Computer Science and Telecommunications Board. (1997). More than screen deep: Toward every-citizen interfaces to the nation's information infrastructure. Washington, D.C.: National Academy Press. Neu, C. R., Anderson, R. H., & Bikson, T. K. (1999). Sending your government a message: E-mail communication between citizens and government. Santa Monica, CA: RAND, MR-1095-MF. Pope-Davis, D. B., & Twing, J. S. (1991). The effects of age, gender, and experience on measures of attitude regarding computers. Computers in Human Behavior, 7, 333-339. Rousseau, G. K., & Rogers, W. A. (1998). Computer usage patterns of university faculty members across the life span. Computers in Human Behavior, 14, 417— 428. Ryan, E. B., Szechtman, B., & Bodkin, J. (1992). Attitudes toward younger and older adults learning to use computers. Journals of Gerontology, 47, 96-101. Sherer, M. (1996). The impact of using personal computers on the lives of nursing home residents. Physical & Occupational Therapy in Geriatrics, 14, 13—31. Temple, L. L., & Gavillet, M. (1990). The development of computer confidence in seniors: An assessment of changes in computer anxiety and computer literacy. Activities, Adaptation and Aging, 14, 63-76. Zandri, E., & Charness, N. (1989). Training older and younger adults to use software. Educational Gerontology, 15, 615—631.

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Aging, Communication, and Interface Design Lila E Laux

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hat is an interface and why are we concerned about interface design in the context of aging and communication? To a human factors engineer or engineering psychologist, the interface is any point where a person and a "thing" interact. Human factors engineers are professionals who focus on human beings and their interactions with the things and processes they encounter in work and in living. They apply their knowledge about people's capabilities and limitations to designing "things" and processes that people can use efficiently and effectively. Some of these things have clear physical attributes: printed material, skillet handles, computer displays, and pill bottles. For these things we can specify the font size, the contrast ratio between text and background, button size, press force, handle circumference, weight, and so on as needed to make the devices usable by older people just like they are for the rest of the population. Other things are more conceptual: voice menus, Web-site navigation, directions for performing complex activities like sending a fax, or the actions required to receive e-mail on a hand-held telephone. The interface specifications that ensure usability for all users with regard to things that typically involve interfacing with a computer are much harder to formulate. There are many challenges associated with designing usable communication systems and communication devices when the systems are integrated with computers. Age-related decrements in sensory, perceptual, cognitive, and psychomotor functioning increase both the need for good interaction design (Cooper, 1999) and the difficulty in ensuring it (Laux, 1995, 1997). 153

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Interaction design includes a task analysis that details the steps people must carry out to reach the end goal they want to accomplish with the device. It also includes determining the order in which steps should be completed. This is then translated into actions to be performed with the device (e.g., input, perceiving choices, responding to requests, decision making). Interface components (e.g., menus, buttons, speech input) are selected that allow users to accomplish those actions efficiently and effectively. As the complexity and portability of communication devices increase and the size of many of these devices decreases, the number and complexity of problems associated with making such devices usable by older members of the population are also increasing. Task analyses of cellular telephone use, for instance, reveal that users can perform a variety of tasks, each relatively complex. Given the market-driven rush to introduce many new computer-integrated communication devices, how can the creators and developers of these devices and processes ensure that all members of the community can access their functionality effectively and efficiently? We can do this by applying human-factors principles. This involves understanding the limitations and the needs of elders and people with disabling conditions and designing to accommodate them. Human-factors specialists are concerned about elements of communication systems such as visual displays, keyboards and touchpads, handsets, microphones, and so on. It is fairly straightforward to provide guidance for developing devices to meet all users' needs with regard to sensory capabilities and psychomotor functioning - we can specify button size, color, amplification, backlighting requirements, touch pressure, and other dimensions. (Kroemer & Grandjean, 1997). To design communications systems and processes that work for older populations and other populations with limiting cognitive conditions, as well as the general population, however, we must also be concerned with the less concrete elements of the human and communication-device interaction. These elements include users' mental models of how these devices work and what they need to do to use the device, their ability to learn, their attentional capacity, the efficiency of their working memory, their reasoning skills, and the strategies they develop for using telecommunications devices. Evaluating all of these components is an integral part of the critical interaction design (Cooper, 1999). Users' mental models, or conceptual understanding of the way devices work, are typically developed through experience with similar types of devices. Because some of the new telecommunications devices are outgrowths of earlier devices, users will approach them with the mental models they developed in interacting with those devices (e.g., telephones, television, and radios). To the extent that the new devices differ in functionality and function, users may be confused.

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In this chapter you will not learn how to carry out the interaction analysis or iterative design process, both of which are absolutely critical to the development process. Nor will we tell you how to develop a user profile. There are numerous excellent texts on these topics to which you may refer (e.g., Coe, 1996; Gardner-Bonneau, 1999; Hackos & Redish, 1998; Kantowitz & Sorkin, 1983; Meister, 1989; Salvendy, 1987; Sanders & McCormick, 1987; Wickens, 1992). Instead, the chapter begins by defining what constitutes a telecommunications device and what the Telecommunications Act of 1996 requires of manufacturers of telecommunication devices, especially with regard to populations with functional disabilities. Then a process is suggested for identifying the interface demands of telecommunications devices and pinpointing where elders and users with disabilities may have difficulties with a specific device or device type. Finally, suggestions are given regarding how to ensure that telecommunications devices are accessible to the largest user population.

THE TELECOMMUNICATIONS ACT The Telecommunications Act (1996) was enacted by the U. S. Congress to ensure that all players in the expanding telecommunications field would have a fair chance to develop and market this technology and that the technology would meet the needs of most users. The Act requires that telecommunications devices be accessible to and usable by individuals with disabilities. This language clearly means that telecommunications devices must also be accessible to and usable by elders with age-related functional decrements. Enforcement of the provisions of the Telecommunications Act (1996) is left in the hands of the Federal Communications Commission. The Telecommunications Act Accessibility Guidelines (Architectural and Transportation Barriers Compliance Board, 1998) further state that "manufacturers shall identify barriers to accessibility and usability as part of a product design and development process" (appendix to Part 1193 Subpart B 1193.23a). The appendix also discusses at length the accessibility requirements for information, documentation, and training (Subpart C1193.33); input, control, and mechanical functions (Subpart C 1193.41); and output, display, and control functions (Subpart Cl 193.43) and provides guidance in meeting the requirements. It is clearly the intent of the drafters of the Telecommunications Act (1996) that the needs of the approximately 40 million Americans who have a disability (D. B. D. Smith, 1990) not be overlooked as this technology evolves. Although the Act does not specifically focus on age-related problems, by emphasizing the needs of the disabled community they have encompassed the needs of the elderly in many instances.

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TELECOMMUNICATION DEVICES What is a telecommunication device? If we look at the roots of the word, "tele" implies something at a distance, and "communication" means the transfer of information from person to person. In the Telecommunications Act (1996), telecommunication is defined more narrowly as "the transmission, between or among points specified by the user, of information of the user's choosing, without change in the form of the information sent and received." (Architectural and Transportation Barriers Compliance Board, 1998, Subpart A 1193.3 Definitions). Traditionally, "telecommunication" has referred to the electronic or computerized transfer of information. This means that traditional telephones, cordless telephones, speakerphones, cellular mobile telephones, pagers, TVs, TV remote controls, video-conferencing systems, and fax machines are all telecommunications devices. Since the advent of personal computers (PCs) and the Internet, computers, too, have become telecommunication devices. Until recently, each of the preceding would have appeared to users as a discrete channel for communication; the distinction between the telephone and the computer, for instance, would have seemed clear to most users. Today, the boundaries are fuzzy and getting fuzzier. For example, Web TV and Web telephones have altered the boundaries among computers, television, and telephones. The unsophisticated user may have a hard time understanding how to interact with these hybrid devices. Even when a device does not incorporate diverse functions such as a Web telephone, functionality has often been modified so that using a familiar device requires a new or more complex mental model. An example is the cordless telephone: When telephones were not cordless, users who wished to make a call were able simply to pick up the handset and enter the number. With many cordless telephones, they may need to remember to press a talk button to turn the telephone "on." When they are finished, they cannot simply put the handset down in the cradle (which doesn't allow them to replace it incorrectly) as they do with a traditional phone; they must either replace it properly on the base (it can easily be positioned improperly), or push a button to turn it off. And, not all cordless phones operate exactly this way, so users who use two or more different cordless phones may have interference from earlier learning experiences. Receiving and sending often require different, sometimes conflicting, user actions with the new telecommunications devices. For example, when the handset on a cordless phone is properly on its base and a call comes in, you can simply pick up the handset and talk; however, if the handset is off

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the base when the call comes in, the user must press the receive button to hear the call. For a cellular phone, as opposed to a cordless phone, you do not have to press the talk button to call out, but you must press the send button after the telephone number is entered. It can be difficult for users, especially older users with many years of experience with traditional phones, to remember the various actions called for with each new device and to inhibit old, overlearned responses that were appropriate for traditional telephones. This is especially true in instances in which users are under time stress or are anxious, such as when they need to call 911. There are also a number of devices such as microwave ovens, automatic teller machines (ATMs), electric clocks or calendars, garage door controls, remote controls, vehicle dashboard displays, and so on, with computer interfaces for communicating with the device. The principles discussed in this chapter are relevant to the design of all communication interfaces to support all users.

WHAT USERS NEED IN AN INTERFACE Users in general need interfaces that are simple and clear and support users to have accurate perceived affordances (Norman, 1988, 1998), and match their expectations. These traits have been found to be critical for novice or occasional users, users with sensory limitations, and users with impaired cognition. Elders, like other users, experience some or all of these conditions so designing to meet the needs of elders usually will produce a design usable by a larger audience. Affordances are the set of actions that can be performed on or with an object (a button affords pushing, a handle affords holding, a slot affords inserting a card or a coin). Perceived affordances are what the user deduces about how to interact with the device from seeing, hearing, or touching it. (Is this something I speak into or listen to?) Without clear and appropriate affordances, users will not know what actions can be performed on or with an object. Good affordances provide strong clues to the operation of the object: The user knows how to interact with the object just by looking, touching, or listening. Users also need devices that have been designed to allow the user to perform a task in the most efficient, effective, and satisfactory way. This means that the device has to allow users to perform the task as quickly as possible (with as few errors as possible) and to feel in control of the interaction. Creating devices that accomplish these goals is not an easy task.

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SO WHY THE SPECIAL FOCUS ON AGE? The population of the United States and of the world is aging (Czaja, 1990; Johnston & Packer, 1987; Serow, Sly, & Wrigley, 1990; Small, 1987). The communication needs of the older population are increasing as families move apart and as more information services are needed (D. B. D. Smith, 1990). More and more often, access to such information and services and the ability to communicate with family and service providers requires the use of a telecommunication device. What are the functional limitations that designers and developers of interfaces need to be mindful of to support older users? The next section will focus on age-related changes in functional abilities and how they may affect the ability of elders to use telecommunication devices.

AGE-RELATED LOSSES IN SENSORY, PERCEPTUAL, PSYCHOMOTOR, AND COGNITIVE FUNCTIONING It is well established that aging is associated with functional losses in many areas that may affect the ability to interact with communication devices: hearing, vision, tactile discrimination, memory, tracking and target acquisition, attention, perceptual speed, strength and flexibility, and response time (Abrams & Berkow, 1990; Abramson & Lovas, 1988; Birren & Schaie, 1985; Corso, 1981; Finch & Shanas, 1985; Kroemer & Grandjean, 1997; Small, 1987). Although different people experience different age-related changes at different points in their lives and to different degrees, in general older people must operate in the world with one or more functional limitations. The following is a brief discussion of the types of age-related handicapping functional losses that may affect the ability to use communication devices. Hearing and Speech Recognition Half of all elders experience significant hearing loss (presbycusis). Typically the first hearing loss is experienced in the higher frequencies, which means many alerting sounds (beeps, pings, chimes) are harder for elders to hear. The implications of these changes for design of interactive systems appear obvious, yet many interfaces use such sounds as part of the interaction. Speech interfaces also present a number of difficulties for elders; women's and children's (higher frequency) voices are harder for elders to detect and understand. As the ability to detect sounds diminishes, so does the ability to discriminate among sounds and comprehend speech, especially high-

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pitched speech. Elders also experience more difficulty comprehending synthesized speech than younger individuals do (Gulya, 1990). Vision By age 40, presbyopia makes everyday tasks like reading more difficult for most people. Elders also experience age-related decrements in dynamic visual acuity, color discrimination, and glare sensitivity. They have higher rates of morbid conditions such as diabetic retinopathy, macular degeneration, and cataract, which impair visual acuity and reduce the visual field. Elders also have diminished ability to see well in low-light environments and to read lightemitting diode (LED) displays (Sekular, Kline, & Dismukes, 1982). Memory Elders experience two kinds of working memory decrements that can interfere with their ability to use communication devices. First, most elders experience working memory deficiencies that cause them to have difficulty retaining specific information such as numbers and designators long enough to act on them. Elders also have difficulty recalling auditory instructions, particularly if the instructions involve multiple steps. They also have trouble remembering sequences (Craik & Jacoby, 1996; Craik & Trehub, 1982; Salthouse & Meinz 1995; A. D. Smith, 1996; D. B. D. Smith, 1990). The second problem that arises from memory decrements is the transfer of knowledge from working to long-term memory (learning). Elders require more practice to do this; this makes it harder for elders to learn complex procedures and to remember complex procedures that are infrequently carried out (Fisk & Rogers, 1991; Gilbert & Rogers, 1996). Attention The ability to divide attention efficiently and to ignore irrelevant stimuli diminishes with age (Hartley, 1992; Rogers, 1992; Small, 1987). This can be a problem if elders must attend to multiple stimuli simultaneously, especially if the stimuli all have attention-grabbing characteristics such as beeping or blinking or there is a time limit imposed on the response. Divided Attention Elders have more difficulty than younger individuals do dividing attention among multiple visual stimuli or attending to auditory and visual stimuli simultaneously.

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Selective Attention Older people also have more trouble than younger people have ignoring irrelevant or competing stimuli in the environment, especially if the stimuli are large, loud, high frequency, unusual, bright, moving, flashing, or colorful. This means that elders may select the wrong aspects of a display to process more fully, at the expense of critical information. Focused Attention Older users may have more difficulty determining which components of an interface are the critical components for a given task. Search Older people need more time to search visual arrays to find targets; the more objects or the more unusual the objects in an array, the greater the performance decrement for elders (Laux & Lane, 1985). They also have more difficulty identifying targets in auditory arrays. Cutaneous Senses Elders have reduced sensitivity to all cutaneous stimuli, including pressure, texture, and vibration. Their ability to detect and interpret tactile stimuli is diminished (Abramson & Lovas, 1988). Psychomotor Functioning Perception response time to essentially all stimuli is lengthened in elders. Older people are also slower or less accurate or both when moving the finger to touch a small target (Finch & Shanas, 1985; Laux & Lane, 1985). Speech Generation As people age, their ability to speak loudly and to articulate clearly may diminish (Abrams & Berkow, 1990).

THE IMPLICATIONS OF AGE-RELATED FUNCTIONAL LOSS FOR INTERFACE DESIGN Given these age-related functional changes, what guidelines should we follow when designing telecommunication interfaces to accommodate an aging user population? The guidelines that follow are simple, yet it is surprising how often they are violated.

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It should be apparent that guidelines like these will not produce usable interfaces for elders, or any other users, unless an interaction analysis has been carried out to determine what users want to do, how they expect to do it, and the steps they need to carry out. Performing such an analysis is not a trivial task, and its importance is paramount. Once we know what users want to do and how they conceptualize or understand the task, there are implementation issues that influence usability. The following guidelines will help design devices to provide effective, efficient, and satisfying interaction for elders, and indeed all users. The same process can be used to evaluate the usability of existing devices for use by elders. Following the guidelines that follow does not automatically mean that the interface will be usable by, and useful to, elders. In many, if not most, cases, you will still need to do usability testing with a population that includes a representative group of elders and people with visual, auditory, and physical limitations. The most efficient process is to involve these users in the design process so problems can be detected before it is too difficult or expensive to change the design. There are many texts that will guide you in setting up a good usability test program (e.g., Mayhew, 1999; Wiklund, 1994). To assure that as many usability problems as possible have been dealt with during the design phase, consider the following guidelines: 1. Adopt a simple, uncluttered style for displays, with few colors (e.g., black and white and one color). 2. Use a font size and style that can be read easily in the environment of use. Sans-serif fonts such as Ariel and a font size of 12 will be readable by most users if the lighting and contrast are adequate. Use high contrast between text and background. Black or navy on a light background is most readable for print; white or yellow on a black background is very readable for LED displays. It is critical to consider where the device will be used in making these determinations (e.g., low light, high noise, and glare). 3. Use words that are meaningful to the users as labels or identifiers for fields and controls. If you use icons or symbols to convey meaning, make certain that users know or can readily determine their meaning. Usability testing is critical for any new icons, symbols, or terms that you want to use. 4. Organize information and controls into task units such as "placing an outgoing call" or "looking up a telephone number." Task units comprise a series of actions that accomplish a goal. Do not make users scroll or skip around on computer displays or keypads to complete a task or subtask. 5. Do not change common practices such as telephone keypad arrangement and red and green meanings.

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6. Avoid time requirements for input or response. 7. Avoid using elements that compete for attention (e.g., blinking or moving objects) except when the goal is to attract attention away from the task (e.g., warnings). 8. Make use of affordances (Norman, 1988, 1998) and memory aids on the interface. Do not require users to remember actions, values, or sequences. 9. Avoid presenting conflicting or noncongruent audio and visual information simultaneously. 10. Provide clear, step-by-step instruction. Important: Do usability testing on your instructions unless usability testing of the device indicates that users will not need the instructions. 11. In the instructions, use terms and language that users know. Use simple diagrams that are large enough to be seen by people with less than 20-20 vision. 12. Place controls that can cause unwanted results in a position where they are not likely to be inadvertently activated. For instance, on a cell phone, don't place a button that terminates a call adjacent to the one that sends the call, especially if the buttons are the same color and shape.

A METHODOLOGY FOR EVALUATING THE DESIGN OF TELECOMMUNICATION DEVICES FOR ALL USERS, INCLUDING ELDERS For most telecommunication devices such as Web phones and fax machines, the potential users are the general population, which includes a significant number of people of all ages and capabilities. The interaction design for these devices must support both novice and expert users as well as users with many types of functional limitations. Given the complexity of many telecommunication devices, this presents a serious challenge to those who hope to develop and market telecommunication devices. It also makes it hard to find devices on the market today for use by elders. How can you design to ensure that the largest percentage of the people who could benefit from using your device, including elders, can use it effectively and efficiently? Assuming that you understand the users and the task(s) that the user wants to accomplish with the device, you can use a matrix such as those in Tables 8.1 through 8.3 to identify points where agerelated functional loss needs to be considered when deciding on an interface component. To evaluate an existing device, try it out and fill in the table as appropriate. Think about where and how the device will most frequently be used.

