When an older person's capabilities don't match the demands of the environment, the environment may need to be changed to adapt environments.

The prospect of increasing numbers of persons living into more advanced age (Taeuber, 1983) suggests that future research and practice in aging will be increasingly dominated by issues of functional impairment in activities of daily living. Advancing age is associated with a greater likelihood of significant changes in physical and psychological capabilities (Saxon and Etten, 1978) and more frequent needs for care and support with daily activities (NCHS, 1983). While supportive social services delivered in the home have been the most frequently employed intervention strategy, advances in technology and design engineering have spurred interest in adapting existing residence environments to provide improved functional support to the older adult (GSA and WGS, 1981).

Separating Functional Impairment from Disability.

Modification of the existing physical environment to enhance the functional levels of persons with reduced capabilities is certainly not novel. Occupational therapy and rehabilitation engineering have developed a range of environmentally-based interventions to address functional impairment associated with specific disabilities; e.g., loss of a limb, neurological disease or insult, or neuromuscular dysfunction. Since most daily tasks such as shopping, making a meal, or combing one's hair can be accomplished in more than one way, interventions utilize the capabilities which the disabled person still retains while alleviating the need for capabilities which are reduced or absent. However, functional impairment in activities of daily living associated with advancing age often reflects gradual, multiple reductions in capabilities which occur either in the absence of specific disabilities or in combination with them. Because impaired functioning in activities of daily living is the common outcome of both specific disability and multiple reductions in capabilities, there is often a tendency to draw on disability-oriented environmental modifications to address both sets of problems. This conceptual aggregation has several problematic consequences.

First, many techniques aimed at a specific disability, are designated to develop and/or trade on compensatory abilities. However, multiple and gradual changes may leave the older adult without one or more areas of strength with which to compensate. An older person requiring a wheelchair because of gradual loss of muscle mass, not have, or be able to develop, the arm strength to use grab bars and similar prostheses which would benefit a younger person who requires a wheelchair because of a specific disability. Second, many older persons who experience problems with daily living in houses or apartments are not specifically handicapped or disabled. Because they don't view their problems as a disability, they don't accept the need for adaptive technologies. Finally, and most importantly, a disability-oriented view of functional impairment in activities of daily living tends to reinforce a view of functional impairment as a characteristic of the person, rather than what it actually is: a way of describing the performance outcome of a transaction between a person with given capabilities confronting an environment of given demands for the purpose of accomplishing a given task. The contribution of the environment and its demand levels to the observed problems in accomplishing the task is often a significant component of the problem.

The Role of Environment in Functional Impairment.

The design of spaces, products, and devices in residence environments is based largely on characteristics of human operators in younger and middle age. As a result, developmental changes in levels of capability, from those associated with mid-life, affect the ability to adapt to the often standard and unchanging demands of the residence environment. We do not view our children as disabled or handicapped. However, we routinely, produce smaller furniture for children in recognition of their shorter stature. We reduce force and grip requirements in recognition of their reduced strength and dexterity. We also trade on these reduced capabilities to create barriers to dangers (e.g., baby locks on cabinets) or employ other forms of safety, engineering in tons and other objects which children handle in recognition of behavior patterns or cognitive sets which might lead to incorrect and perhaps dangerous patterns of use. Yet we accord ourselves no similar, nonjudgmental consideration of our capabilities at other points in our development where design and engineering might have equally positive impacts.

When we assess the ability, of the older individual to perform particular activities of daily living tasks against criteria of needing or not needing assistance, we are asking the individual if (s)he can use the residence environment, as it is set up at that moment, to accomplish these tasks. When (s)he clearly cannot, the dominant response is to interpret the problem as being the person's impairment: for example, we might define the problem as shorter overall stature, reduced hand grip and lifting strength, reduced ability to make major postural changes (such as bending, stepping over a barrier), gradual losses in visual, auditory, and tactile senses (i.e., sensing both heat and pressure), or cognitive change, impacting on memory. We should begin to seriously, examine the extent to which the environment may be "impaired" in the sense that its design reflects an artificially, narrowly, view of appropriate users. Human engineering provides a means of approaching the environment as part of the problem, a nd solution, so that we might accord ourselves, in advancing age, the same considerations we so generously, render ourselves in our early years.

Human Engineering for Functionability.

