by Alain Monteux, Managing Director of Tunstall France & Benelux
Oct 1, 2024
This week, all over the world, nations are marking the UN International Day of Older Persons. Alain Monteux, Managing Director of Tunstall France & Benelux, takes the opportunity to reflect on age stigma, highlighting why addressing our collective attitudes towards aging is so important to enabling happier and more independent lives for older people.
Age stigma should concern us all. This week, for the first time, someone gave up their seat for me on the metro. That's it, I'm perceived as old in the eyes of others.
Ageism, meaning stereotyping and prejudice towards individuals based on their age, can lead to significantly worse health outcomes, as well as reducing quality of life not only because of negative individual experiences, but also down to actions not taken because of fear of discrimination.
Adopting telecare, meaning technology-enabled devices to support independent living, is one action which can significantly enhance quality of life for the elderly, supporting that independence, reducing loneliness and reducing the risk of falls. However, a fear of being seen as old prevents individuals from seeking these solutions when they need them. In France, we see this issue play out in all sorts of ways: the average age of a new Tunstall user is 82 years, and the average French citizen enters a nursing home at 85 years. These figures hide complex social dynamics around aging and a reluctance to seek assistance.
Telecare cannot solve the societal and cultural challenge of age stigma alone. However, the solutions we provide, and independence they enable, must be seen as part of the solution. First, we must reframe the role of existing telecare solutions in peoples’ lives, highlighting that rather than marking an individual out as old, these solutions enable the independence which we so want to maintain and support in those around us.
According to l’Insee, France’s data and statistics agency, the number of dependent older people in France is set to double between 2015 and 2030. Several initiatives have been introduced in recent years to support this growing segment of the population, such as the creation of 9 ‘gérontopoles’ which facilitate sharing of research, innovation and expertise relating to aging within regions. Nevertheless, health and care for the elderly remains fragmented.
The reputation of nursing homes across France has been impacted by a series of scandals. While not directly related to age stigma, these issues have strengthened the perception that care homes are an option of last resort for older people, and a place where they will not always be treated with dignity. The majority of care homes have highly committed staff and provide an excellent service; however these incidents contribute to negative perceptions of old age.
The ‘Plan anti-chute’ or ‘Anti-falls Plan’ is a government initiative which is designed to reduce the number of fatal or disabling falls by 20% over two years, and recognises that national systems are not yet set up well to prevent harm from falls. The Plan anti-chute puts telecare at the heart of bringing about these reductions, and highlights that France is among the late adopters of telecare solutions compared to European neighbours (with a 5% penetration rate amongst the 65+ population, compared to 14% in the UK or 10% in the Netherlands, according to Berg Insight data).
We see the challenges the Plan highlights every day in our interactions with end users. The stigma associated with adopting telecare is an issue to overcome, highlighting how the language used by some organisations contributes to the perception that telecare solutions are only for the frail; forgetting that this is, above all else, a prevention solution, providing social connection. It can benefit those with a need for this preventative support, just as much as those with greater caring needs.
Despite examples of people remaining active in public life into their 70s, 80s and beyond, and challenging expectations of what aging looks like, this has yet to filter into wider society, and age stigma continues. It occurs between individuals, within institutions, and in ourselves, as internalised ageism. As a result of this internalised stigma, elderly people are reluctant to seek support. This can lead to worse health outcomes, as individuals may assume that a medical problem is the natural result of aging, and not seek help until the condition has worsened. Age bias also impacts health professionals, who may overlook symptoms because of these same perceptions. Just weeks ago, I experienced this personally, when a doctor told me that there was nothing he could do for my pain, I was just getting old!
Social isolation because of age stigma is also a concern, but an area where telecare can help. Older adults may isolate themselves or avoid social situations for fear of their aging being witnessed, resulting in loneliness and more rapid decline in physical and mental health. The effects of age bias can also strain family relationships, creating misunderstanding between generations.
Addressing the stigma surrounding aging is not clearly just a question for individuals and is often deeply embedded in social and cultural understandings. But in the telecare sector, we can be part of the answer.
At Tunstall, our vision is of a world where people have the freedom to live life to the full in a place of their choice. Independence and the ability to make choices about one’s life, irrespective of age or vulnerability, are central to how we view the services we provide. But how does this relate to addressing negative perceptions of aging?
We can support a change in mindsets by talking about our technology differently. There is still a perception here in France that our technology is ‘just a red button’ to press in an emergency, and that this is a solution from the past. This is not the case. Telecare solutions such as personal alarms may not be new, but they have demonstrated their effectiveness at saving and improving lives, as well as providing savings for the social system.
Telecare solutions can be an important bridge for elderly people who are less comfortable with technology, but also connect them 24/7 different existing services, making them immediately accessible. For example, providing physical activity coaching, learning how to fall, providing small local services such as changing a light bulb, involving the occupational therapist in a systemic way, making it easier to connect with family and friends, finding a doctor or providing consultation at home…
Rather than acting as a source of stigma, the use of telecare solutions in fact enables social contact, medical support and independence, playing a key role in breaking down negative perceptions.
France is far from alone in witnessing the impacts of age stigma. To address it, we can look to our close neighbours such as Spain, and to global initiatives which are helping to change the conversation, both in relation to telecare and more broadly.
In Spain for example, the integration of health and care is enabling a more constructive approach to telecare and to breaking down of misconceptions. As a result, many in Spain benefit from publicly funded telecare solutions, which are underpinned by proactive and preventative models.
I believe that the disjointed nature of services for elderly people in France and elsewhere contributes to this issue. The system relies on individuals to seek telecare solutions themselves, rather than having this signposted to them, as is the case in Spain. It is my personal experience that many people are prepared to invest to protect themselves or their parents as they age, but are simply not aware that telecare solutions exist. And building a database of services is not going to solve the problem if there are no human resources to make the links and to explain the different services and possibilities.
In France, the burden is on the individual, and a combination of a lack of awareness and internalised stigma prevents people from seeking assistance. In a more integrated model, the suggestion can be made by health or care professionals, and the path to accessing support facilitated. A specific example of this takes place in Barcelona, where training is provided to elderly individuals on how to fall, reducing the fear of falling and potentially reducing the risk of harmful falls. Care professionals follow up with individuals who have fallen previously to offer support. This is also the service we are setting up for our customers in Belgium as part of a preventive and digital integrated approach with an occupational therapist service.
These sorts of initiatives can prove life-changing for individuals and support a less stigmatising approach to seeking telecare and other forms of support. But we also need a collective mindset shift for wider society. As our populations age, we need to look broadly at how we support older people, and not view this section of society as somehow separate. This means addressing areas such as housing, urban design and transport and mobility, and including older people in decision-making processes. My father, who was living in Paris, would often complain that his routes around his local town were based on the locations of toilets and benches, demonstrating how poorly designed urban areas are for older residents.
Initiatives such as the WHO’s Global Network for Age-friendly Cities and Communities and the French division, the Réseau Francophone des Villes Amies des Aînés, are making a difference here, helping break down stigma by demonstrating the range of activities older people are active in in their communities, as well as pushing for change in the areas identified above, and sharing best practice examples between regions.
As we’ve seen, a reluctance to adopt telecare or seek other forms of support is often based on the fear of being viewed as dependent, which stems from widespread age bias and stigma. To counter this, there is a role for governments, for companies and for individuals in our personal as well as professional lives. Within telecare, we can help reduce stigma by making our products and services accessible, and demonstrating their positive impact, which is so often not well understood. By reframing how we talk about and implement these technologies, we can begin to dismantle the stereotypes that isolate older people and limit their access to essential support.