Table 8.1

Major Factors to Be Considered When Evaluating an Existing or Proposed Communication Device for Use by Elders; Example: A Cordless Telephone

Environment where device will be used

Sensory requirements

Psychomotor requirements

Cognitive requirements

Speech requirements

Physical requirements

Light level: low light, darkness, or glare

Able to see at all; low vision, ability to see color Able to hear Able to discsriminate through touch





Able to speak

Able to press a button



Able to select and land on a target



Able to grasp; hand strength Manual dexterity, fine motor control

Noise level: high

Table 8.2

Major Factors to Be Considered for Evaluating Existing or Proposed Communication Devices for Use by Elders; Example: Touch-Screen Application Interface*

Environment where device will be used

Sensory requirements

Psychomotor requirements

Cognitive requirements

Speech requirements

Light level: low light, darkness, or glare

Able to see at all; low vision, able to see color Able to hear



Working (short term) memory load

Able to press a button (virtual)

Noise level: high Presence of vibration: dust, etc.

Able to select and land on a target

Able to comprehend written text or drawings Able to make decisions/judgments

^Examples of a touch-screen application interface are a microwave oven control panel or an ATM.

Physical requirements

Table 8.3

Major Factors to Be Considered for Evaluating Existing or Proposed Communication Devices for Use by Elders; Example: A "Talking" Pager

Environment where device will be used

Sensory requirements

Noise level: high

Able to see at all; low vision, able to see color (or hear) Able to see or hear

Presence of vibration, dust, glare, etc.

Able to discriminate through touch

Psychomotor requirements

Cognitive requirements Working memory load

Able to select and land on a target

Able to comprehend written text or drawing; Able to make decisions or judgments

Speech requirements

Physical requirements Able to press a button

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To evaluate a design, consider the various functional requirements for the device and determine what feasible alternatives there are for meeting that requirement. Then consider how each of those alternatives would affect users with various limiting conditions. From the matrix shown in Table 8.1, interaction with a cordless telephone can be described in terms that allow the designer of the interface to identify constraints that may prevent people with various limitations from using the device effectively. For instance, in the cordless-telephone example, in order to use the device the user must press key digits on a keypad. This means that users who have limited or no use of upper limbs or who are unable to control their motions because of palsy or arthritis will have difficulty using the device. The designer will also recognize that if the device is to be usable in low-light environments or by people with low vision, there must be high-contrast labels, shape coding, or backlighting, or some combination of these on controls. Further, the designer will recognize that, as planned, the device would not be usable by people who cannot speak or by most hard-of-hearing users unless there is a volume control or amplification device. For an interactive interface like a touch screen (Table 8.2), the designer can use the matrix to determine that the ability to see, and accurately land on a target and press with the finger will be functional requirements unless voice input and output are added. Further, users will have to be able to understand procedural text material and make decisions to "command" the device. Unless the designer can develop the interface so that the user can locate the "beginning" of the interaction and "tab" through the site, users with cerebral palsy or upper-limb problems and those who are blind will not be able to use the application. The simple paging device described in Table 8.3 vibrates when the page comes in or can be set to beep. It can be used in any environment. The calling number is displayed on a backlighted LED and provides a voice readout if the "Read" button is pressed. The designer or evaluator can determine that the user must be able to either see or hear to get the message and hear or detect vibrations to know when a message is incoming. The user must be able to press a button to activate the voice readout and to turn it on or off.

HOW TO USE THIS INFORMATION Once the device designer or evaluator has performed such an analysis, potential problem areas for elders and others with limiting conditions can

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be identified. For evaluators, this can help to identify which device among several is most likely to meet the needs of older users. For designers or manufacturers who are in the process of selecting a design for a device, this type of analysis can point to areas that need to be addressed if the device is to fulfill the requirements of the Telecommunications Act (1996) and meet the functional needs of most segments of the potential user population. Where should designers and manufacturers turn for advice and help in solving the design problems that surface in this type of analysis? There are many books that describe the appropriate methodology for designing products that will be usable by the largest portion of the population (e.g., Kantowitz & Sorkin, 1983; Sanders & McCormick, 1987; Kroemer & Grandjean, 1997; Salvendy, 1987; Wickens, 1992); as well as a wealth of online materials such as those at the Trace Center (Available at: http://trace.wisc.edu/world/), a source that includes materials concerning universal access directly related to telecommunications products, as well as reports of their own research and work in this area (e.g., Connell et al., 1997). On this site, you will also find access to the Telecommunications Act (1996) and the Access Board Guidelines (1998).

CONCLUSIONS This chapter provides a flavor of the complexity that faces designers of communication devices today. The devices themselves are more complex and more multifunctional than they were in the past, and they are smaller and more portable. Although these traits may make them more desirable from a marketing perspective, they increase the difficulty of ensuring that the devices are usable by and useful to all of the potential user population. In addition, the complexity does not stop with the devices and their functionality. The needs and abilities of the people who want and need to use these devices are also very complex. The world population is aging and so is the workforce. People with handicapping conditions are moving into the workforce and living more independently. As a result of social and legislative pressures, elders and people with functional limitations of all types are now understood to be a part of the general user population and entitled to have access to this technology. Many telecommunication devices today are not fully accessible to any but those who designed them, and therefore understand them. By applying basic human-factors engineering principles to the conceptualization, interaction design, and interface design of such devices, the needs of the popu-

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lation at large, which includes elders, can more appropriately be met. Our goal should be to provide effective, efficient, and satisfying interaction with the devices for all people who need access to their functionality.

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Hartley, A. A. (1992). Attention. In F. I. M. Craik & T. A. Salthouse (Eds.), The handbook of aging and cognition (pp. 3-49). Hillsdale, NJ: Erlbaum. Johnston, W., & Packer, A. (1987). Workforce 2000: Work and workers for the twenty-first century. Indianapolis, IN: Hudson Institute. Kantowitz, B., & Sorkin, R. (1983). Human factors understanding people-system relationships. New York: Wiley. Kroemer, K. H. E., & Grandjean, E. (1997). Fitting the task to the human. Bristol, PA: Taylor & Francis. Laux, L. (1995). Aging techniques. In J. Weimer (Ed.), Research techniques in human engineering. Englewood Cliffs, NJ: Prentice Hall PTR. Laux, L. (1997). Designing web pages and web applications for people with disabilities. In C. Forsythe, E. Grose, & J. Ratner (Eds.), Human factors and web development. Mahwah, NJ: Lawrence Erlbaum. Laux, L., & Lane, D. (1985). Information processing components of substitution test performance. Intelligence, 9, 111-136. Mayhew, D. (1999). The usability engineering life cycle. San Francisco, CA: Morgan Kaufman. Meister, D. (1989) Conceptual aspects of human factors. Baltimore, MD: Johns Hopkins University Press. Norman, D. (1988). The psychology of everyday things. New York: Basic Books. Norman, D. (1998). The invisible computer. Cambridge, MA: MIT Press. Rogers, W. (1992). Age differences in visual search: Target and distractor learning. Psychology and Aging, 7, 526—535. Salthouse, T. A., & Meinz, E. J. (1995). Aging, inhibition, working memory, and speed. Journal of Gerontology: Psychological Sciences, 50B, P297—P306. Salvendy, G. (Ed.). (1987). Handbook of human factors. New York: Wiley. Sanders, M., & McCormick, E. (1987). Human factors in engineering and design. New York: McGraw-Hill. Sekular, R., Kline, D., & Dismukes, K. (Eds.). (1982). Aging and human visual functioning. New York: Alan R. Liss. Serow, W., Sly, D., & Wrigley, J. (1990). Population aging in the United States. New York: Greenwood Press. Small, A. (1987). Design for older people. In G. Salvendy (Ed.), Handbook of human factors. New York: Wiley. Smith, A. D. (1996). Memory. In J. E. Birren & K. W. Schaie (Eds.), Handbook of the psychology of aging (4th ed., pp. 236-250). San Diego: Academic Press. Smith, D. B. D. (1990). Human factors and aging: An overview of research needs and application opportunities. Human Factors, 32, 509—526. Telecommunications Act of 1996. Pub. L. No. 104-104, 47 U. S. C. § 255; chapter XI, 36 C. F. R. Wickens, C. D. (1992). Engineering psychology and human performance. Champaign-Urbana, IL: HarperCollins. Wiklund, M. (1994). Usability in practice. Boston: AP Professional.

9 Face Memory Skill Acquisition Reinhold Kliegl, Doris Philipp, Matthias Luckner, and RalfTh. Krampe

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hen asked which memory skill they wanted to improve most, 61 % of older adults mentioned learning and remembering of names among their top four choices (Leirer, Morrow, Sheikh, & Pariante, 1990). Such high agreement does not come as a surprise because all at one point or another we have all had the opportunity of suffering through a potentially embarrassing encounter with a person who treated us with familiarity but whom we did not recognize. If lucky, we recognized the face and only missed her or his name. It appears that these situations are difficult to prepare for, quite unlike a trip to the grocery store, for which assembling a shopping list ahead of time effectively takes care of potential memory problems in the store. Moreover, not remembering the face or the name of a person is a communication failure of very high personal relevance. If face and name memory can be improved effectively, or if at least we have better understanding of the boundary conditions under which this is possible, we may take care of at least one salient aspect of older adults' communication problems. There is much evidence that in principle healthy older adults are able to acquire new cognitive and in particular mnemonic skills (for a recent review see Camp, 1998; Verhaeghen, Marcoen, & Goossens, 1992). For example, Kliegl, Smith, and Baltes (1989) trained young and old adults in the method of loci for the recall of word lists. Shortly after instruction in the mnemonic, both age groups exhibited a noticeable improvement in their performance. Indeed, older adults scored higher than untrained younger adults did, a result of considerable practical importance because this is about the 169

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level most older adults wish to achieve in a training program. Mnemonic training also led to a clear separation of age groups (Baltes & Kliegl, 1992): Only one younger and one older adult scored in the range of the other age group, respectively. This is also important because training programs should keep expectations about maximum levels of performance in a reasonable range; presumably age-related limits of brain biology will most likely not allow older adults to compete with younger adults for the highest score in such tasks. Moreover, cognitive skills are quite stable over extended periods of time. After a similar mnemonic training, Stigsdotter Neely and Backman (1993) reported maintenance of memory skill for recall of concrete nouns and displayed objects in a 3-year follow-up. So far this is good news. Surprisingly, despite the high practical relevance of face-name memory there has been hardly any training research on this topic. Moreover, as far as we know, there is no evidence that face-name interventions that worked in the laboratory were actually put to use in everyday life. Thus, the long-term goal of our research program is to develop an effective face-name memory training program that effectively eliminates a potentially highly embarrassing communication disorder in older adults in everyday life. This chapter has five sections. First, we present the background for our research: a review of face-name memory training research, a few highlights of unsuccessful and successful transfer of mnemonic skill from lab to life, and our cognitive engineering approach for skill acquisition. In the next three sections, we summarize results from experiments in which we had younger and older adults acquire a skill in face memory. To foreshadow the results, our success ranged from complete failure in the beginning to modest success at the end. The final section oudines how this program, in particular the third experiment, will be continued to achieve our long-term goal.

RESEARCH BACKGROUND Face-Name Memory Training Face-name training modules are invariably part of any memory course, book, or audio tape about how to improve one's memory (e.g., Lorayne, 1988). Typically, participants or readers are told to form vivid mental images or associations between visually salient features of the face and the name. Such images are easier to construct if both name and facial feature can be related to a concrete object (Morris, Jones, & Hampson, 1978). Therefore, it is not too difficult to remember a person named Hawk bearing a nose in classic

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Roman style. A person named Crake, however, does not afford such a simple image. In this case a recoding of the name into a phonologically similar one, like "crack," could be used. Perhaps a tiny gap between the front teeth lends itself to the construction of a durable memory trace. Obviously, the second case is much more difficult and requires considerable creativity or specialized knowledge. Novices most likely are overwhelmed by the dual task of conducting a conversation and coming up with memorable links of this kind, but, as has been shown for many cognitive skills, one should not discount practice. Moreover, an expert is likely to deploy many more than one such device to secure multiple encodings of a new face and name. There has been little research on training of face-name memory strategies. McCarty (1980) found improvements for young adults with instruction in visual imagery mnemonic as outlined before. Facial features to be used in the visual image were provided by the experimenter. Similarly, Yesavage, Rose, and Bower (1983) reported training benefits for older adults after four training sessions. They also found that self-generated cues for visual images led to similar levels of recall as those provided by the experimenter. In the most effective training group, participants improved from 2 to 6 face-name pairs out of 12. In a later study with only two sessions, young, middle-aged, and elderly adults differed in baseline scores but showed the same amount of benefit from training (Yesavage & Rose, 1984). In this study, mnemonic cues were provided by the experimenter. Moreover, this skill was maintained over a 6—month period (Sheikh, Hill, & Yesavage, 1986). Note, however, that the task trained in the studies by Yesavage and Rose (1984) and Sheikh and colleagues (1986) was carried out under comparatively easy conditions; there was hardly a time pressure during encoding (i.e., 1 minute study time per pair). Also, in the age-comparative study, older adults with a mean age of only 61.4 years doubled their recall from pretest to posttest, but that meant they improved from recalling 1.4 to 2.8 out of 12 face-name pairs. Obviously, even with generous encoding times, a larger number of training sessions is required to achieve a noticeable training gain. From Lab to Life Camp (1998) described three phases of memory intervention research. The first phase was built on laboratory paradigms, most notably recall of word lists. Accordingly, research questions reflected primarily narrow theoretical issues of memory researchers and to a lesser extent the practical needs of participating older adults. In the second phase, the effectiveness of training programs moved into the focus leading to proposals of combinatorial and multifactorial interventions. For example, Stigsdotter Neely and Backman

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(1995) combined standard mnemonic instruction with tasks highlighting the relevance of attention in remembering and with relaxation exercises. Oswald and Rodel's (1998) memory training focused on practice of specific cognitive functions as well as training of mnemonics oriented toward everyday needs. The program includes training of perceptual speed in addition to that of specific memory functions, mnemonic techniques (e.g., method of loci), and provided knowledge about memory and age-related trends. The role of metacognitive aspects of memory performance has been a major focus in general. In a meta-analyses of 27 studies, Floyd and Scogin (1997) examined the impact of participation in a memory-training program on a subjective rating of its usefulness. Results suggested a change of memoryrelated beliefs in older adults. Finally, memory interventions also took a "broad look" at the problems. Consequently, interventions not only focused on internal mnemonic devices but also instructed people in the use of external devices (e.g., notes, calendars), to look at whether this was the most effective solution for a specific memory problem (e.g., keeping appointments). The third phase of intervention research addressed the issue that skills acquired in the laboratory were rarely put to use in everyday life (see Camp, 1998, for a review). The low impact of such memory training was probably due to the laboratory character of the tasks. There are now quite a few examples of successful transfer to real-life issues. For example, Leirer, Morrow, Pariante, and Sheikh (1988) reported that recall failure led to medication nonadherence levels of 31% in alert older adults and that simple mnemonic designs can improve this situation. Park and Jones (1997) reported similar positive results with devices such as 7-day organizers including time of day and other external aids. Finally, chapters 4 and 10 in the present volume provide good examples that cognitive training can indeed reliably change everyday behavior. In summary, past research documented reliable positive results for objective and subjective evaluations of memory training programs with older adults. Older adults can learn and use the instructed strategies in the laboratory. Also, behavioral strategies that reduce or externalize the memory load appear to be effective. Whether these training programs can reduce memory problems in everyday life is still an open question. Our hypothesis is that with respect to face-name memory this will only be the case for persons who achieve an expert-like level of performance. Cognitive Engineering Memory for faces and names is the top-rated complaint about age-related cognitive changes. Moreover, as the earlier review showed, this memory

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problem appears to be quite resistant to training interventions, especially as far as their impact on everyday behavior is concerned. To prove our case we plan to cognitively engineer a face-name memory skill in the laboratory following the principles implemented in a training program for the acquisition of skilled digit memory (Kliegl & Baltes, 1987). We distinguish the following three components to illustrate this difference: skill assembly, deliberate practice, and tailored learning. Skill Assembly The core idea of traditional skill acquisition was to change the representation of knowledge and to practice specific subcomponents of the task to achieve a high level of automaticity in behavioral routines readily available in normal persons. In cognitive engineering this is the second step. Using expert behavior as both a model and a goal for the training program, the first step is to build up new knowledge and implement new procedures that effectively circumvent normal processing limitations associated with working memory that hold for normal persons and experts alike (Kliegl & Baltes, 1987). Thus, expertise is not normal behavior executed more efficiently but is based on a qualitatively different organization of behavior. The idea of circumventing general constraints is quite consistent with the observation that expertise is not a function of general intelligence. It is also compatible with limited transfer to tasks outside the specific expertise; that is, experts usually surpass normal persons only in a a narrowly defined domain (Ericsson, 1996; Proctor & Dutta, 1995). Deliberate Practice The final component of the training program is deliberate practice. In this context, Ericsson, Krampe, and Tesch-Romer (1993) (see also Charness, Krampe, & Mayr, 1996; Krampe & Ericsson, 1996) distinguish among effort, intensity, and motivation. Effort can be approximated by global measures, such as the total number of hours practiced. However, deliberate practice implies a certain intensity (i.e., focus and concentration). "Exercising" a skill at a leisurely level does not lead to the desired improvement. Rather, detailed feedback, ideally by a master coach in one-on-one instructional settings, must be available to uncover weaknesses in the performance and to develop appropriate strategies for their compensation. Tailored Learning Tailored learning implements our conceptualization of keeping a high level of motivation to reduce the chances of the permanent problem of expertise acquisition: burnout. Burnout can result from exaggerated training, from

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setting unrealistic goals, and from inadequate social comparisons. Longterm expertise acquisition requires control of demand and performance levels by the individual or a trainer. Acquisition of real-life expertise is typically a process spanning many years of devoted practice and execution of the skill. Acquisition of expertise in a laboratory setting can optimize practice in some ways. For example, we can provide training software that keeps task difficulty at an intermediate level to avoid boring as well as frustrating learning situations. We can develop a large variety of training programs tailored to the individual needs. To sum up, we propose that an expertise-acquisition approach to facename memory will provide conclusive evidence that the top ranking cognitive complaint of healthy older adults can be fixed for their everyday life. We used a typical practice schedule with tailored learning in each of the three experiments to be reported in the following. In addition, in Experiment 3 we provided very detailed instruction in task-specific knowledge and practice in bringing this expert knowledge to bear in the memory task. (For information about procedural details see Kliegl, Krampe, Philipp, & Luckner, 1999.)