The central thesis of human factors engineering, aptly stated by McCormick (1970) is that the human use of virtually any manmade thing can be enhanced, or, conversely, degraded by its design. The general approach, echoed in the gerontological literature (Lawton, 1977), views the ability, to perform particular tasks as being a function of the fit between relevant person capabilities and environment demands. In seeking the optimal fit, human factors emphasizes design of environments and behavioral systems that match human capabilities. In considering ways to adapt the environment, the central question is not what the individual can no longer accomplish relative to younger-populations. Rather, the question is what capabilities the older person still possesses and how to go about modifying the environment to support task accomplishment given these capabilities. While a particular capability, many, with advancing age, be less than what it was at a younger age, it may still be at a level commensurate with meeting relevant environment demands and thus still allow the person to function.

This distinction is illustrated in results from a preliminary, but instructive, application of a human factors approach to functional ability among older women in meal preparation (Faletti, 1984). Task analysis of meal preparation indicates that manipulative tasks are the most frequent type of activity. The ability to grip and handle objects is consistently employed in using the kitchen environment. Data on full hand grip force, one characteristic of grip capability, were collected from three samples of older women: those living independently in the community, those receiving community based assistance, and those residing in nursing homes. While independent older women averaged significantly greater grip force (11 Kg) relative to those receiving assistance (5 to 7 Kg) or those in nursing homes (4 Kg), these independent and functional olderwomen still averaged well below grip force measured in general populations of women (30-33 Kg). Thus, the line between function and non-function does not appear to be in reductions noted in the older samples relative to younger populations, but rather at some point between the average for the independent sample and non-independent samples; a point which may correspond to a demand level which can be met by some older women (the independent sample) and yet not by others (nonindependent samples).

Results from this same set of data illustrate the potential impact of environmental characteristics on functional capability. Specifically, the grip dynamometer used to assess force also had an adjustable handle such that each of five grip surface sizes could be presented. For most subjects, both independent and nonindependent, lower average forces were exerted when the handle size was set to the smallest (standard utensil handle) and largest (large jar) positions. The highest force exertions were obtained with the handle set to middle positions (the size of a pot handle). Dynamometer handle size is only a crude simulation of object size, and object size is only one factor in handling ability. However, these and other results (Rohles, 1983) suggest that the simple choice of size for a handle, jar, can, or other product can affect the degree of effective force which a person can employ in handling an object. Given the narrow differences in capabilities associated with meeting environment demands and retaining function, it is sobering to consider that features of the environment can further impact the already reduced capabilities of many older users. This is especially true when these features (e.g., designer handles, oversize jars) reflect esthetic choices, not functional absolutes. We must recognize that other choices are possible. The ways in which we currently accomplish daily tasks have been, and will continue to be, changed by tastes and by new technologies; the microwave oven and food products designed for it being one example. While more hard data on person capabilities and environment demands are needed, there are some other activities of daily living areas where the level of environment demand might be reduced via design engineering and technological support to assist the older person.

Age-Response Environments for Daily Living.

The community, environment presents a range of demands for physical and mental capability, to accomplish the many tasks involved in daily living. Demands for physical activity are clearly present in a number of areas. Providing for nutrition involves access to and transport of goods to the home, menu selection, preparation of meals, and consumption of meals. Transport of goods to the residence often requires lifting and carrying, weightlifting a demand which can be alleviated by the use of a wheeled cart. However, distances and obstacles between the residence and stores often require significant strength and stamina if the person does not drive a car. The use of a computer technology, can, given a delivery system, allow shopping from home. However, a small powered cart, operated with existing remote control technology can allow one to make trips outside the residence for the purpose of shopping. (This is also often an important source of social contact.)

Accessing goods from storage shelves in stores and kitchens demands major changes in posture (reaching up and bending down). For example, the lower shelf in most kitchens is 6 inches from the floor and high shelves are about 72 inches. While remote grip devices can grab an object out of reach, they often require considerable arm strength to support the object until it is placed on a surface. Add-on shelves which swing up (or down) can be mounted within existing cabinets to bring the shelf and its contents to the user for easier location and retrieval of objects. Spring loading could reduce the force required to operate such a shelf.