EXPERIMENT 1: TRANSFER OF A MNEMONIC SKILL TO FACE-NAME MEMORY The first experiment of face-name memory was a follow-up study with participants of the age-comparative memory training program reported in Bakes and Kliegl (1992; Kliegl et al., 1989). Regression analyses confirmed that participants used different mechanisms before and after instruction in the method-of-loci mnemonic (Kliegl, 1995; Kliegl, Smith, & Bakes, 1990). In this study, participants had overlearned a mental walk past 30 Berlin landmarks. Participants encoded the concrete nouns to be remembered in the order of presentation at these landmarks by forming vivid visual images combining the landmark and the noun. At recall, activation of a landmark led to the recall of the current image from which the current noun can be retrieved. Obviously, the imagery component is critical and received much practice. Therefore, we expected that the mnemonic skill would transfer to a new face-name memory task because training programs invariably emphasize the relevance of visual imagery for linking a person's face and name. In addition, we recruited new samples of older and younger adults without prior mnemonic expertise for the face-name memory training. Fifteen younger (24.0 years; range, 19 to 29 years) and 16 older adults (71.3 years; range, 65 to 80 years) from the Bakes and Kliegl (1992) study

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Figure 9.1 Face-name recall scores for two reliable interactions in the crossexperiment analysis. Left: Younger adults profit more from practice than do older adults. Right: Word-list experts and novices differ only at posttest (Experiment 1).

participated in six sessions of face-name memory training. For further details see Kliegl et al. (1989). In addition, 20 younger (M = 24.1 years; range, 21 to 28 years) and 19 older adults (M = 73.9 years; range, 65 to 81 years) without prior mnemonic experience were recruited as a control group for the memory experts. Experts were instructed to use their mnemonic skill in the face-name memory task that used line drawings of faces scanned from Berlin newspapers and names sampled from the telephone directory. Similarly, all novice participants were given an instruction about imagery techniques and how these could be used to remember faces and names prior to any test. Following these instructions, all of the expert and half of the novice participants were given four sessions of mnemonic practice; the other half of the novice group performed an unrelated mouse click training. At pretest and posttest (sessions 1 and 6), six lists with 10 face-name pairs each were presented for cued recall (lists 1 to 3) and in a forced-choice format (list 4 to 6). Facename pairs were presented for 15 seconds, 10 seconds, and 5 seconds in this order within each test format. Results of Experiment 1 are in line with previous research. First, younger adults profit more from mnemonic instruction and training in face-name memory than do older adults (see left panel of Figure 9.1). This has also been reported for meta-analyses of training studies (Verhaeghen et al., 1992). In the present study, this was true only for the novices in the present experiment; the interaction was not significant for younger and older adults who had participated in the Bakes and Kliegl (1992) study. Note, however,

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Figure 9.2 Face-place recall scores for younger and older adults at pretest and posttest for two presentation rates. Only younger adults show practice-related gains (Experiment 2).

that the interaction between age, expertise, and pretest and posttest was not reliable in the comparison across experiments. So, we cannot conclude strongly that prior memory training eliminated the age-differential effect in face-name skill acquisition. Second, the across-experiment comparison did not reveal any immediate transfer of mnemonic skill for word lists to the pretest in the face-name memory task (see pretest scores in right panel of Figure 9.2) . This was the case despite the fact that all participants had been told to use visual imagery to encode names and facial features by means of visual imagery. This result can be construed as evidence for the well-documented limits of transfer of cognitive skills (e.g., Proctor & Dutta, 1995). The third result suggests that although transfer effects were not immediate, they did show up eventually (see posttest scores in right panel of Figure 9.2). Prior expertise in memory for word lists led to larger training gains in the subsequent face-name memory task compared with control groups. Thus, some practice with the face-name memory task was needed to adapt the available skill-relevant knowledge to the new situation. Four hours of practice does not seem like much of an investment to achieve transfer to a new situation. Previous skill research may have underestimated the transfer potential by not providing enough time for similar adjustments. Finally, if we limit the analysis to novices, older adults without prior mnemonic skill did not improve across four sessions of practice in cued face-name memory. Note, however, that our participants had been instructed in the imagery technique prior to the pretest, whereas in previous re-

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search such instruction typically takes place after the pretest. Even with prior instruction, pretest performance was rather low and even for experts in the mnemonic skill four sessions of practice resulted in a gain of only one more face-name pair recalled correctly. Obviously, the face-name memory task was very difficult, and it is unclear whether the difficulty of the task resides primarily in encoding the faces, in encoding the names, or in the combination of integrating these two pieces of information. Experiment 2 was a first attempt to localize the source of the difficulty.

EXPERIMENT 2: FACE-PLACE MEMORY TRAINING Names vary widely in the ease with which they can be used in interactive imagery. There are names that are identical to concrete nouns (e.g., canon), professions (e.g., baker) or colors names; typical mnemonics should work fine for them. Most names, however, are not of this sort, and recodings are required. In the present experiment we bypassed this difficulty by changing the task to a face-place memory task; that is, participants had to remember at which place (e.g., bridge, theater) a specific face had been presented. We know from method-of-loci studies that even a limited set of places works very well for encoding and recall of concrete nouns. If there are still no practice gains, a special problem with encoding faces is indicated. We also changed the face stimuli. Instead of line drawings of real people we used faces generated with a computer program (Mac-a-Mug) from a limited set of features (hair, eyes, nose, etc.) and variants of these features. Overall, the similarity of the faces used in the present experiment was much higher than that in Experiment 1, and this increased task difficulty. Finally, we also changed the format of the practice sessions. In Experiment 1 we adjusted presentation time, but participants received only four practice lists with 15 face-name pairs in each session. Consequently, there were only three adaptations of time per session. In the present experiment we adapted the difficulty of the training list by changing the number of faces to be remembered. With a criterion of perfect recall for an increase in list length we could administer 20 lists per session. Eight younger (M - 24.5 years; range, 20 to 28 years) and 8 older adults (M - 73.8 years; range, 69 to 79 years) participated in 11 sessions. At pretest and posttest we assessed word-place memory and face-place memory with four lists of 15 pairs each; two of the lists were presented with 4 seconds per item and two lists with 2 seconds per item. After pretest, participants received imagery instructions and a demonstration of the task on the computer. In each of the following nine practice sessions, partici-

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pants memorized 25 lists of face-place pairs. All participants started with a list of three items. Subsequently, list length (i.e., the number of face-place pairs) depended on performance in the last list. The list length was increased by 1 to a maximum of 15 after a perfect recall of a list and decreased by 1 to a minimum of 2 items otherwise. The results are shown in Figure 9.2. Younger adults scored higher in the face-place task than older adults did, and this age difference increased from pretest to posttest. Performance was higher for the 4-second presentation rate for both age groups, but training and presentation rate interacted only for younger adults, who improved more in the 4-second condition. Most importantly, for older adults there was no change in performance from pretest to posttest; there was actually a slight trend towards worse performance at posttest! The main result for the present context was the failure to engineer a new cognitive skill in a positively selected sample of older adults. Data from practice sessions showed the same pattern. There can be many reasons for failures of training programs. If indeed it is not possible for older adults to acquire a cognitive skill for face-place memory, the result needed at least a replication in the context of a modified training program.

EXPERIMENT 3: FIVE CASE STUDIES IN FACE-MEMORY SKILL ACQUISITION In Experiment 3 we followed up the null result of Experiment 2 with the following modifications. We worked with a small sample of only five older participants to allow a maximum of individual coaching. These participants had exhibited high motivation and performance in previous experiments in our lab (three of them had actually scored above the mean of young adults in the digit symbol substitution test). They were also informed about our previous failures of training older adults in this task (i.e., Experiments 1 and 2), which led them to accept this study as especially challenging. Their mean age was 72 years (range, 69 to 77 years). The experiment comprised 19 sessions. In the first five sessions we replicated the training regime of Experiment 2. Then we implemented two new interventions to establish the type of expert knowledge we hypothesized to be critical for overcoming normal performance limitations. First, participants learned to recede the facial features of our experimental material into task-specific knowledge. That is, rather than having participants come up with creative recodings of faces "on-line" as is implied by standard mnemonic instructions, we had them acquire a large amount of task-specific knowledge "off-line" at home and in

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Figure 9.3 Pretest and posttest scores in recall of face-place and face-pairs for five participants (Experiment 3).

the lab. To this end we prepared a complete set of cards with examples for each of the five facial features (i.e., 14 variants of eyes, 13 noses, 13 mouths, 13 chins, and 13 hair styles in light and dark shades) used in the construction of the experimental material. The effect of this intervention was assessed in the first posttest in session 11. As a second intervention, we changed the type of practice so that participants could work effectively on the weak spots of their expert knowledge. In each of these sessions participants were presented two or three lists with 15 items until they perfectly recalled the list. Presentation time was selfpaced up to a maximum of 15 seconds for a given pair. Thus, within this 15-second limit per item, participants could selectively allocate study time to those face-place pairs they failed to recall. Obviously, by repeating the same list participants noticed problematic features and could adjust their task-specific knowledge accordingly. Such a training procedure is clearly much more in the general spirit of coaching someone in the context of skill acquisition. The experiment comprised 19 sessions. At pretest and in the two posttests two face-place lists were presented at 8 seconds and two lists at 4 seconds per face-place pair; the presentation time manipulation had no reliable effect. As shown in Figure 9.3, there was also no reliable improvement from pretest to the first posttest; indeed, as in the previous experiment there was a tendency in the opposite direction. Thus, we replicated the results of Experiment 2 with an even more select group of older adults. Moreover, task-specific knowledge acquired in independent studies was not sufficient to improve on the face-place memory task.

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Performance at posttest 2 was, however, reliably better than at previous assessments. After participants had optimized their knowledge by practicing with the same list until a complete recall of the list was possible, they showed a better recall of face-place pairs. Importantly, this improvement was reliable for each of the five participants in individual time-series analyses of the data collected in practice sessions. In these sessions, list length was increased by one face-place pair after correct recall of a list and decreased by one otherwise. As in previous experiments, there was no transfer to a related task in which participants were shown pairs of female and male pairs using the material of Experiment 1. At recall they were shown one of the faces and had to select the partner face among four alternatives. Obviously, performance gain in the face-place task was related to the specific knowledge that had been acquired for this type of experimental material.

DISCUSSION Face-name and face-place memory proved surprisingly resistant to practicerelated improvement in older adults. This conclusion holds despite some expertise-related transfer in the first experiment and the eventual success in the third experiment. These results are in contrast to many other cognitive tasks (such as memory for word lists or psychometric intelligence tasks) for which improvements on the order of 0.5 to 1 standard deviations have been reported with a few hours of instruction. The limit of about four items in face-place span across many lists in the practice sessions (i.e., 225 lists in Experiment 2, 120 lists in Experiment 3) in the absence of the opportunity to selectively optimize task-relevant knowledge is similar to results reported for training of the digit-span tasks. As in the case of the digit-span task, individual refinement of this knowledge allowed participants to overcome the four-item limit in the face-span task (Ericsson, 1985). These results bear on theoretical notions of skill-acquisition theory. They also set up constraints for improving everyday face-name memory.

THEORETICAL ISSUES Skill-Acquisition Theory/Deliberate Practice The results of the series of experiments are in support of a number of tenets of skill-acquisition theory, focusing the role of deliberate practice (Ericsson et al., 1993; Charness et al., 1996; Krampe & Ericsson, 1996). One tenet

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of skill-acquisition theory is that expertise is not just an enhancement of processes used by all people but is based on special knowledge and procedures that allow the circumvention of common processing limitations. Thus, in contrast with normal behavior, expert performance is based on a qualitatively different organization of cognitive performance. This transition, tied to the buildup of special knowledge, was evident in the participants of Experiment 3, even if changes were not very dramatic overall. A second tenet of skill-acquisition theory is that expert-like levels of performance require highly individualized training with systematic elimination of weaknesses, attention to detail, and optimal feedback. The amount of such deliberate practice is the prime signature of professional expertise in arts and sports and is the most important predictor of maximum levels of performance achieved (Ericsson et al., 1993). The relevance of this distinction between "general practice" and "deliberate practice" is probably best captured in the absence of improvement in the face-place span task until features of this proposal were implemented in the final intervention. Finally, acquisition of an expertise requires a strong motivational commitment to sustain the stretches of sometimes boring and strenuous practice. For this reason, and after the "failures" of the first two experiments, we decided to focus on select individual cases. We explicitly informed them about our previous failures with training for this task and presented the problem as a challenge to them. We also told them about their high cognitive status relative to their same-age peers and that if they did not succeed, we were not certain that any older adult would. Participants accepted the challenge of the task and granted us generous credit for the claim that eventually this might very well benefit their everyday problems in face-name recall. Skill Resilience and Development of Compensatory Strategies There seemingly exists a paradox in skill research. On the one hand, expertise is characterized by a high degree of domain specificity. In the present research, for example, an improvement in face-place span was limited to facial features of the experimental material. On the other hand, it is a common-sense characteristic of experts that, because of to their large amount of specialized knowledge, they typically handle unforeseen problems much better than novices do. In real-world examples, this often appears to be equivalent to a transfer of expertise. One result of the first experiment may indicate the solution of this puzzle: Transferring a word list mnemonic to face-name memory was not immediate but, with a few sessions of practice, word list mnemonists significantly outperformed persons without prior memory skill. Thus, for a better understanding of skill transfer we need to allow time and practice for the skill to develop in the transfer domain. As far as we know,

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these processes are hardly researched at this point in time. Laboratory research and case studies are needed for a better understanding of skill resilience and the development of compensatory strategies (Kliegl & Baltes, 1987). In experimental analogs of skill acquisition, we are clearly in a better position to map out the boundary conditions of the expertise by manipulating critical parameters such as presentation time or memory load. Moreover, we can selectively interfere with critical component processes because in the course of skill acquisition we built the components into the skill. By giving an expert a chance to adjust to this new situation we experimentally induce compensatory behaviors that in the end will broaden the domain of the expertise (Kliegl & Baltes, 1987). For example, in a continuation of Experiment 3 we will determine the impact of exchanging the list of places with which the participants have been working. We would expect a temporary disruption and quick adaptation to this change in the task environment. Exchanging places for names, that is, converting the task to a face-name span task, represents a much more dramatic change that most likely will not succeed without additional knowledge buildup (e.g., a dictionary of names with recodings into concrete nouns). We point out that sometimes such testing beyond limits induces compensatory efforts to maintain expert level functioning because experts are typically very reluctant to accept a limit of their expertise. Solutions are often novel, creative, and unpredictable (for examples from the domain of a word-list mnemonic see Kliegl & Baltes, 1987). Practical Issues Face-name memory problems are genuine everyday problems. Any practical solution will require that people pay close attention to facial features and probably joint recodings of these facial features and name as well. Attention to these details needs to be practiced and habitualized. Obviously, the results of our research suggest that more and different measures are required if we want to have an impact on everyday life. In the following, we will outline a number of additional components to augment the training program sketched in Experiment 3. If implemented as a package they will highlight the relevance of faces and names in daily life and perhaps even generate a substantial preoccupation with this aspect of life. Of course, this is to be expected from what we know about experts in other domains. New Training Components Assessment and Monitoring of Face-Name Problem Prevalence. There is a need to establish the baselines of face-name retrievals and retrieval failures. We are not aware of any statistics detailing the number of names we routinely

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retrieve in a given day or week although there were some diary studies recording memory failures (e.g., Cavanaugh, Grady, & Perlmutter, 1983). We know that we sometimes cannot recall a name, and because this frequently generates discomfort, the event may be quite salient for some time. Persons interested in doing something about their face-name problem should know their failure statistics and be able to calculate the costs (mostly in terms of practice time) of acquiring a face-name expertise. To this end, we plan to equip participants in our training program with mechanical counters to obtain reliable information about the frequency of successful name retrievals and name retrieval failures. Dictionary of Names. The goal of this research project is to develop an effective face-name memory skill but even the acquisition of a face-place memory skill, which we had planned as an intermediate step, proved quite strenuous for older adults. Nevertheless, the next step must be taken eventually. Face-name memory artists (e.g., Lorayne & Lucas, 1974; Wilding & Valentine, 1985) recommend the compilation of a dictionary of abstract names with proposals for an effective receding into a noun that can be imaged (e.g., "Crake" into "crack"). A large compendium of name recodings serves to speed up the image-creating process in a real-time encounter with a new person. The difficulty associated with receding of names is evident in the fact that the skill is sometimes restricted to the recall of first names, which obviously is a much smaller set of items to deal with. Online Strategies for Encoding of New Face-Name Pairs. Face-name mnemonics, as instructed in the present experiments, is but one strategy that may lead to a durable memory trace. Others are (1) the immediate and repeated use of the name in the conversation, (2) pretending that one did not understand the name and force the person to articulate it a second time, (3) asking for the person's calling card and reading the name slowly, and (4) engaging the person in a conversation about the name, for example by asking about possible etymological roots or about potential relations with another person of that name. The basic idea is that any activity involving the new name will increase the likelihood of a successful retrieval at a later time. An effective management of face-name memory problems must also address the embarrassing situation of a name or face retrieval failure. (Eventually, this should happen only for names that were not encoded according to face-name mnemonic principles.) We want to practice effective excuses (which can range from plain admittance of the failure to creative or humorous statements) and teach the participants to use such situations for an effective encoding or re-encoding of the forgotten name and face.

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Off-Line Strategies. Most importantly, ideally as part of a daily or weekly routine, face-name expert apprentices should reserve time to work on faces and names of new persons they were introduced to lately. This activity involves filing new calling cards (or making new ones if not available) and reviewing the ones in store already. A calling card can be used as a retrieval cue for the person's face. This is also the time to rehearse and elaborate the associated face-name mnemonics written on the back of the card. Participants of the training study will be asked to keep diaries about these online and off-line activities. They will also be asked to record instances of successful name retrievals that they attribute to the training program and instances of failures of name retrieval despite the training program for which a revision or embellishment of the face-name mnemonic would be required. Obviously, these activities are quite analogous to those of experts in many professional domains, such as chess masters who typically work through their matches after a tournament. Transfer of Technology Use

Our training programs are tailored to individual levels of proficiency. There is broad agreement that such a training context will be conducive to fast skill acquisition. It also implies that computer technology is used to administer the tasks and to monitor the progress. Indeed, we furnished the apartments of participants of Experiment 3 with computers to increase the amount and intensity of training. We hope to observe computer literacy as a collateral benefit of computer-assisted tailored learning and deliberate practice, ideally in the spirit of the study reported by Bikson and Bikson in chapter 7. One implication is that cognitive skill acquisition (such as a face-name memory expertise) may provide the ideal learning context for joining modern technology and that it will be clearly within reach of healthy older adults. One learns to value modern technology by doing something useful with it.

ACKNOWLEDGMENTS We thank Petra Griittner, Annette Rentz, Werner Scholtysik, Mirko Wendland, Leif Johannsen, and Alexandra Engst for research assistance. Experiments 1 and 2 were conducted at the Max Plank Institute for Human Development, Berlin; Experiment 2 was Matthias Luckner's diploma thesis. Experiment 3 is ongoing at the University of Potsdam and is sponsored by AK gerontologie of MSD Sharp & Dohme GmbH.

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REFERENCES Bakes, P. B., & Kliegl, R. (1992). Further testing of limits of cognitive plasticity: Negative age differences in a mnemonic skill are robust. Developmental Psychology, 28, 121-125. Camp, C. J. (1998). Memory interventions for normal and pathological older adults. Annual Review of Gerontology and Geriatrics, 18, 155—189. Cavanaugh, J. C., Grady, J. G., & Perlmutter, M. (1983). Forgetting and use of memory aids in 20-to 70-year-olds' everyday life. International Journal of Aging and Human Development, 17, 113—122. Charness, N., Krampe, R. T., & Mayr, U. (1996). The role of practice and coaching in entrepreneurial skill domains: An international comparison of life-span chess skill acquisition. In K. A. Ericsson (Ed.), The road to excellence: The acquisition of expert performance in the arts, sciences, sports, and games (pp. 51— 80). Mahwah, NJ: Erlbaum. Ericsson, K. A. (1985). Memory skill. Canadian Journal of Psychology, 39, 188231. Ericsson, K. A. (1996). The road to excellence: The acquisition of expert performance in the arts, sciences, sports, and games. Mahwah, NJ: Erlbaum. Ericsson, K. A., Krampe, R. Th., & Tesch-Romer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100, 363-406. Floyd, M., & Scogin, F. (1997). Effects of memory training on the subjective memory functioning and mental health of older adults: A meta-analysis. Psychology and Aging, 12, 150—161. Kliegl, R. (1995). From presentation time to processing time: A psychophysics approach to episodic memory. In F. E. Weinert & W. Schneider (Eds.), Memory performance and competencies (pp. 89-110). Mahwah, NJ: Erlbaum. Kliegl, R., & Baltes, P. B. (1987). Theory-guided analysis of mechanisms of development and aging through testing-the-limits and research on expertise. In C. Schooler & K. W. Schaie (Eds.), Cognitive functioning and social structure over the life course (pp. 95-119). Norwood, NJ: Ablex. Kliegl, R., Krampe, R. T, Philipp, D., & Luckner, M. (1999). Face memory skill acquisition. Manuscript submitted for publication. Kliegl, R., Smith, J., & Baltes, P. B. (1989). Testing-the-limits and the study of adult age differences in cognitive plasticity of a mnemonic skill. Developmental Psychology, 25, 247-256. Kliegl, R., Smith, J., & Baltes, P. B. (1990). On the locus and process of magnification of adult age differences during mnemonic training. Developmental Psychology, 26, 894-904. Krampe, R. Th., & Ericsson, K. A. (1996). Maintaining excellence: Deliberate practice and elite performance in young and old pianists. Journal of Experimental Psychology: General, 125, 331-359.

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Leirer, V. O., Morrow, D. G., Pariante, G. M., & Sheikh, J. I. (1988) Elders' nonadherence, its assessment, and computer assisted instruction for medication recall training. Journal of the American Geriatrics Society, 36, 877-884. Leirer, V. O., Morrow, D. G., Sheikh, J. I., & Pariante, G. M. (1990). Memory skills elders want to improve. Experimental Aging Research, 16, 155—158. Lorayne, H. (1988). How to remember names and faces? New York: Random House AudioBooks. Lorayne, H., & Lucas, J. (1974). The memory book. New York: Stein & Day. McCarty, D. L. (1980). Investigation of a visual imagery mnemonic device for acquiring face-name associations. Journal of Experimental Psychology: Human Learning and Memory, 6, 1145-155. Morris, P. E., Jones, S., & Hampson, P. (1978). An imagery mnemonic for the learning of people's name. British Journal of Psychology, 69, 335-336. Oswald, W. D., & Rodel, G. (1998). Das SIMA-Projekt: Gedachtnistrainig—Ein Programm fur Senioren [The SIMA-project: Memory training—A program for older adults]. Gottingen: Hogrefe. Park, D. C., & Jones, T. R. (1997). Medication adherence and aging. In A. D. Fisk & W. A. Rogers (Eds.), Handbook of human factors and the older adult (pp. 257-287). New York: Academic Press. Proctor, R. W., & Dutta, A. (1995). Skill acquisition and human performance. Thousand Oaks, CA: Sage. Sheikh, J. L, Hill, R. D., & Yesavage, J. A. (1986). Long-term efficacy of cognitive training for age-associated memory impairment: A six-month follow-up study. Developmental Neuropsychology, 2, 413—421. Stigsdotter Neely, A., & Backman, L. (1993). Long-term maintenance of gains from memory training in older adults: Two 3 1/2—year follow-up studies. Journals of Gerontology: Psychological Sciences, 48, P233—P237. Stigsdotter Neely, A., & Backman, L. (1995). Effects of multifactorial memory training in old age: Generalizability across tasks and individuals. Journals of Gerontology: Psychological Sciences, 50B, P134-P140. Verhaeghen, P., Marcoen, A., & Goossens, L. (1992). Improving memory performance in aged through mnemonic training: A meta-analytic study. Psychology and Aging, 7, 242-251. Wilding, J., & Valentine, E. (1985). One man's memory for prose, faces, and names. British Journal of Psychology, 76, 215—219. Yesavage, J. A., & Rose, T. L. (1984). The effects of a face-name mnemonic in young, middle-aged, and elderly adults. Experimental Aging Research, 10, 5557. Yesavage, J. A., Rose, T. L., & Bower, G. H. (1983). Interactive imagery and affective judgements improve face-name learning in the elderly. Journal of Gerontology, 38, 197-203.

10

A Systems Approach for Training Older Adults to Use Technology Wendy A. Rogers, Regan H. Campbell, and Richard Pak

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early every minute of every day, we encounter, interact with, and rely on technology. On any given day at the office, one might be typing on a computer keyboard (and hoping that the system will save the work), listening to a compact disc player, adjusting a portable heater, and periodically fighting with a printer that seems to have a mind of its own. Consider also the home environment of today: individuals in their 60's have a computer system, an answering machine, a videocassette recorder (VCR), a microwave oven, an automatic dishwasher, and so on. If an individual becomes ill, the inventory of home technologies could expand to include complicated home health-care devices such as blood glucose meters, heart rate monitors, blood pressure gauges, infusion pumps, and more. The technology in our world is enough to overwhelm even technologysavvy individuals and may be downright mind-boggling to the uninitiated. How do we learn to interact with all of the various systems on which we have come to rely? That is the question we will focus on in this chapter. Our primary goal is to provide guidance for the development of training programs in the context of training older adults to use technology. We conceptualize technology broadly to include answering machines, VCRs, telecommunications, computers, home health-care technologies, interactive databases, and more. Broadly speaking, technology can be defined as "a capability given by the practical application of knowledge" (MerriamWebster, 1994, p. 1210). However, technology also contributes to countless frustrations and perhaps lack of capability, particularly for older individuals, as we will illustrate. 187

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THE NEED FOR TRAINING In an ideal world perhaps, training to use technology would be unnecessary, because all systems would be intuitively easy to use. However, many systems are not designed for the actual user population. Moreover, the goals and background experience of potential users vary, and technological systems are becoming increasingly more complex. The need for training is apparent and will likely remain far into the future. Theories of training abound in the research literature (for a review, see Swezey & Llaneras, 1997). Unfortunately, there has traditionally been a disconnect between the developers of training theories and the practitioners who could benefit most from the application of such theories (Salas, Cannon-Bowers, & Blickensderfer, 1997). By training, we include materials such as manuals and online tutorials included with software. Training programs developed without consideration of training theories will be less than optimal. Moreover, technology training may not be provided at all because system developers assume either that training is not necessary or that people can teach themselves. The consequences of poor or no training for computer technology, for example, may be particularly problematic for older individuals for a number of reasons. First, individuals over age 60 have less experience with computer technology (Rogers, Cabrera, Walker, Gilbert, & Fisk, 1996). Second, perceptual, motor, and cognitive declines that accompany aging may influence technology interactions (Fisk & Rogers, 1997). In addition, such age-related changes may necessitate age-specific training programs that are tailored to the capabilities of various age groups (e.g., Mead & Fisk, 1998).

A SYSTEMS APPROACH TO TRAINING "Intuition and standard practice are poor guides to training." —Bjork, Metacognition: Knowing about Knowing It is not sufficient to rely on one's own intuition to develop a viable and effective training program, nor is it wise to simply adopt the status quo and follow the training practice that others have used in the past. Training programs should be developed according to a systems approach in which the following questions are asked and answered: (a) What should be trained? (b) How should training be designed? and (c) Is training effective and why? (See Cannon-Bowers, Tannenbaum, Salas, & Converse, 1991.)

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The systems approach is based on the idea that training programs must consider the user of the technology, the environment in which the technology will be used, and the characteristics of the technology itself. We have developed a model to represent the systems approach to training that is based on prominent theories and models in the training and human factors literature. Our model is illustrated in Figure 10.1. We based our model primarily on Helander (1997) and Salas et al. (1997). The first step in the process is a needs assessment, which will provide the information necessary to develop the appropriate training program (Goldstein, 1993). In the needs assessment the scope of the problem is understood. One major aspect of the needs assessment is a task analysis to determine the elements of the task, how the task elements are arranged and ordered, and so on (see Luczak, 1997). In concert is an understanding of how difficult the task is and the requirements to carry out that task. A detailed task analysis allows researchers to understand and organize knowledge about a system to understand what the user expects from a system. The outcome of the task analysis will be the knowledge, skills, and abilities required to perform the tasks. As such, the product of this aspect of the systems approach will be a detailed understanding of the performance requirements that should be considered in the development of the training program. Parallel to the task analysis, a person analysis should be conducted that focuses on the user characteristics (Helander, 1997). This analysis should consider potential modulating variables such as age, competence, experience, motivation, self-efficacy, sex, and so on. The results of the person analysis will be an understanding of the capabilities and limitations of the user that should be considered in the development of the training program. Where the results of the task and person analysis meet is the selection and design of training program(s). Within this intersection, the task and person analysis results are reconciled to form a training program. The training program does not have to begin from scratch; instead, previous training programs can be modified to reflect the results of the new task and person analysis as well as the theoretical results of previous research. One might decide to select several existing programs for comparison or design a new training program or set of programs. Training developers can appeal to general training principles (Salas et al., 1997) as well as build from previous training programs and training research. Once the programs are selected, the next step is evaluation. During the evaluation phase, criteria should be developed for determining whether or which training programs are successful. Evaluation should include usability testing, as well as measures of transfer (i.e., from the training environment to other environments) and retention (i.e., maintenance of learning across time).

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Needs Assessment

Task Analysis

Knowledge Skills Abilities

Person Analysis

Modulating VariablesAge, Competence, Experience, Motivation, SelfEfficacy, Sex

Selection and Design of Training Program(s) Performance Requirements/

Training Principles Previous Training Programs Previous Research Evaluation Development of Criteria Usability Transfer and Retention Training Program Recommendations

Figure 10.1 A systems approach to training.

At the end of the evaluation stage, several decisions can be made, as indicated by "feedback" loops in Figure 10.1 from the evaluation step back to the selection and design step or back to the needs assessment. After each evaluation, the researchers decide if they were satisfied with the training program. If one or several of the training programs were evaluated and deemed successful, then specific recommendations for training could be made. If all of the training programs were failures (i.e., did not meet criteria), one might decide to go back to the needs assessment phase to determine if aspects of that process had been carried out incorrectly. Another possibility would be to return to the selection and design phase to develop different training programs for testing. Of course, in real-world practice, the number of iterative steps involved would be constrained by many factors, one of which is cost.

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The remainder of the chapter will be devoted to illustrating by example the relevance of the systems approach to training older adults to use technologies. We will start with a case study to illustrate the process from beginning to end. This illustration will come from our research on training older adults to use automatic teller machines (ATMs). We will then provide two illustrations of work in progress that is also following the systems approach to training. First is training older adults to use the World Wide Web and second is training older adults to use telemedicine systems.

A CASE STUDY: AUTOMATIC TELLER MACHINES To illustrate the various components of the systems approach to training (see Figure 10.1), we will provide a description of each component in the context of the development of a training program to teach older adults to use an ATM. Research on ATMs should be generalizeable to other systems because ATMs are representative of many technologies currently available. They contain hierarchical menus and are dynamic and interactive like many computer systems, on-screen programming devices, and telephone answering systems. One interesting difference between ATMs and "home" technologies (e.g., VCRs, computers, and answering machines) is that a person must learn to use the system online. That is, one cannot currently read a manual or practice with the system at home. Rather, one must learn to use the system while actually trying to conduct a banking transaction. Given this constraint, and the fact that many people have difficulty understanding how to use an ATM, it may not be surprising that fewer older adults use ATMs. Needs Assessment In essence, the needs assessment phase involves defining the training question and specifying all of the potentially relevant parameters. We started with the following question: Is training necessary for older adult users of ATMs? The assumption that training would be needed for ATMs was certainly not shared by members of the banking industry. In fact, ATM transactions are considered so easy that many banks choose not to provide training at all. We conducted an informal survey of 13 banks in a large metropolitan area. Only 2 of the banks (15%) provided a brief pamphlet describing the functions of their ATM. The remaining 11 banks (85%) told us they did not provide any instructional materials for using ATMs. Many expressed the opinion that ATMs are easy to use and so intuitive that training is unnecessary.

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Thus the needs assessment phase for this particular project was necessary to determine whether training was needed (or wanted), what aspects of the task might be particularly problematic, what the user characteristics were, and an understanding of who might benefit from training. Task Analysis A task analysis was conducted for all of the functions available to users (e.g., withdrawals, deposits, fast cash, and so on). In the interest of brevity here, we will only provide a sample task analysis for the withdrawal function. First, the bank card must be inserted with the correct orientation. Next, the user must enter his or her personal identification number (PIN). The ATM then prompts the user to choose a transaction type (e.g., withdrawal, deposit). After the transaction type has been selected (in this case, withdrawal), the ATM prompts the user to enter the amount to be withdrawn. Using the number pad, the user would enter the desired amount (e.g., $100.00). After confirming that $100.00 was available from the account, the ATM would process the transaction. The ATM then provides the cash, the receipt, and the ATM card in their respective slots. The user should then take all three items to complete the transaction. At every step, the task analysis may be elaborated to include possible errors and consequences of those errors. For instance, inserting the bank card could be done incorrectly if the card were upside down or backwards, or both. This error would result in the machine returning the card, and the user not being able to get money from the machine. However, this is not a critical error because many current machines show the correct orientation of the card and provide an error message that states the card is incorrectly inserted. A more critical error (in terms of cost to the user) might be selecting the wrong account or amount for a withdrawal. In sum, the task analysis provides information about the specific steps involved in performing functions on an ATM, the possibilities for error, and the consequences of errors. A detailed task analysis for all possible functions will guide the development of a suitable training program. Person Analysis The use of technology in general is lower among older adults than other age groups (Gilly & Zeithaml, 1985; Rogers, Cabrera, et al., 1996). The lowered use may be for a variety of reasons, such as motivation (older adults may not see a need for the services provided by new technology), cohort differences (younger adults have had more direct experience with current technologies through school and work), or cognitive differences (age-related cognitive declines may hinder the acquisition of skills needed to use new technologies).

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Recent surveys have shown that older adults are also infrequent users of ATMs (Gilly & Zeithaml, 1985; Rogers, Cabrera, et al., 1996). The highest-rated reason older adults reported for not using ATMs in the more recent Rogers, Cabrera, et al. survey (1996) was not concern for safety while using ATMs but a preference for dealing with people rather than machines. However, ATMs could be of benefit to older adults for several reasons. First, ATMs can provide more convenient access to banking services, which is important for individuals with reduced mobility. The use of ATMs in grocery stores, for example, would enable the completion of several tasks in a single location. Second, some ATMs currently have a wide range of services, such as transferring funds between accounts and paying utility bills. Third, the looming trend to charge for "human assisted" banking may necessitate ATM use for individuals on fixed incomes (Meier, 1995). Given our focus on older adults, the person analysis included determining the types of difficulties this user population might experience using this particular system. Hatta and liyama (1991) assessed the ability of 12 older adult ATM users (ages 52 to 68) to use an ATM. These individuals had difficulty understanding the instructions and the operations of the ATM. In addition, relative to a group of younger adults (ages 20 to 23), the older group required more time to enter information, did more backtracking, had much longer inter-key intervals, and tended to make more errors. An interview study by Rogers, Gilbert, and Cabrera (1997) found that older users reported a variety of problems using ATMs, such as difficulty inserting their card, forgetting their secret code, responding too slowly for the ATM, pressing the wrong keys, and so on. In addition, several of the older users mentioned that they had difficulties when they first began using an ATM (e.g., they felt uncomfortable, intimidated, were unsure of what to do). These data certainly suggest that the performance of older ATM users is not optimal. However, current theories of aging and skill acquisition suggest that these performance problems can be overcome with training (Rogers, Fisk, & Walker, 1997). Selection and Design of Training Programs Training Programs We designed a study that tested three experimental conditions and compared them with a control condition that received no training but a description of the ATM. The control condition is referred to as the description group. (For more information, see Rogers, Fisk, Mead, Walker, & Cabrera,

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1996). The three instructional conditions were a text guide, a pictorial guide, and an online tutorial. The type and amount of information about how to perform a transaction were equated across the conditions, only the instructional delivery differed. The text guide was designed to provide information on how to perform five basic transactions: fast cash withdrawal, other withdrawal, deposit, transfer, and account information. Step-by-step instructions, including the spatial locations of buttons, were presented in paragraph format. The pictorial guide provided step-by-step information necessary for performing the five basic transactions in outline form, along with a picture of each simulator screen. Such a representation might help users develop a "mental model" of how the system worked that would aid them in using the system (e.g., Kieras, 1988). A potential drawback of this set of instructions was that it required the integration of the text and pictorial information, which might increase cognitive load and interfere with learning (Sweller, 1988). The online tutorial provided trainees with the opportunity for hands-on experience with the ATM during training. They were led step-by-step through examples of each transaction type and were required to perform each action as instructed by text windows on the simulator screen. Thus, the trainees had the opportunity to interact with the system, actually perform sample transactions, and practice components of the task. One potential limitation of a tutorial approach is that the trainees may become passive because they are told exactly which button to press and when to press it. Such passivity may limit the benefits of a tutorial (Palmiter & Elkerton, 1993; Palmiter, Elkerton, & Baggett, 1991). The training programs we selected for testing were designed after investigating training principles, previous research, and previous training programs. Next we provide a brief overview of our selection process. Training Principles There were three major training principles that led us to believe that the online tutoring would be superior to a text guide or a pictorial guide. First, the online tutorial provided hands-on, interactive experiences to the user. Second, it provided specific consistent practice of the task. Third, it provided the equivalent of worked examples to the user and therefore reduced their cognitive load (Sweller, Chandler, Tierney, & Cooper, 1990). Previous Research A minimal amount of research has been devoted to understanding how best to train individuals to use ATMs. Perhaps this lack of data is because bank officials do not see a need for such training.