A majority of manipulative tasks in meal preparation (e.g., cutting, chopping) involve coordinated action and/or exertion of force; this often taxes the strength and dexterity of the aging hand. While convenience foods can moderate these demands, the types of packaging used with many such products may not improve, and may actually degrade, the situation. The boiler bag, for example, is a difficult technology to use; forcing the person to handle a hot item while trying to open it and remove contents. New shelf-stable, minimum preparation food systems (e.g., Rhodes, 1977) are one option. However, improvements in product packaging to make opening, resealing and general handling easier would help; so would improved engineering of mechanical devices such as can openers to require less force and provide greater cushioning at the point where hand pressure is applied.

Personal care includes bathing, grooming, dressing, and use of the bathroom. Bathtubs and even some showers require stepping over barriers, often where footing is unsure. This has been an area of long-standing concern and a range of add-on chair lifts to assist the person in and out of tubs have been developed. Grab bars are also used, although they probably help more with balance than actual movement of the body using upper arm strength. There is also a range of devices currently targeted to personal care tasks (Breuer, 1982). In addition, clothes hanger bars placed at a lower height would provide more ready access to clothes for older users and Velcro closures on clothes could minimize manipulative tasks involving buttons and zippers. Using a bath towel for drying the body requires postural change - reaching and bending to contact all parts of the body. While sitting makes the task easier, an air dryer with a large enough flow to dry the body would only require some standing movement rather than major body movements.

Getting in and out of bed involves major changes in posture (i.e., lying to sitting to standing). Because grab bars and trapeze devices may require arm strength beyond the capability of many older adults, a bed that raises the upper part of the body would assist in bed transfers. A more radical approach might employ a contoured bed/chair that would be entered/exited like a chair and then recline back for sleep. Contouring might provide better support for the aging body in addition to minimizing entry and exit problems.

Cleaning/maintenance of the home includes heavy cleaning of floors, walls and work surfaces as well as laundry and waste disposal. Improved surfacing materials which are more easily cleaned and resistant to soil could reduce demands for bending and scrubbing. Easily disassembled appliances (i.e., toaster ovens, refrigerator shelves) could minimize physical force and activity required to clean and maintain these devices. Small, lightweight vacuum cleaners that work on all surfaces and are easily stored can reduce the bending and carrying required by many, current models. In general any features of the task environment that require dexterity postural change, and weight transport can be modified by technology, to reduce demands on physical capabilities that decline with advancing age.

While providing support for sensory and cognitive functions is more difficult, two approaches using voice synthesizer technology offer promise. Auditory, stimulation is more intrusive than visual stimulation and does not require as much attention to the source. For example, many, subjects in the meal preparation admitted to not noticing a control light on a stove. An add-on "talking control" to provide auditory feedback for ovens and stoves would provide a more intrusive cue as to the status of these devices.

As we increasingly confront the problem of cognitive disorientation as a source of functional problems, we can envision a system providing orienting information about the environment via micro-processoractuated voice synthesis. The system would require only a basic physical motion from the user and be cued by the user's movement through, and use of, the environment. While much more task analysis work with activities of daily living confronts us in even developing a first approach to such a system, it could be of use in cases of mild to perhaps moderate disorientation. In a sense, the technology is designed to mimic some of what we do now; reminding ourselves and repeating information slowly to assist with information processing.

Technology and the Continuum of Care: High Tech and High Touch.

These and other possible uses of technology and engineering to develop more assistive environments do not imply either an exclusive attention to high technology or a complete substitution of technology for human services. Those concerned with development and application of technology increasingly use the term "appropriate technology," to emphasize technological complexity at the level of the problem, not for the sake of complexity. The "churchkey" can opener is not high technology - but it is an elegant piece of engineering. It is simple (no moving parts), reliable, and requires the minimum operator force to accomplish the task, requires no special training, and is inexpensive to make and sell.

However, the pace of microprocessing and robotic technologies does appear to offer more appropriately complex solutions to more complex problems within certain limits. Many manipulative tasks required for daily living primarily involve coordinated motion by two hands handling a range of object types. The development of robotic technology to interface an older user with severely reduced manipulative capability (i.e. reduced hand flexion and strength) would, for the above task, require a voice commanded device with two arms and grip devices capable of coordinated movement in three dimensions with visual and touch sensors capable of discriminating object size, shape and texture to control target object approach and grip jaw force application. Even the most optimistic technologists would have to admit that there is currently only one operational device sophisticated enough in design to have these biomechanical and information processing capabilities -- the human.