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Evidence of the importance of training older adults to use ATMs comes from three sources: (1) the finding that older adults do not use ATMs as much as others (Gilly & Zeithaml, 1985; Rogers, Cabrera et al., 1996), (2) an analysis of the difficulties users have with ATMs (Hatta & liyama, 1991; Rogers, Gilbert, et al., 1997), (3) the finding that older adults are more interested in learning to use ATMs if they are first provided with training (Rogers, Cabrera, et al., 1996). Previous Training Programs An ATM training study of older adults was conducted by Adams and Thieben (1991). They used a part-task training technique to teach 80 individuals over age 50 (range not provided) to use an ATM simulator. They had four experimental groups: (1) demonstration only; (2) demonstration plus definition training in which participants were taught declarative knowledge such as the meaning of "withdrawal"; (3) demonstration plus sequence training in which participants were taught how to make a series of sequential decisions; and (4) demonstration plus definition training plus sequence training. Adams and Thieben (1991) reported that having any training improved performance (i.e., groups 2, 3, and 4 were better than group 1) and having both types of training was better than either alone (i.e., group 4 was better than groups 2 and 3). However, even the best training method (demonstration plus definition training plus sequence training) yielded only 55% perfect performance. That is, only 11 of the 20 participants in that group were able to perform the target transaction successfully by means of the most direct route. Although the Adams and Thieben (1991) research was an important first step in the development of an ATM training program, several questions remained. First, their definition of "perfect performance" was unclear in part because it did not include remembering to take one's card, one's receipt, or one's cash, where applicable. Moreover, Adams and Thieben tested their participants on only a single transaction after training. There was no opportunity for the participants to practice using the ATM. It is not clear if performance on that single transaction is representative of success in using an ATM. Nor is it clear whether the training benefits would transfer to other ATM transactions or to other ATM systems or would afford retention beyond initial learning. Evaluation of the Training Methods Criteria The first step of the evaluation process is to develop criteria to determine the success or failure of the training programs. Our general criteria for a

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successful ATM training program were as follows. Flexibility such that the training could be done at the ATM, in the bank, or even in the home. The training should be simple, yet informative, and should be targeted for older adults. At the conclusion of the training program, the older adult trainees should be able to use the exact ATM they trained on, as well as other similar models. Benefits of training should be maintained across periods of nonuse. Usability Usability was evaluated in the ATM study through both performance measures and satisfaction measures. The performance results showed that the online tutorial group performed consistently better than the description group, and the pictorial and text guide groups were typically intermediate. Post hoc comparisons revealed statistical differences between the online tutorial and description groups for withdrawal (p < 0.003), transfer (p < 0.01), and account information (p < 0.02); and between the online tutorial and text guide groups for account information (p < 0.038). To measure satisfaction, the participants were asked a series of questions before they began working with the ATM simulator and again after they had completed the experiment. One of the questions asked whether the participant would like to use an ATM. Before participating in the study, 28% of participants expressed an interest in using an ATM. Subsequent to their experience with the ATM simulators, 60% answered in the affirmative. Thus, as a result of having the opportunity to interact with an ATM simulator, there was a significant increase in interest in using an ATM (p < 0.0003). This increase did not differ across the training conditions. Retention Performance was measured after a 24—hour interval to assess retention of the acquired knowledge. The 24-hour interval did not result in a significant degradation in performance for any of the instructional groups and thus the superiority of the online training was maintained. Transfer

Transfer was assessed in two ways. Having the trainees perform familiar transactions on the new ATM assessed "surface transfer." That is, they had to transfer their knowledge to a system with different surface features. Transferring from one version of an ATM to another one did not significantly disrupt performance for any of the groups if the specific tasks were familiar (i.e., surface transfer). However, the online tutorial group's performance was superior at transfer.

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Having trainees perform novel transactions on the new ATM assessed "far transfer" (e.g., purchase a lottery ticket). Transfer in this sense requires success in applying general knowledge about how an ATM works to unfamiliar tasks. All groups performed more poorly in the far transfer condition, but the online tutorial group's performance was still superior. An additional analysis was conducted to determine if the decrement in performance differed for the surface transfer and the far transfer transactions. For all of the groups, there was significantly more disruption for the far transfer condition relative to the surface transfer. Having to perform completely novel transactions on an unfamiliar simulator was more difficult than performing familiar transactions on the unfamiliar simulator. Evaluation Outcome The Rogers, Fisk, et al. (1996) training study was designed to compare the benefits of different instructional programs for ATMs. The accuracy and transaction time data for initial practice, retention, and transfer converge to suggest that the online tutorial yielded the highest level of performance. The online tutorial provided the equivalent of worked examples (Sweller et al., 1990) and gave participants hands-on experience with the system. Perhaps most importantly, the tutorial provided repeated practice on the consistent components of the task such as entering the PIN, removing the ATM card, and taking the cash and receipt at the end of each transaction. As a result, the participants in the online group performed more transactions correctly, completed the transactions more quickly, and maintained their advantage even for completely novel transactions on an unfamiliar ATM. The provision of only a description of an ATM (i.e., the description group) clearly resulted in the lowest levels of performance. These participants were at a disadvantage throughout practice and retention and at transfer, in terms of both accuracy and transaction time. Simply having a brief description of the system and being allowed to practice with it did not result in good performance. Unfortunately, as inadequate as the description condition was in facilitating performance, this condition is better than most current bank practices. New customers receive their ATM cards, their PIN, and, at most, a brief description of the ATM but have no opportunity to practice using the system. The lack of any instructions or practice opportunity may account for the fact that only 33% of older adults choose to use an ATM (Rogers, Cabrera, et al., 1996). The results also clearly demonstrate that, at least for older adults, there is a need for ATM training. Throughout practice, retention, and transfer, the text guide and pictorial guide groups were generally indistinguishable and were intermediate be-

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tween the online tutorial and the description groups. Having a detailed explanation of how to perform various transactions was helpful, although not as helpful as having actually performed the transactions by means of a tutorial program. From a practical perspective, text and pictorial guides may be easier and more cost effective to distribute to bank customers than online tutorials are. Thus the potential benefits of such training programs should be investigated in more detail. In the meantime, banks should provide training to use an ATM as a customer service to individuals who wish to use their machines. Training Program Recommendations Based on the initial Rogers, Fisk, et al. (1996) study, several recommendations could be made to bank managers wishing to provide their customers with training. The best performance was found for the online tutorial followed by the pictorial and text guides. However, because users were far from perfect in performing various transactions, we continued the research by looping back to the selection and design phase. Additional training programs were designed and tested. Mead and Fisk (1998) showed that the online tutorial could be improved by focusing specifically on the actions required to perform a particular transaction. In addition, Jamieson and Rogers (in press) found that intermixing practice on different transactions was particularly beneficial for older adults. Together these studies illustrate a range of training options for older adults and ATMs. The bottom line is that training is required for older adults to successfully perform the range of transactions available on these systems.

FUTURE APPLICATIONS: THE WORLD WIDE WEB The Internet is seemingly the hottest topic in communications and computing these days. With the ability to send e-mail across the globe, communication can be as rich as writing a letter and as quick as picking up the telephone and dialing. On-line communities (e.g., newsgroups, chat rooms) have sprouted across the Web to allow people with similar interests from the unusual to the mundane to communicate with others who share their interests, not necessarily from the same town, state, or country. Commerce on the Web has grown, just in the past few years, allowing Web users to shop on-line from the comfort of their home. Having so many services from the home is especially convenient for people who are homebound or

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have disabilities that limit mobility. It is disturbing then that although the percentage of older adults in the United States is increasing at a significant rate (Czaja & Guion, 1990), they remain one of the most underrepresented segments on the Internet (Miller, 1996). This finding is ironic and unfortunate because the Internet can serve as a vital source of information and communication for the older adult. Ideally, Web training would not be needed for older adults because the Web would be designed such that both younger and older adults could easily use it. Unfortunately, most Web sites are constructed by artists and software designers with little or no regard for the needs of older adults. This is unfortunate because the design principles advocated by human factors scientists (e.g., Mead, Batsakes, Fisk, & Mykityshyn, 1999; Spiezle, 1999) for the design of Web sites for older adults would be beneficial to users of all ages (Mead, Lanson, & Rogers, in press). Given that the Web cannot change in 1 day to be more accommodating to older adults, it is probably a more fruitful approach to train the older adult with the ability to use the Web as it is today. In this section, we will illustrate the approach in Figure 10.1 for designing a Web training program for older adults that we are currently testing. Needs Assessment In designing a program to train older adults to use the World Wide Web, one must first specify the scope of the problem. There is a substantial amount of information on the Web that is particularly relevant to older adults (e.g., obtaining health information, communicating; see Koch, 1992, for further relevant examples). However, only about 3—5% of current Web users are adults over age 65 (Miller, 1996). What is keeping older adults from using this beneficial source of information and communication? Czaja (1996) conducted a review of the literature and found that older adults were generally receptive to the use of technology, thus making fear of technology an unlikely cause of the problem. Morrell, Mayhorn, and Bennett (in press) conducted a survey of middle-aged and older adults and found that the primary reasons that older adults did not use the Web was a lack of knowledge of how to use the Web, no access to a computer, and no understanding of what to do with the Web. Particularly illuminating was that most older adults would like to start using the Web if they had some training available. Similarly, a report by SeniorNet (Adler, 1996) showed that when non-computer users were asked what would make them more interested in buying a computer, the top response was the availability of easy to use learning materials.

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The needs assessment has shown that (1) there is a benefit to using the Web, (2) older adults want to use the Web but do not, and (3) there is a definite desire among older adults to receive training on Web use. Once the problem has been defined, the next steps are task and person analysis.

Task Analysis In the Web training task analysis, we focused on a somewhat "micro" level (that of searching for information on a Web site) as a means to limit the initial scope of the problem. Macro level details of getting on the Web (logging on, signing in) will be addressed in future research. The task analysis of "browsing" a Web site for information involves several steps. First, the user must spatially orient to their desired hyperlink. They must then move their mouse pointer to the desired link on the page and click, or the user must move the pointer into a special location and type using the keyboard. Our preliminary task analysis of using the Web revealed that mouse operation is vitally important for it is the primary means of navigation within and between pages on the Web. Another issue revealed in the task analysis was that users need to understand certain fundamental concepts about the Web. For example, if the user is not aware of the "hyper-linked" nature of the Web, it can be a very confusing assemblage of semirelated documents. The user must understand that the Web is merely composed of documents residing on computers scattered over large physical distances instead of all residing on their single computer. In essence, a large amount of knowledge is required before users can browse the Web for information. A mental model may be helpful in organizing this knowledge (e.g., Kieras & Bovair, 1984). We are continuing the task analysis process to clarify the opportunities for error in browsing the Web along with the consequences of such errors. We are also investigating the degree to which users of the Web have an accessible mental model of the system (Pak, Rogers, & Stronge, in press). Person Analysis The person analysis phase is critically important, especially for research on aging, because this is when the capabilities and limitations of the target population are assessed. Relevant to our Web training example is the fact that the target audience of older adults is known to have problems with manual dexterity in terms of moving a mouse (e.g., Walker, Philbin, & Fisk, 1997). This poses a problem because the mouse is the primary method of navigating the Web. Impairments in episodic and working memory (for a review, see Smith, 1997) may make it more difficult for an older adult to keep track of where

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they are in a hierarchical system such as the Web. Difficulty remembering previously visited links may lead to frequent visits to the same page (Mead, Spaulding, Sit, Meyer, & Walker, 1997). Another issue that arose from the person analysis was that of older adults' self-efficacy and attitudes toward general computer use. Users' selfefficacy, their belief that they can do the task at hand, and general computer attitudes have been shown to be moderately related to computer proficiency (see Kelley & Charness, 1995, for a brief review). Based on the fact that fewer older adults own computers than do middle-aged or younger adults (Adler, 1996), the general statement that older adults are less experienced could be made. This lack of experience could cause or be caused by anxiety toward computers. Reducing this anxiety toward computers has been shown to be effective in enhancing training, although the effect is rather weak (see Kelley & Charness, 1995). According to Morrell et al. (in press) the reasons cited by older adults for not using the Web were that they did not know how it worked and did not know what to do on the Web. This is important because these are factors that can be addressed in the training phase. Selection and Design of Training Programs The results of the needs assessment clearly indicated the important issue of dexterity in using a computer mouse. Given that this is a critical prerequisite to using the Web, we would include a separate training session prior to the actual Web training session. We believed that we could alleviate the major problems with using the mouse by providing practice. We chose this route over other methods such as changing the interface (e.g., font size, mouse characteristics) for ecological validity reasons—we wanted to portray the Web in training as it really is, not an idealized version. In the mouse training session, participants perform several hundred trials of using the mouse (e.g., clicking, double clicking). We reviewed the computer training literature and selected a common paradigm for computer training. In this paradigm, the trainees are separated into different groups, each of which receives different instruction types. In our training program, the user is given either illustrated instructions or plain text instructions. In the illustrated instructions condition, a representation of the browser window that they will be working with is annotated with procedural steps in relevant locations. The plain text condition contained instructions from a software manual. This set of instructions did not contain any graphical elements. According to cognitive load theory (Chandler & Sweller, 1991), the illustrated instructions should provide better

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retention because they do not require the user to look up at the screen, look down at the text, and then manually integrate the instructions (Chandler & Sweller, 1996). In the text plus pictures instruction condition, everything participants need to know about each screen is located on a single page. In addition, our review of the literature on advance organizers suggested that such an organizer might help clarify the Web to our trainees who would be novice Web users. An advance organizer (Mayer & Bromage, 1980) is a paragraph that gives a general overview of the system to be learned. We surmised that perhaps having an analogy as the advance organizer to the Web would allow the older adults to conceptualize the Web in terms of something with which they are already familiar. Evaluation of the Training Methods To test the efficacy of our training program, we will evaluate whether the new instructional manipulation, mouse training, and advance organizer constitute a successful training program. We will have the older adults navigate three different Web sites, each varying in similarity to the one they will train on. The first site will have a similar look and underlying hyperlink structure (similar menus and options), but the content will be different. This will be the measure of near transfer, content dissimilar. In the next site, the content will be similar but the underlying structure will differ. This will be the measure of near transfer, content similar. In the far transfer condition we will use a Web site with differing content and hierarchical structure. For each Web site, participants will be required to browse the site for answers to specific questions. For example, if they are being tested on a cooking-related site, they might be asked the question, "What is a canelle?" The answer would be located somewhere on the site (it is a cooking utensil). The primary dependent variable will be success or failure in obtaining the information as well as speed to get the information. We will also measure the number of conceptual, mechanical, and navigational errors. A conceptual error is a fundamentally wrong way of getting to the required information. An example might be misunderstanding the instructions and going outside the designated site. A mechanical error is caused by clicking the wrong button or link, and a navigational error might be pressing the forward button instead of the back button. Having these multiple dependent variables will allow us to elaborately understand the nature of our training manipulation. Understanding the effect of the training manipulation is important in the evaluation phase of our model because it informs us whether the training program was a success based on set criteria. For example, we could determine if our training

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program reduced the number of conceptual errors but had no effect on navigational errors. In this case, we might retain the program or go back and "tweak" our program or start over depending on whether reducing navigational errors was a critical criterion for success. The approach just presented in the form of our Web example is a good example of how the systems approach "flows" and eventually, if followed correctly, leads to a training program. In our Web example, we are currently following the systems approach to fine tune the resultant training program. Initial evaluation of the pilot training program has shown that even with the mouse practice, mouse operation is still difficult for older adults, resulting in many mouse-related errors. The level of performance, according to our criteria is unacceptable so we must loop back to the training development and selection phase to determine whether more or different mouse practice or some type of modification to the user interface to make mouse movements easier is needed. We will then proceed to testing the more theoretical aspects of Web training such as the benefits of an advance organizer and the importance of integrated instructions.

FUTURE APPLICATIONS: TELEMEDICINE Our research into telemedicine applications is relatively new, so we have not completed all the steps of the training systems approach depicted in Figure 10.1. We have, however, done a needs assessment, including a task analysis and a person analysis. After conducting more basic research into telemedicine, we will select and design a training program for training older adults. Telemedicine is broadly considered as the use of electronic communications to exchange medical information from one site to another for the health and education of the patient. It is the way of the future in both health care and communication. Although it has been in use since the early 1970s, telemedicine has recently experienced dramatic growth, with more than 87 telemedicine programs located in the United States (Grisby & Allen, 1997). Although there has been a large influx of research into telemedicine and video conferencing applications, there has been no research studying older adults and their ability to interact with the technology. There are reasons to assume that older adults might particularly benefit from telemedicine research. For instance, many studies have shown that individuals experience more communication difficulties as they age and that older adults rely on their visual channels to compensate for these difficulties. Therefore, the addition of a visual channel to the telephone (like telemedicine) may mitigate some of the communication difficulties experienced by older adults.

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Needs Assessment The problem is that there is no research to document whether older adults are able to interact with telemedicine technology. We can assume that they are willing to use the technology given training, as indicated by the World Wide Web research. We can also show that there are possible benefits of using this technology. Therefore, we need to know how to train older adults in this setting. Task Analysis

A task analysis of telemedicine would be quite extensive and unwieldy, because there are so many different tasks that can be done using this technology. Thus we have chosen to focus on a particular task being performed in a telemedicine context. Our task is loading a medication organizer with the assistance of a nurse. In the telemedicine setting, there is a need to connect the parties, give instructions, understand the instructions, open the bottle, load a pill into each slot of the medication organizer, and close the bottle. This task is repeated numerous times in our task and provides many opportunities for errors at each step. Our research is attempting to determine which errors people make, how often errors are made, and why they are making the errors (i.e., cognitive difficulties, incorrect hearing of the instructions). These performance requirements will later be used to determine specific components to be included in a training program. Person Analysis

Research has shown that older adults rely more heavily on their visual channels and knowledge of semantic constraints to compensate for deficits in hearing and working memory as they age (Tun & Wingfield, 1997). Older adults also have difficulty with speech that is masked by noise or filtered through different bandwidths, such as occurs during telephone conversations (Tun & Wingfield, 1997). In fact, problems using the telephone significantly increase with age for both men and women (Koyano et al., 1988). Because telephone conversations have only verbal and paralinguistic cues (e.g., tone of voice) and can be taxing on working memory, Ryan, Anas, Hummert, and Laver-Ingram (1998) stated that older adults might have particular trouble conversing over the telephone, especially with unfamiliar people. Therefore, it might be reasonable to assume that the older adult would find some performance benefits from a visual channel even in cases where the young do not (see Campbell, Rogers, & Fisk, in press). These capabilities and limitations, in concert with the performance requirements, will be used to determine the specific training programs to be assessed.

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CONCLUSIONS We are advocating a systems approach to training older adults to use technologies. This approach is really standard practice in the field of human factors and ergonomics (see Helander, 1997). However, it is unfortunately not standard practice in environments wherein older adults are being trained. Typically, training is either not provided for common technologies (e.g., ATMs) or it is not empirically and theoretically based training (e.g., online computer training). Inherent in the systems approach is the consideration of the user within the context of the tasks that will be performed. Detailed analyses of the tasks and users must precede the development and selection of training programs. Salas et al. (1997) have argued that too often trainers skip the analysis phases of the process and proceed directly to selection of training programs—without a solid basis for their selection. Our goal in this chapter was to demonstrate the systems approach to training older adults to use technology. We illustrated the process within the context of a particular research program that was designed to provide training for older adults interested in using ATMs. The research began with the needs assessment phase incorporating both a task analysis and a person analysis. Based on the results of these analyses, along with a review of existing training programs, principles, and research, we developed several training programs. Evaluation of the programs involved immediate usability (i.e., performance and satisfaction) as well as transfer to different systems and retention across time. The results of this initial study led to general recommendations for training as well as additional research to better refine the training programs. To demonstrate the generality of the approach we also provided a snapshot of how the approach is currently being applied in two very different training domains: the World Wide Web and telemedicine. Although these latter studies are still in progress, our intent was to show that the systems approach is a process with broad generality. This approach is likely to have application to any area in which one might wish to develop a training program.

ACKNOWLEDGMENTS The authors were supported in part by a grant from the National Institutes of Health (National Institute on Aging) Grant No. P50 AG11715 under the auspices of the Center for Applied Cognitive Research on Aging (one of the Edward R. Roybal Centers for Research on Applied Gerontology) and Grant No. R01 AG18177.

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REFERENCES Adams, A. S., & Thieben, K. A. (1991). Automatic teller machines and the older population. Applied Ergonomics, 22, 85-90. Adler, R. P. (1996). Older adults and computers: Report of a national survey [On line]. Available: www.seniornet.org/research/surveyl.html Bjork, R. A. (1994). Memory and metamemory considerations in the training of human beings. In J. Metcalfe & A. P. Shimamura (Eds.), Metacognition: Knowing about knowing (pp. 185-205). Cambridge, MA: MIT Press. Campbell, R. H., Rogers, W. A., Fisk, A. D. (in press). Providing environmental support through the use of a visual channel. Proceedings of the Human Factors and Ergonomics Society 44th Annual Meeting. Santa Monica, CA: Human Factors and Ergonomics Society. Cannon-Bowers, J. A., Tannenbaum, S. I., Salas, E., & Converse, S. A. (1991). Toward an integration of training theory and technique. Human Factors, 33, 281-292. Chandler, P., & Sweller, J. (1991). Cognitive load theory and the format of instruction. Cognition and Instruction, 8, 293-332. Chandler, P., & Sweller, J. (1996). Cognitive load while learning to use a computer program. Applied Cognitive Psychology, 10, 151-170. Czaja, S. J. (1996). Aging and the acquisition of computer skills. In W. A. Rogers, A. D. Fisk, and N. Walker (Eds.), Aging and skilled performance: Advances in theory and applications (pp. 241—266), Mahwah, NJ: Lawrence Erlbaum. Czaja, S. J., & Guion, R. M. (1990). Human factors research needs for an aging population. Washington, DC: National Academy Press. Fisk, A. D., & Rogers, W. A. (1997). Handbook of human factors and the older adult. San Diego, CA: Academic Press. Gilly, M. C., & Zeithaml, V. A. (1985). The elderly consumer and the adoption of new technologies. Journal of Consumer Research, 12, 353-357. Grisby, B. & Allen, A. (1997). Fourth Annual program review—a cooperative study by Telemedicine Today and the Association of Telemedicine Service Providers. Telemedicine Today [Online], 1—12. Available: www.telemedtoday.com/articles.htm Goldstein, I. L. (1993). Training in organizations: Needs assessment, development, and evaluation (3rd ed., pp. 29-82). Pacific Grove, CA: Brooks/Cole. Hatta, K., & liyama, Y. (1991). Ergonomic study of automatic teller machine operability. International Journal of Human Computer Interaction, 3, 295-309. Helander, M. (1997). The human factors profession. In G. Salvendy (Ed.), Handbook of human factors and ergonomics (2nd ed., pp. 3-16). New York: Wiley. Jamieson, B. A., & Rogers, W. A. (in press). Age-related effects of blocked and random practice schedules on learning a new technology. Journal of Gerontology: Psychological Sciences. Kelley, C. L., & Charness, N. (1995). Issues in training older adults to use computers. Behavior and Information Technology, 14, 107—120.

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Kieras, D. E., & Bovair, S. (1984). The role of mental models in learning to operate a device. Cognitive Science, 8, 255-273. Kieras, D. E. (1988). What mental model should be taught: Choosing instructional content for complex engineered systems. In J. Psotka, L.D. Massey, & S. Mutter (Eds.), Intelligent tutoring systems: Lessons learned (pp. 85-11). Hillsdale, NJ: Lawrence Erlbaum. Koch, S. (1992). Realizing the benefits of new computer and telecommunications technologies for older Americans. Washington, DC: National Association of Area Agencies on Aging. Koyano, S., Shibata, H., Nakazato, K., Haga, H., Suyama, Y., & Matsuzaki, T. (1988). Prevalence of disability in instrumental activities of daily living among elderly Japanese. Journal of Gerontology: Social Sciences, 43, 541-545. Luczak, H. (1997). Task analysis. In G. Salvendy (Ed.), Handbook of human factors (2nd ed., pp. 340-416). New York: Wiley. Mayer, R. E., & Bromage, B. K. (1980). Different recall protocols for technical texts due to advance organizers. Journal of Educational Psychology, 72, 209225. Mead, S., & Fisk, A. D. (1998). Measuring skill acquisition and retention with an ATM simulator: The need for age-specific training. Human Factors, 40, 516— 523. Mead, S. E., Lanson, N., & Rogers, W. A. (in press). Human factors guidelines for web site usability: Health-oriented web sites for older adults. In R. W. Morrell (Ed.), Older adults, health information, and the World Wide Web. Mead, S. E., Spaulding, V. A., Sit, R. A., Meyer, E., & Walker, N. (1997). Effects of age and training on World Wide Web navigation strategies. Proceedings of the Human Factors and Ergonomics Society 41st Annual Meeting (pp. 152156). Santa Monica, CA: Human Factors and Ergonomics Society. Mead, S. E., Batsakes, P., Fisk, A. D., Mykityshyn, A. (1999). Application of cognitive theory to training and design solutions for age-related computer use. International Journal of Behavioral Development, 23, 553-573. Meier, B. (1995, April 27). Need a teller? Chicago bank plans a fee; in some cases, a cost of $3 a transaction. The New York Times, p. Cl. Merriam-Webster's Collegiate Dictionary (10th ed.). (1994). Springfield, MA: Merriam-Webster. Miller, T. E. (1996). Segmenting the internet. American Demographics, 18, 48-50. Morrell, R. W, Mayhorn, C. B., and Bennett, J. (in press). A survey of World Wide Web use in middle-aged and older adults. Human Factors. Pak, R., Rogers, W. A., and Stronge, A. (in press). How would you describe the World Wide Web? Analogies of the web from users. Proceedings of the Human Factors and Ergonomics Society 44th Annual Meeting (p. X). Santa Monica, CA: Human Factors and Ergonomics Society. Palmiter, S., & Elkerton, J. (1993). Animated demonstrations for learning computer-based tasks. Human-Computer Interaction, 8, 193-216. Palmiter, S., Elkerton, J., & Baggett, P. (1991). Animated demonstrations vs.

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written instructions for learning procedural tasks: A preliminary investigation. International Journal of Man-Machine Studies, 34, 687-701. Rogers, W. A., Cabrera, E. R, Walker, N., Gilbert, D. K., & Fisk, A. D. (1996). A survey of automatic teller machine usage across the adult lifespan. Human Factors, 38, 156-166. Rogers, W. A., Fisk, A. D., Mead, S. E., Walker, N., & Cabrera, E. F. (1996). Training older adults to use automatic teller machines. Human Factors, 38, 425-433. Rogers, W. A., Fisk, A. D., & Walker, N. (1997). Aging and skilled performance: Advances in theory and application. Hillsdale, NJ: Erlbaum Rogers, W. A., Gilbert, D. K., & Cabrera, E. F. (1997). An analysis of automatic teller machine usage by older adults: A structured interview approach. Applied Ergonomics, 28, 173-180. Ryan, E. B., Anas, A. P., Hummert, M. L, & Lavar-Ingram, A. (1998). Young and older adults' views of telephone talk: Conversation problems and social uses. Journal of Applied Communication Research, 26, 83—98. Salas, E., Cannon-Bowers, J., & Blickensderfer, E. L. (1997). Enhancing reciprocity between training theory and practice: Principles, guidelines, and specifications. In J. K. Ford, S. W. J. Kozlowski, K. Kraiger, E. Salas, & M. S. Teachout (Eds.), Improving training effectiveness in work organizations (pp. 291-322). Mahwah, NJ: Erlbaum. Smith, A. D. (1997). Memory. In J. E. Birren & K. W Schaie (Eds.), Handbook of the psychology of aging (pp. 236-250). San Diego: Academic Press. Spiezle, C. (1999). Effective web design considerations for older adults [On-line]. Available: http://www.microsoft.com/seniors/content/pr99/webdesign-doc.asp Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science, 12, 257-285. Sweller, J., Chandler, P., Tierney, P., & Cooper, M. (1990). Cognitive load as a factor in the structuring of technical material. Journal of Experimental Psychology: General, 119, 176-192. Swezey, R. W, & Llaneras, R. E. (1997). Models in training and instruction. In G. Salvendy (Ed.), Handbook of human factors and ergonomics (2nd ed., pp. 514_577). New York: Wiley. Tun, P. A., & Wingfield, A. (1997). Language and Communication: Fundamentals of speech communication and language processing in old age. In A. D. Fisk & W. A. Rogers (Eds.), Handbook of human factors and the older adult (pp. 125-149). San Diego, CA: Academic Press. Walker, N., Philbin, D. A., & Fisk, A. D. (1997). Age-related differences in movement control: Adjusting submovement structure to optimize performance. Journal of Gerontology: Psychological Sciences, 52B, 40-52.

11 Aging, Vision, and Brain Plasticity: Restoring Lost Visual Functions by Computer-Based Training Bernhard A. Sabel, Dorothe A. Poggel, Tilman Schulte, and Erich Kasten

AGING, VISION, AND BRAIN PLASTICITY Aging In a society striving for ideals such as beauty and youthfulness, for most people, the process of aging is inseparably associated with the deterioration of bodily and mental functions. Biologically, this decay may be explained by gradual cell loss, especially of neurons in the central nervous system (CNS), starting at the moment of birth and resulting in a slow accumulation of deficits in the organism. Because those changes mostly occur over long periods of time, it is not surprising that a gradual loss of function is hardly ever noticed by the individual or by his or her social environment. Moreover, any slow development, for example, memory impairments with age, allows for an efficient adaptation of the organism to changed conditions, for example, using a shopping list when one cannot remember all items or retreating from social life when the content of recent communication cannot be retained in memory. Although elderly people usually adapt—more or less adequately—to those deficits spontaneously, there is increasing evidence that regular use of mental capacities may help to maintain a high level of functionality and probably also prevent further loss of function. 209

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Models of aging commonly depict the image of slow decay over time. Only very few authors take into account positive developments, for example, increasing wisdom in the elderly, or sudden functional loss that presents an even greater challenge for old people than do gradual changes. For instance, there is an increased risk for stroke in the elderly based, among other factors, on higher incidence rates of diabetes or cardiovascular disorders. Skepticism concerning the recovery of function after an abrupt event like a stroke causing focused damage in the brain has been even greater than the pessimistic attitude toward the maintenance or regaining of mental capacities after gradual, diffuse cell loss in the CNS. However, in most patients one can observe at least some spontaneous recovery after stroke. Moreover, several weeks or months after the lesion, patients usually begin to develop strategies devised to ameliorate difficulties in everyday life. Vision Since the advent of new (communication) technologies, for example, television, computers, household equipment with visual displays and so on, vision has become the most important perceptual domain for dealing efficiently with the challenges of everyday life. However, it is not only handling technical devices that makes life difficult for persons suffering from visual impairment. Along with the technological revolution of the past decades, living environments changed markedly; for instance, the increase of traffic especially in big cities or the opening of large supermarkets and closing down of the "little shop on the corner" make even the seemingly easiest tasks such as crossing a street or going shopping very hard for visually impaired people. Moreover, the orientation in well-known as well as in foreign surroundings, the acquisition of information, and, above all, social life are dramatically cut down when a person suffers from loss of visual functions (Kasten, Wiegmann, & Sabel, 1994; see also chapter 6). Especially in elderly people, incidence rates of visual impairment are considerably high (Elliott et al., 1997). Very common among old people are disorders of the peripheral visual apparatus, for example, glaucoma, cataract, retinal detachments and so on. These disorders as well as other age-dependent processes may be very disabling for the affected person. Additionally, as mentioned before, the incidence rate of stroke is comparatively high in the population of old people and the probability of acquiring a visual field defect after a brain lesion reaches 20—30% in medical surveys. Consequently, many elderly people not only are affected by gradually increasing visual deficits but also have a high chance of abrupt loss of visual abilities. Although the visual system has a very clear cut and, as most authors

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conclude from this fact, inflexible anatomic structure, neuronal connections in vision-related brain areas show an astonishing degree of flexibility (Sabel, 1997, 1999). Therefore, the visual system seems to be an adequate model for studying the consequences of aging and cell loss as well as the processes of plasticity and recovery. Brain Plasticity As mentioned previously, the process of aging is mostly associated with decay and loss of function. However, even very old people are able to learn new information and to adapt to fundamental changes in their lives. This suggests that models of decline or even of static representation of mental functions do not tell the whole story. Early neuropsychological theories stated that any (mental) capacity was represented in a circumscribed brain area. This notion of a static organization of the brain implicitly led to a rejection of the concept of functional recovery as any "taking over of function" by other brain areas seemed to be impossible because of the high degree of specialization. As a consequence, only very few attempts were made to influence the course of recovery, even though spontaneous improvement of the patient's abilities had been observed. This pessimistic view had also been adopted in vision research. Because of the highly specific processing of visual information, for a long time visual field defects in brain-injured patients have been considered unchangeable because the specificity of the visual system would not allow for other regions of the brain taking over functions. However, in the beginning of the 20th century, there were systematic observations of spontaneous recovery and also first attempts to compensate for deficits caused by visual field defects in soldiers with gunshot wounds of the brain (Poppelreuter, 1917). Since then, several investigators have observed spontaneous recovery from visual field loss, albeit with very different results (Kolmel, 1988; TielWilck, 1991). These findings prepared the way for designing new therapeutic methods aimed at the compensation or restitution of lost functions (Kasten, Schmid, & Eder, 1998). Especially since the advent of computers in rehabilitation settings, a wide range of treatment methods has been established for specific functional loss. Probably this comparatively optimistic view is more adequate for a clinical approach, and there is some chance that treatment methods for patients with loss of higher brain functions will be invented and applied successfully. In this chapter, we will present the consequences of functional loss and the role residual functions and intact visual domains play in coping with

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everyday tasks. Furthermore, we will show that systematic training can help patients to compensate for their deficits or even to regain parts of the original capacities, showing that the aging brain does possess a remarkable plasticity potential.

CONSEQUENCES OF VISUAL FIELD LOSS Patients suffering from visual deficits experience many limitations in their activities of daily living. Visual orientation may be seriously impaired, as shown in the following self-report: "I played squash. I had to watch the ball very closely, and if I lost it in the scotoma, I had no idea where it was. The visual noise was very distracting in the bright white court" (Kolb, 1997, p. 145). Partially blind patients have problems with the complete exploration of visual environments, especially when these scenarios are getting more complex, such as a station hall crowded with people or a street busy with cars, bicycles, pedestrians, and so on. Therefore, they often miss people or objects in their blind field, so that the risk of accidents and injuries is increased compared with people with a fully intact visual field. Frequently, hemianopic patients experience their visual field defect as smaller, and, occasionally, in a condition termed anosognosia, the patients are not even aware of the deficit. This further decreases the possibility of dealing efficiently with tasks of everyday life. In most countries, patients suffering from visual field loss are not allowed to drive motor vehicles (see the next section); in other words, they experience severe limitations of their independence and mobility (Schulte, Strasburger, Miiller-Oehring, & Sabel, 1999). For many patients, especially those with complete hemianopia (i.e., one half of the visual field missing on both eyes without any sparing of the central visual field that has the highest visual acuity), reading difficulties are the most prominent cause of suffering. In patients with hemianopia on the right side, the last parts of words are often missing. In contrast, patients with left-sided visual field defects cannot see the beginning of lines or words. Very frequently, they get lost within a page or line and have to restart in order to understand a sentence or paragraph. Reading a book or a newspaper becomes extremely tedious because patients have to make more eye movements to compensate for what they do not see. Finding words in texts is very difficult because affected persons cannot perceive the whole text at one glance (Kasten, Wiegmann, & Sabel, 1994; Kasten & Sabel, 1995). They also misinterpret visual scenes in a TV movie; objects appear suddenly from somewhere and disappear in the same sudden way.

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Many patients suffering from visual field defects feel uncomfortable interacting with people. For example, when communicating with another person, they only perceive parts of the interlocutor's face. Any facial expression is therefore difficult to analyze; shaking hands can also be a major problem. Because cerebral blindness is not directly observable for the interacting partner, these patients also have to cope with unappreciative reactions from their social environment. Understandably, visual field impairments are often the cause of unemployment in younger patients. Because most tasks can be done only very slowly and sometimes with several mistakes or even complete failure, loss of self-confidence is another common consequence of visual deficits. This often results in reactive depression, preventing the search for and application of neuropsychological treatment. Recent research on effects of visual impairment in the elderly shows that severely visually impaired old people were comparable to mobility-impaired older adults on many measures of activities of daily living (ADL). Moreover, emotional adaptation and life satisfaction as well as the degree of orientation toward the future decreased over time (Wahl, Schilling, Oswald, & Heyl, 1999). Visual capacity was found to be one of the most important predictors of competence in everyday life, range of action outside the home, and social and nonsocial activities in leisure time; in other words, intact vision is also necessary for social contact and communication (see chapter 6). Given that 20% of people over 60 and 25% of people over 75 suffer from visual impairment, the relevance of sensory loss for the individual as well as the society becomes clear. Although loss of visual functions leads to a multitude of negative consequences, there have been only very few attempts (from a social scientist's as well as from a neuroscientist's perspective) to explore residual functions and intact capacities in patients with visual impairments. These intact or residual visual functions might be the key for better coping with tasks of everyday life (see "Resources and Residual Functions") and the latter also for the application of systematic treatment in order to achieve recovery of functions (see "Computer-Based Training").

RESOURCES AND RESIDUAL FUNCTIONS Brain damage affecting the visual system can be classified as being of prechiasmatic or postchiasmatic anatomic location, resulting in different kinds of monocular or binocular deficits. Individuals with visual field defects are able to use intact areas of their visual field for general orientation because

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eye movements may be sufficient to compensate at least partially for their limited field of view. Often, it is even possible to perceive a complete picture just by using the intact area, although parts of the picture are located in the blind field. Intact parts of the brain try to process and analyze incoming information, and by mechanisms of Gestalt completion and filling-in, missing parts are added. As an example, Safran, Achard, Duret, and Landis (1999) described the "thin man" phenomenon in two patients with homonymous paracentral scotoma in the lower right quadrant of the visual field. Both subjects described a contraction of their interlocutor's left shoulder that reached into the blind field; in other words, they did not—as one might expect—perceive a gap in their field of vision. The authors concluded from their observations that higher visual functions, such as shape recognition, are determined by contextual influences that spread over large brain areas and that the size of the brain region activated by this top-down information critically depends on the complexity of the object. To improve the visual capacity and to overcome the deficit, patients can be trained to use the remaining intact field efficiently. Poppelreuter (1917) had described the effects of training on reading abilities in soldiers suffering from visual field defects after gunshot wounds in World War I. This kind of treatment was a predecessor of today's more elaborate and mostly computer-based compensation training programs. These methods do not focus exclusively on reading but also on other situations in which eye movements are necessary in order to achieve a complete exploration of a complex scene. Especially in the early phase after the brain lesion, when patients are not yet used to the limitation of their visual field and often collide with other people or with objects hidden in their blind field, this type of training can be very helpful because the individual learns to make automatic eye movements to scan the blind side efficiently and to prevent accidents and injuries. A major question that is of great relevance to the patients is whether they are capable of safe driving to continue with their typical daily activities. Driving is a complex task requiring visual, cognitive, and motor skills (McGwin, Owsley, & Ball, 1998). There is some evidence that impairment in these skills is increasingly common in the later decades of life (Tielsch, Sommer, Witt, Katz, & Royall, 1990; Whitehouse, 1993). There are few studies dealing with driving skills after brain injury with subsequent visual field loss. Therefore, empirical evidence for being considered unfit to drive a motor vehicle on the basis of perimetrically evidenced field loss is weak (Johnson & Keltner, 1983; Katz et al., 1990). Most patients are motivated to retain their mobility and thus exhibit a high interest for information concerning their driving skills. Therefore, we conducted a study using a driving simulator in order to answer the question of how visual field loss

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will affect driving skills (Schulte, Strasburger, Miiller-Oehring, & Sabel, 1999). We investigated nine patients with cerebrally induced visual field defects who had no further neuropsychological or ophthalmologic deficits. The control group consisted of 10 healthy subjects of comparable age. We found no differences in any of the tested parameters (driving speed, reaction time, and driving error rate) between the visually impaired subjects and the normal participants. This suggests that patients with visual field defects perform approximately as well as normal individuals in realistic driving scenarios. Thus, the assessment of driving capability should not be based on perimetric examinations alone, and patients with field defects should not in general be excluded from participation in motor vehicle traffic. So far, we have described resources of visually impaired patients resulting from intact visual field areas, but in a host of experiments, several authors could even show residual functions within the blind area in some patients. For instance, some patients were able to react to moving stimuli without any conscious perception of the stimuli. This phenomenon is termed "blindsight" (Weiskrantz, 1986; Rafal et al., 1990). In a typical study, patients are asked to estimate the location of a dot appearing shortly in the blind field or the direction of a moving stimulus. Despite the patients' assurance that they cannot see anything, the number of correct answers significantly exceeded random level. Apart from blindsight that only occurs in a rather small percentage of subjects with visual field defects, many patients with cerebral blindness have zones of residual visual functions that are typically located between blind and intact areas and allow conscious perception. These areas have been termed "transition zones" (Zihl, 1980). In our studies (Kasten, Wiist, Behrens-Baumann, & Sabel, 1998), we have found that some subjects showed a sharp visual field border and accordingly a small transition zone, whereas other subjects with a medium extension of the partially defective area were categorized as having a normal visual field border. Finally, some patients showed a fuzzy border; in other words, they had a large transition zone and rather scattered visual field defects. We propose a relationship between these residual functions and recovery of vision (Kasten, Wiist, Behrens-Baumann, & Sabel, 1998). Although strategies of compensation, especially teaching the patient to make eye movements toward the blind hemifield, are very helpful, particularly as a kind of "first-aid kit" to permit efficient coping with a limited field of view, they do not have any influence on visual field size; in other words, the patient has to "live with the visual field defect," as most ophthalmologists and neurologists tell patients. However, in recent years, we have witnessed a new development in neuroscience: a growing acceptance of the

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opinion that the brain possesses a remarkable plasticity, being able to compensate for lost functions during a period of recovery following injury (Freund, Sabel, & Witte, 1997). On the basis of the residual visual capacities described before, we assume that recovery from visual field defects can be achieved when transition zones are systematically stimulated. We will now go on to describe the role of transition zones in spontaneous and training-induced visual recovery.

RECOVERY FROM VISUAL FIELD DEFECTS AND SYSTEMATIC TRAINING PROCEDURES Because a pessimistic view concerning visual system plasticity dominated neuropsychology in the first half of the 20th century, the focus of treatment design was on methods of compensation for visual field loss instead of aiming at recovery of lost functions. Some researchers used special prisms or mirror glasses to project missing parts of the environment's image into the intact visual field of the patient. However, this proved to be very confusing for most people affected by partial cerebral blindness and was therefore not applied as a standard tool of treatment (Kasten, Wiegmann, & Sabel, 1994). Other rehabilitation techniques (Poppelreuter, 1917; Kerkhoff, Munssinger, & Meier, 1994; see "Resources and Residual Functions") aimed at helping the patients to compensate for the blind field by teaching them to make automatized eye movements into the affected zone so that they could compensate for the lost function. These techniques have been refined over the last decades and are still successfully applied in neuropsychological rehabilitation. With regard to the clear-cut evidence of visual system plasticity in animals, the question arises to what extent the human visual system also possesses the potential to adapt to loss of functions and what consequences restoration of visual functions might have for ADL. As we will see later, recovery may either take place spontaneously or be induced by systematic training procedures, both phenomena influencing objective as well as subjective measures of everyday functioning. Spontaneous Recovery As mentioned before, Poppelreuter (1917) observed spontaneous recovery from visual dysfunctions in soldiers with gunshot wounds. Since then, several investigators have studied spontaneous enlargement of visual field de-

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fects with rather heterogeneous results. Different authors mentioned rates of recovery between 7% and 85% improvement (Bogousslavsky, Regli, & van Melle, 1983; Hier, Mondlock, & Caplan, 1983; Kolmel, 1984, 1988; Messing & Ganshirt, 1987; Tiel-Wilck, 1991; Trobe, Lorbert, & Schlezinger, 1973; Zihl & von Cramon, 1985, 1986). Moreover, those studies yielded very heterogeneous findings with regard to the percentage of patients showing recovery and the duration of visual field enlargement. As a consequence, it is currently not possible to predict to what extent and in which time course a given patient may recover. However, one common finding was that patients having visual field borders with broad zones of "relative" defect (i.e., relatively large transition zones, see "Resources and Residual Functions") usually showed a larger amount of spontaneous recovery (Tiel-Wilck, 1991). In a long-term case study, we observed the course of recovery in a patient suffering from a lower visual field defect caused by a gunshot wound at the back of his head (Poggel, Kasten, Miiller-Oehring, & Sabel, 1998; Poggel, Kasten, Miiller-Oehring, Sabel, & Brandt, 1999). Initially, patient R.V. was completely blind, but only a few days after the lesion, he reported a first diffuse perception of light. Almost 3 months after the incident, the upper half of the visual field was completely intact, but progress in the lower visual hemisphere continued. Although the average duration of spontaneous recovery usually ranges between 3 weeks (Zihl & von Cramon, 1985) and 6 months (Messing & Ganshirt, 1987), R.V. still continued to improve until 16 months after lesion. We found that visual field enlargement gradually proceeded from the visual field border into the blind area. The greatest recovery was found in partially defective areas, in other words, in transition zones between intact and blind parts of the visual field. In parallel with the improvement in light detection, performance in color and form discrimination increased, showing the same pattern as the gain in stimulus detection; recovery of these parameters started in partially defective zones along the visual field border. Our single-case observation thus indicates that the visual system possesses a high degree of plasticity even when large cortical areas are damaged. This capacity is retained over months or years after the lesion, at least in some patients. Presumably, the brain maintains the ability to adapt flexibly to lesions (and of course to less dramatic changes of its functional status) over the entire life span, although it seems possible that this capacity might decrease somewhat with age or diffuse cell loss, or both. Still, the observation of spontaneous recovery as an indicator of visual system plasticity raises the question of whether plasticity may be actively manipulated, for example, by applying training procedures to induce additional restitution of visual functions.

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Training-Induced Recovery First attempts to study recovery from visual field defects in humans were made in the 1980s. In their pioneering experiments, Zihl and colleagues (Zihl, 1980; Zihl & von Cramon, 1985) found a significant increase of visual field size in patients with postchiasmatic brain lesions (i.e., lesions of the cortex itself or of the optic radiation) when luminance thresholds were systematically measured at the same position of the visual field border. However, their results were criticized because alternative explanations of the effects, for example, methodological artifacts such as spontaneous recovery or a change in the patients' fixation, could not be ruled out (Bach-y-Rita, 1990; Balliet, Blood, Bach-y-Rita, 1985). Meanwhile, other authors have presented single-case studies that showed visual field enlargement using various devices (Potthoff, 1995; Schmielau, 1989; Tegenthoff, Widdig, Rommel, & Malin, 1998; Werth & Mohrenschlager, 1997). Nevertheless, many neuroscientists question these findings in the absence of any prospective, randomized, placebo-controlled clinical trials. In 1990, we started developing computer programs with the goal to achieve restitution of visual functions in brain-damaged patients (VRT programs) by systematic stimulation of partially defective areas. In one of the training programs, "Visure," a large flickering stimulus that moves from the intact area into the blind field, crossing the transition zone on its way, is presented on a dark computer screen. The patient has to press a key on the computer keyboard whenever he or she is able to detect the stimulus appearing on the monitor. When the subject stops responding because he or she cannot see the stimulus any longer, it starts to move in the opposite direction, in other words, back into the intact area. When the patient indicates that he or she can see the stimulus again by pressing the key, the stimulus turns around and again moves into the defective area. During a treatment session, this process is repeated line by line so that the entire visual field border is stimulated. Once the patient can detect 90% of the stimuli presented, the more difficult program "Seetrain" is applied in a second stage of training. In this program, static stimuli increasing in brightness or size are presented at random locations in a previously defined area (mostly the transition zone) of the visual field. Our programs run on commercially available personal computers so that visual field training can be done at home. Because partially blind patients, even old people who have never before used a computer, are able to use the program independent of staff or highly specialized technical equipment, a large number of training sessions can be achieved. Over a period of 6 months, each patient performs two training sessions of 30 minutes each

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day. A high frequency as well as a long time period of restitution training is needed because a change in large cell populations of the brain's visual areas is much harder to achieve than is learning a compensatory motor task such as moving one's eyes into the blind hemisphere. Treatment results are stored on a disk so that compliance and changes in visual field size can be recorded minutely from session to session. In a pilot study (Kasten & Sabel, 1995), 11 patients took part in a training program lasting approximately 1 year. Three untreated patients were found to suffer a slight decrease of visual field size, whereas the treatment group showed a reliable enlargement. The latter group experienced not only a significant improvement in detection of white light stimuli but also an increase in color and, to a lesser but notable degree, shape discrimination. Additional training of form recognition and color discrimination also proved to be beneficial. Treatment outcome depended on the age of the patients, in other words, younger patients showed a larger benefit, and on the size of the brain damage, but, much to our surprise, we did not find a significant correlation of time since lesion or cause of lesion, respectively. This indicates that, although the degree of brain plasticity might decrease with age, the basic ability to adapt to lesions is not abolished by the passing of time, leading to the optimistic view that it is never to late to try to change things. These pilot results encouraged our opinion that systematic stimulation of partially defective areas can lead to a restitution of visual functions. However, because of many methodological limitations, especially the small sample size, the conclusions of the first trial were only preliminary, and any final statement on whether visual restitution is possible could only be made on the basis of a more strictly controlled clinical trial. We therefore initiated a randomized, double-blind, placebo-controlled trial with postchiasmatic patients (Kasten, Wiist, Behrens-Baumann, et al., 1998, Kasten et al., 1999). Nineteen patients took part in the prospective trial. The experimental group received visual field training with the VRT programs described before; the placebo group performed a fixation training ("Fixtrain") that forced the patients to make eye movements towards the stimulus. Patients in both groups were trained over a period of 6 months (about 175 hours of training). The experimental group showed a significant increase of intact visual field size in the trained area amounting to almost 8%. On average, the visual field border shifted about 5 degrees of visual angle toward the blind field. In contrast, visual field size in control group patients decreased slightly. Moreover, patients in the experimental group who showed a significant visual field enlargement also improved in color discrimination and form recognition.

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Because we have regularly observed that rats can recover rather well from optic nerve injury, this type of lesion is of particular interest. From a practical point of view, lesions (stroke, trauma, tumor, and surgery) or agedependent atrophy of the optic nerve are also very common in old people, so it was interesting to see whether our programs could also be helpful in patients suffering from these more peripheral lesions. Therefore, in a second, independent trial, patients with optic nerve injury were treated with VRT (Kasten, Wiist, Behrens-Baumann, et al., 1998, Wiist, 1997). Specifically, 19 subjects were assigned to either the experimental or the control group under blind conditions (age matched). The training effect of VRT was even more pronounced in patients with optic nerve injury than it was in the group with postchiasmatic lesions. Visual field size in the experimental group increased by almost 22%. In the control group, we also found an increase of 6%. The average shift of visual field border in the experimental group amounted to about 6 degrees of visual angle. Unlike the postchiasmatic group, patients with prechiasmatic lesions showed improvements occurring primarily in the early stage (within weeks) after the training had started. It is interesting to note that optic nerve patients also showed an improvement of visual acuity, but, in contrast to postchiasmatic patients, there were smaller generalized effects of light detection training on form or color perception; in other words, we found less transfer to other visual functions. For a clinical setting, it is important to determine whether training effects are transferred to other (neuropsychological) functions and to everyday life. We found some transfer of VRT to performance in paper-pencil tests of visual exploration and attention (Zahlen-Verbindungs-Test [ZVT]; d2test). These results indicate that benefits of visual field restitution even generalize (at least in part) to measures very different from campimetric or perimetric tests, suggesting that patients may be better able to cope with demands of the visual environment after training. Because the increase of correctly detected numbers of stimuli on a computer monitor may be only of academic interest without practical consequences in everyday life, we also assessed subjective changes in visual functions using a questionnaire. Many patients reported a positive influence of the training on ADLs; 72% of the patients of the experimental group, but only 17% of control group patients reported subjective improvements of vision in everyday life. Most recently, we tested whether our patients had maintained their regained vision after training had been discontinued for more than 6 months. The results showed a stable visual field size compared with High-Resolution Perimetry measurement immediately after training, suggesting that they may have used (i.e., regularly activated) their partially surviving brain re-

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gions in everyday life and thus sustained the training effects (unpublished observations, 1999).

CONCLUSIONS Over the past two decades, numerous studies were conducted indicating that, despite its strict neuronal organization and specificity, the visual system can adapt to lesion-induced changes. These phenomena of neuronal plasticity within the visual system can be observed on the behavioral level in terms of recovery from visual field defects or other dysfunctions caused by brain injury. Patients suffering from visual field loss can recover spontaneously or restitution can be induced by special training procedures (Potthoff, 1995; Schmielau, 1989; Tegenthoff, Widdig, Rommel, & Malin, 1998; Werth & Mohrenschlager, 1997; Zihl, 1980; Zihl & von Cramon, 1985). So far we can only speculate on the neuronal level mechanisms that are responsible for the visual field enlargements we find on a behavioral level in patients. Understandably, these neuronal rearrangements definitely need more time than common processes of learning, for example, of eye movement patterns. In parallel to those rather local effects, there should also be a rewiring on a macrolevel, in other words, in the interaction of brain areas responsible for processing of light, form, color, movement, and so on. Even a local lesion can therefore have immense effects on large parts of the brain, and likewise recovery from that lesion involves many other areas apart from the one that is primarily responsible for functional loss. According to the hypothesis of "minimal residual structures" (Sabel, 1997) very few neurons surviving in a lesioned area of the brain could be sufficient to induce functional recovery either spontaneously or by systematic stimulation, in other words, visual field training. The brain can compensate for the lesion with just a few fibers remaining in the damaged system itself. We speculate that by repetitive visual stimulation of these surviving neurons in a long-term training schedule, these cells may be reactivated, perhaps by reducing the threshold of firing. Based on this argument, a training-induced enlargement of the visual field border would enhance transfer of information to intact, higher visual areas. In the studies reviewed in this chapter, we have shown that plasticity is an inherent characteristic of the human brain that is retained over the entire life span and also for a long (perhaps unlimited) time after lesion. New technologies, for example, personal computers, the Internet and so on, can be used to offer efficient treatment methods to patients suffering from functional loss even if a very intensive training is necessary. As we have seen,

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visual field defects have an enormous impact on patients' everyday life, and systematic treatment should contribute to reintegrate specifically older patients into their social and physical environment. What is true for vision might also apply to other functional domains represented in the brain: any lesion (or age-dependent cell loss) has direct effects, in other words, functional loss. Moreover, there are many secondary effects aggravating the original condition. We consider the application of systematic stimulation therapy necessary first because it could stop functional loss in normal aging and second because in a large part of the patient population it could help to (partially) restore lost functions. Any mental function (including perceptual capacities) must be exercised to prevent deterioration. Certainly, not all effects of aging can be prevented, and not all functions lost because of cerebral lesion can be restored, but it is important to adopt a more optimistic view with regard to functional loss because very often adequate methods can be applied to support the patients' reintegration into everyday life and a more self-determined way of living.

ACKNOWLEDGMENTS The work described here was supported by the Cultural Ministry of Sachsen-Anhalt, the Deutsche Forschungsgemeinschaft (DFG), Kuratorium ZNS and the Barbara and David Hirschhorn Foundation. We thank Ulrike Bun zenthal and Elke Berger for their help with examining the patients and data analysis and Andreas Bohne for computer programming.

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Freund H.-J., Sabel, B. A., & Witte, O. (1997). Brain Plasticity. New York: Lippincott-Raven. Hier, D. B., Mondlock, J., & Caplan, L. R. (1983). Recovery of behavioral abnormalities after right hemisphere stroke. Neurology, 33, 345-350. Johnson, C. A., & Keltner, J. L. (1983). Incidence of visual field loss in 20,000 eyes and its relationship to driving performance. Archives of Ophthalmology (Chicago), 101, 371-375. Kasten, E., Poggel, D., Miiller-Oehring, E. ML, Gothe J., Schulte T., & Sabel, B. A. (1999). Visual system plasticity: Residual functions and training-induced restitution in brain-damaged patients. Restorative Neurology and Neuroscience, 15, 273-278. Kasten, E., & Sabel, B. A. (1995). Visual field enlargement after computer training in brain-damaged patients with homonymous deficits: An open pilot trial. Restorative Neurology and Neuroscience, 8, 113-127. Kasten, E., Schmid, G., & Eder, R. (1998). Effektive neuropsychologische Behandlungsmethoden [Efficient neuropsychological methods of treatment]. Bonn: Deutscher Psychologen Verlag. Kasten, E., Wiegmann, U., & Sabel, B. A. (1994). Rehabilitation cerebral bedingter Gesichtsfeldeinschrankungen—Uberblick [Rehabilitation of cerebrallyinduced visual field defects—A review]. Zeitschrift fur Neuropsychogie, 5, 127-150. Kasten, E., Wiist, S., & Sabel, B. A. (1998). Residual vision in transition zones in patients with cerebral blindness. Journal of Clinical and Experimental Neuropsychology, 20, 581-598. Kasten, E., Wiist, S., Behrens-Baumann, W., & Sabel, B. A. (1998). Computerbased training for the treatment of partial blindness. Nature Medicine, 4, 1083-1087. Katz, R. T., Golden, R. S., Butter, J., Tepper, D., Rothke, S., Holmes, J., & Sahgal, V. (1990). Driving safety after brain damage: Follow-up of twenty-two patients with matched controls. Archives of Physical Medicine and Rehabilitation, 71, 133-137. Kerkhoff, G., Munssinger, U., & Meier, E. K. (1994). Neurovisual rehabilitation in cerebral blindness. Archives of Neurology, 51, 474-481. Kolb, B. (1997). Recovery from occipital stroke: A self-report and inquiry into visual processes. In N. Kapur (Ed.), Injured brains of medical minds (pp. 138 151). New York: Oxford University Press. Kolmel, H. W. (1984). Coloured patterns in hemianopic fields. Brain, 107, 155167. Kolmel, H. W. (1988). Die homonymen Hemianopsien Klinik und Pathophysiologie zentraler Sehstorungen [The homonymous hemianopias]. Berlin: Springer. McGwin, G. Jr., Owsley, C., & Ball, K. (1998). Identifying crash involvement among older drivers: Agreement between self-report and state records. Accident Analysis and Prevention, 30, 781-791.

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Index

Accessibility of communication technologies, 155 Action regulation sensory function, 113 Activities of daily living (ADLs) vision loss and, 110–111 Adams, A. et al., 195 Age-related changes, 9, 11-20, 12t, 158-160 attention, 159-160 brain plasticity, 211-212 cognition, 18—20 cutaneous senses, 160 design solutions, 20-22, 25 hearing loss, 16-18, 158-159; see also Hearing loss implications for interface design, 160-162 affordances, 161 display, 161 font size, 161 information organization, 161 instructions, 161 wording, 161 memory, 159 over time, 209-210

psychomotor, 13-14 psychomotor functioning, 160 speech generation, 160 speech production, 18 speech recognition, 158 vision loss, 14-16, 159, 210-211; see also Vision loss Aging cognition and, 81-83 communication and interface design, 153-167 culture and, 86-88 definitions of, 4 over-accommodations for, 30-37 sensory function and social function, 108-123 under-accommodations for, 37–42 vision and brain plasticity, 209–211 Alzheimer's disease communication and, 19 Anderson, M., 58 Arthritis effect on communication, \2t, 13 ATM training program evaluation, 195-198 needs assessment, 191–193

Page numbers followed by "f" indicate a figure; those followed by "t" indicate a table.

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228

Index

ATM training program (cont.) person analysis, 192–193 program design, 193—195 program recommendations, 198 task assessment, 192 ATMs user friendliness and, 53-54 Attention age-related changes, 159–160 divided, 159 focused, 160 search, 160 selective, 160 Baby boomers aging of, 49 Baddeley, A., 41, 95-96 Bakes, P. et al., 174 Bikson, T. et al., 127 Blindsight study of, 215 Bourgeois, M., 19 Brain plasticity age-related changes, 211–212 vision loss and, 221—222 Browsing the Net, 66 Burnout cognitive engineering and, 173–174 Camp, C, 19, 171 Caplin, L. et al., 68t, 70-71 Cerebrovascular disease effect on communication, 12t Channel capacity characteristics of, 5 emotion and, 5-6 Charness, N. et al., 68t, 69-70 Cognition age-related changes, 18-20, 82 aging and, 81–83 communication channels and, 6 cultural differences and, 85-86, 8994 culture and aging, 86–88

Cognitive engineering memory and, 172-174 deliberate practice, 173 skill assembly, 173 tailored training, 173-174 Cognitive primitives, 89-90 Cognitive requirements interface design, 163t, 164t Communication; see also Communication technologies age-related changes that effect, 9, 11-20, 12t cognition, 18—20 design solutions, 20-22, 25 hearing loss, 16—18 psychomotor, 13—14 speech production, 18 vision, 14-16 aging, culture, and cognition, 8889 concepts, 5-8 culture and, 83-85, 100-101 definitions of, 5 goals of, 5 how of, 8-10 risk factors for difficulty with, 11,

I2t, 13 sensory function and, 113 Communication channels, 5—6, 5f calibrating, 9 channel capacity, 5 Communication effectiveness, 6-8 comprehension, 7 defined, 6 Communication technologies advantages and disadvantages, 22, 23t-24t, 25 evaluation of design, 162, 163t,

164t, 165 experimental project, 128—144 baseline information, 131-132, 131t, 132t computer experience, 139-140, 140t

Index

field procedures, 129-131, 130t outcomes, 139 pattern of use, 138-139 retirement experience, 142-143, 143t, I44t task experience, 140-142, 141t, 142t work group structures, 133—138, 134f, 135t, 136t interface design and, 20-21, 153-

167 sensory function and, 123 systems approach for training, 187— 206 Compensatory strategies skill resilience and, 181-182 Comprehension in communication channels, 7 Computer programs for vision loss, 218-221 Computer skills acquisition of older adults, 67, 69-72 ComputerLink, 62 Computers, see Personal computers (PC) Contrast computer use and, 50 vision and, 16 Cooper, A., 57 Cordless telephone interface design, 163t, 165 Culture aging and cognition, 86—88 cognition and, 85-86, 89-94 communication and, 83-85, 100101 interpreting differences across, 94— 100 decisions, 97-99 individual differences, 99—100 patterns, 95-97 tasks, 94-95 Cutaneous senses

229

age-related changes, 160 Czaja, S, 199 Czaja, S. et al., 68t, 70, 73t, 74 Delia, J., 83 Deliberate practice cognitive engineering and, 173 Dementia communication and, 19 Design; see also Interface design age-related changes and, 20-22, 25 challenges for, 47—59 Digit span task, 91, 92 Disabled individuals telecommunications Act and, 155 Divided attention, 159 Ease of use computer industry definition, 48 Egan, D. et al., 67, 68? Elderspeak, 31-37 defined, 31-32 effectiveness of, 33 parameters in, 32-33 studies on, 34—36 Electronic information seeking, 64—67 components of, 65 Internet and, 60-6161-62 older adults and, 72-75 strategies for, 66 Elias, P. et al., 67, 68t Emotion communication channel capacity and, 5-6 Engineering psychologist, 153—154 Ergonomics aging and, 8 Ericsson, K. et al., 173 Evaluation in ATM training, 195-198 process of criteria, 195-196 retention, 196 transfer, 196-197

230

Index

Evaluation, process of (cont.) usability, 196 of training programs, 189, 190f in World Wide Web training, 202-203 Face—name memory training, 169—184 case studies, 178-180, 179f cognitive engineering, 172-174 current, 107-171 mnemonic skills and, 174-177, 175f, 176f theoretical issues, 180-184 practical issues, 182-184 skill-acquisition theory, 180—182 training, 177-178 Face-to-face interaction, 114-116 hearing loss and, 115-116 level of social function, 114 vision loss and, 115 Financial management Internet and, 63 Fiske, A. et al., 101 Floyd, M. et al., 172 Focused attention, 160 Freedle, R., 40 Freudenthal, D., 73-74, 73t Galliene, R. et al., 62

Gerontechnology approach to communication, 8 Gist, M. et al., 68t, 69 Gould, O. et al., 20 Graphical user interface (GUI), 55-56 Guaranteed quality of service (QOS), 21 Hasher, L. et al., 40 Hatta, K. et al., 193 Health care Internet and, 62 Hearing aids role of, 119, 120f Hearing loss; see also Sensory function age-related changes, 16-18, 158-159

effect on communication, 12t, 111 — 112 in face-to-face interaction, 115-116 in social integration, 119, 120f in social relations, 116-117 statistics about, 109 Helander, M., 189 Human factors approach to communication, 8 in interface design, 153—154 Information seeking, 64—67 components of, 65 Internet and, 60-6161-62 older adults and, 72-75 strategies for, 66 Information transmission model, 5, 5f Instrumental activities of daily living (lADLs) vision loss and, 111 Interface touch-screen interface design, 163t, 165 Interface design, 153—167; see also Design age-related changes and, 160-162 evaluation of, 162, 163t, 164t, 165 future implications, 166-167 users need and, 157 Internet, 60-76 current use of, 60—61 experimental project, 128-144 baseline information, 131-132,

131t, 132t computer experience, 139—140, 140t field procedures, 129-131, 130? outcomes, 139 pattern of use, 138-139 retirement experience, 142—143, 143t, 144t task experience, 140-142, 141t, 142t work group structures, 133-138, 134f, 135t, 136t

Index

history of, 60 information seeking and, 60-6161-62 older adults use of, 146—147 training for use, 198-203 evaluation, 202—203 needs assessment, 199-201 person analysis, 200-201 program design, 201-202 task analysis, 200 usability of, 47-49 World Wide Web vs., 63-64 Internet appliances (IAs) user friendliness and, 55-57 Kelley, C. et al., 128 Kemper, S., 9 Kemper, S. et al., 32, 33, 41, 42, 84 Kirsh, I. et al., 38 Kliegl, R. et al., 169 Leirer, V. et al., 172 Longevity design challenges and, 47-59 McCarty, D., 171 Mead, S. et al., 68t, 71, 73t, 74, 198 Mean clauses per utterance (MCU) studies on, 34-36 Mean length of utterance (MLU) studies on, 34—36 Memory age-related changes, 82, 159 aging and, 86, 87t cognitive engineering and, 172-174 deliberate practice, 173 skill assembly, 173 tailored training, 173-174 communication and, 19 face-name, 169-184 case studies, 178-180, 179f cognitive engineering, 172-174 current, 107-171 mnemonic skills and, 174-177, 175f, 176f

231

theoretical issues, 180-184 practical issues, 182-184 skill-acquisition theory, 180—182 training, 177-178 training for, 169-184 phases of, 171-172 working, 39-40 aging and, 86, 87t in different cultures, 92-93 study of, 90-91 Minimal residual structures hypothesis of, 221 Mnemonic skills face-name memory training and, 174-177, 175f, 176f Morrell, R. et al., 199, 201 Motivation in social functioning, 122 Multiinfarct dementia communication and, 19 Needs assessment in ATM training, 191-193 in telemedicine training, 204 for training programs, 189, 190f in World Wide Web training, 199-201 Negotiation communication and, 9-10 Nisbett, R. et al., 85 Noise effects on reading, 18 on speech, 17 Norman, D., 48, 52 Orange, J. et al., 33 Orientation sensory function, 113 Oswald, W. et al., 172 Over-accommodations for aging, 30-37 downward spiral triggered by, 38f Pager talking interface design, 164t, 165

232

Index

Park, D. et al., 86 Passive communication channels, 5-6,

5f channel capacity, 5 PC, see Personal computers (PC) Person analysis in ATM training, 192-193 for telemedicine training program, 204 for training program, 189, 190f in World Wide Web training, 200201 Personal computers (PC); see also Communication technologies current age-related considerations, 50-51 design considerations for seniors,

52-59 information seeking, 64-67 needs of older adults, 49-50 vision loss, 49—50 potential age-related considerations,

51-52 usability of, 47-49 user friendliness and, 55—57 Physical requirements interface design, 163t, 164t Poppelreuter, W, 214, 216 Pragmatics, 9 Primary/external control processes, 42 Processing speed aging and, 86, 87? Program design in ATM training, 193-195 for training program, 189, 190f in World Wide Web training, 201202 Psychomotor function age-related changes, 13—14, 160 Psychomotor requirements interface design, 163t, 164t Public switched telephone network (PSTN), 21, 23?-24? Rabbitt, P., 18

Readability formulas, 38—39 Reading comprehension age-related changes and, 39—42 reader/listener variables, 40 text variables, 40 Rehabilitation of hearing loss, 122 of vision loss, 122 Remote controls user friendliness and, 54 Repeated trauma disorders, 14, 14f Residual functions in vision loss, 213-216 Retention in training evaluation, 196 Retirement, transition to, 128-144 baseline information, 131—132, 131t, 132t computer experience, 139-140, 140t field procedures, 129-131, 130t outcomes, 139 pattern of use, 138-139 retirement experience, 142—143, 143t, 144t task experience, 140-142, 141t, 142t work group structures, 133—138,

134f 135t, 136t Rogers, W. et al., 68t, 71, 193, 197 Ryan, E. et al., 9, 30, 33, 42 Safran, A. et al., 214 Salas, E., 189 Selective attention, 160 Semantics, 8-9 Sensory function communication technologies and, 123 function of in communication, 112-113 action regulation, 113 communication, 113 orientation, 113

Index hearing loss; see also Hearing loss age-related changes, 16-18 effect on communication, 12? social functioning and, 108-123 vision loss; see also Vision loss age-related changes, 14-16 effect on communication, 12? Sensory requirements interface design, 163t, 164t Shannon model for passive communication, 5-6, 5f Sheikh, J. et al., 171 Skill-acquisition theory, 180-182 Skill assembly cognitive engineering and, 173 Skill resilience compensatory strategies and, 181— 182 Social functioning levels of, 113-114 face-to-face interaction, 114 social integration, 114 social relations, 114 sensory function and, 108-123 Social integration, 117-119 hearing loss and, 119, 120f level of social function, 114 role of hearing aid, 120f vision loss and, 117-119, 118f Social relations, 116-117 hearing loss and, 116-117 level of social function, 114 vision loss and, 116 Speech impairment age-related changes, 18, 160 effect on communication, \2t Speech recognition age-related changes, 158 Speech requirements interface design, 163t, 164t Spontaneous recovery, 211 vision loss and, 216-217 Stigsdotter, A. et al., 170, 171-172 Stroke

233

effect on psychomotor function, 13-14 Syntactics, 8 Systems approach to training, 187-206, 188-191,

190f ATM case study, 191-198 evaluation, 189, 190f needs assessment, 189, 190f person analysis, 189, 190f program design, 189, 190f task analysis, 189, 190f telemedicine case study, 203-204 WWW case study, 198-203 Tailored training cognitive engineering and, 173—174 Talking pager interface design, 164t, 165 Task analysis in ATM training, 192 for telemedicine training program, 204 for training program, 189, 190f in World Wide Web training, 200 Telecommunication devices; see also Communication technologies defined, 156-157 evaluation of design, 162, 163t, 164t, 165 Telecommunication devices for the deaf (TDDs), 21 Telecommunications Act (1996), 155 Telecommunications Act Accessibility Guidelines, 155 Telemedicine, 62 training program for, 203-204 needs assessment, 204 person analysis, 204 task analysis, 204 Telephone cordless interface design, 163t, 165 Television remote controls user friendliness and, 54

234

Index

Touch-screen interface interface design, 163t, 165 Trace Center, 166 Training ATM case study, 191-198 communication impairments and, 20 face—name memory learning, 169— 184 systems approach to, 187—206, 188-191, 190f evaluation, 189, 190f, 195-198, 202-203 need for, 188 needs assessment, 189, 190f 191-193, 199-201, 204 person analysis, 189, 190f, 192193, 200-201, 204 program design, 189, 190f, 193195, 201-202 task analysis, 189, 190f, 192, 200, 204 telemedicine case study, 203—204 WWW case study, 198-203 Training-induced recovery vision loss and, 218—221 Transfer in evaluation process, 196—197 Under-accommodations for aging, 3742 downward spiral triggered by, 31f Usability in training evaluation, 196 User friendliness for personal computers (PC), 52—59 Users' mental models, 154 Users need interface design and, 157 Vanderheiden, G., 20 Vicente, K. et al., 73t, 74 Vision loss; see also Sensory function activities of daily living and, 110— 111

age-related changes, 14-16, 210— 211 brain plasticity and, 221-222 consequences of, 212—213 effect on communication, 12t in face-to-face interaction, 115 recovery, 216—221 spontaneous, 216—217 training-induced, 218—221 residual functions, 213-216 in social integration, 117-119, 118f in social relations, 116 statistics about, 109, 213 strategies of compensation, 215-216 training for, 214 Vocabulary aging and, 86, 87t Voice over Internet protocol (IP), 21,

23t-24t Vora, P. et al., 64 VRT program long-term effectiveness, 220—221 pilot study, 219 training effect of, 220 for vision loss, 218-221 Watzlawick, P. et al., 8 Web design for older adults, 63 Web sites for all ages, 50 Wechsler Adult Intelligence Scale (WAIS), 97 Well-being vision loss and, 117, 118f Westerman, S. et al., 72-73, 73t Wisdom aging and, 86-87 Work-related injuries effect on psychomotor function, 14, 14f Working memory, 39—40 aging and, 86, 87t in different cultures, 92—93

Index

study of, 90-91 World Wide Web (WWW), 75-76; see also Internet Internet vs., 63—64 training for use, 198-203 evaluation, 202-203 needs assessment, 199-201 person analysis, 200—201

program design, 201-202 task analysis, 200 Yesavage, J. et al., 171 Zandri, E. et al., 68t, 69 Zihl, J. et al., 218

235