Martin V. Faletti, Ph.D., is Director, Research Division, Stein Gerontological Institute, Miami Jewish Home and Hospital for the Aged, Miami, FL. This article is based on human factors research supported by NIA Grant #RO1-AG-02727 and contributions by M. Cberie Clark, Human Factors Project Manager.

REFERENCES

Breuer, J. M., 1982. "A Handbook of Assistive Devices for the Handicapped Elderly: New Help for Independent Living." Physical and Occupational Therapy in Geriatrics, 1:2, pp. 1-77.

Faletti, M. V., 1984. "Human Factors Research and Functional Environments for the Aged." In I. Altman, J. Wohlwill, and M. P. Lawton (Eds.). Human Behavior and the Environment: Vol 7. The Elderly and the Environment. New York, NY: Plenum Press.

Lawton, M. P., 1977. "The Impact of Environment on Aging and Behavior," In J. E. Birren & K. W. Schaie (Eds.). Handbook of the Psycholoogy of Aging. New York, NY: Van Nostrand Reinhold, pp. 276-301.

McCormick, E. 1970. Human Factors Engineering. New York: McGraw-Hill, Co.

Rhodes, L., 1977. "NASA Food Technology: A Method for Meeting the Nutritional Needs for the Elderly." The Gerontologist, 17, pp. 333-340.

Rohles, F., 1983, October. "Opening Jars: An Anthropometric Study of the Wrist-Twisting Strength of the Elderly." Proceedings of the 27th Annual Meeting of the Human Factors Society, 1, pp. 112-116.

Saxxon, S. and Etten, M., 1978. Physical Change and Aging. New York: The Tiresias Press.

Taeuber, C. M., 1983. America in Transition: An Aging Society. (U.S. Bureau of the Census, Current Populations Reports, Series P-23, No. 128), Washington, DC: US Government Printing Office.

US National Center for Health Statistics. 1983. B. Feller: Americans Needing Help to Function at Home - Advance Data from Vital Healtb Statistics, No. 92. Washington, DC: DHHS Pub. No. (PHS) 83-1250.

Western Gerontological Society (WGS) and Gerontological Society of America (GSA). 1981. Conclusions and Recommendations from the First National Conference on Technology and Aging, Wingspread Conference Center, Racine, WI. Washington, DC: Conference Report.

Reprinted with permission from Generations, Journal of the American Society on Aging, Summer 1984, pp. 35-38. Copyright ASA.

When an older person's capabilities don't match the demands of the environment, the environment may need to be changed to adapt environments.

The prospect of increasing numbers of persons living into more advanced age (Taeuber, 1983) suggests that future research and practice in aging will be increasingly dominated by issues of functional impairment in activities of daily living. Advancing age is associated with a greater likelihood of significant changes in physical and psychological capabilities (Saxon and Etten, 1978) and more frequent needs for care and support with daily activities (NCHS, 1983). While supportive social services delivered in the home have been the most frequently employed intervention strategy, advances in technology and design engineering have spurred interest in adapting existing residence environments to provide improved functional support to the older adult (GSA and WGS, 1981).

Separating Functional Impairment from Disability.

Modification of the existing physical environment to enhance the functional levels of persons with reduced capabilities is certainly not novel. Occupational therapy and rehabilitation engineering have developed a range of environmentally-based interventions to address functional impairment associated with specific disabilities; e.g., loss of a limb, neurological disease or insult, or neuromuscular dysfunction. Since most daily tasks such as shopping, making a meal, or combing one's hair can be accomplished in more than one way, interventions utilize the capabilities which the disabled person still retains while alleviating the need for capabilities which are reduced or absent. However, functional impairment in activities of daily living associated with advancing age often reflects gradual, multiple reductions in capabilities which occur either in the absence of specific disabilities or in combination with them. Because impaired functioning in activities of daily living is the common outcome of both specific disability and multiple reductions in capabilities, there is often a tendency to draw on disability-oriented environmental modifications to address both sets of problems. This conceptual aggregation has several problematic consequences.

First, many techniques aimed at a specific disability, are designated to develop and/or trade on compensatory abilities. However, multiple and gradual changes may leave the older adult without one or more areas of strength with which to compensate. An older person requiring a wheelchair because of gradual loss of muscle mass, not have, or be able to develop, the arm strength to use grab bars and similar prostheses which would benefit a younger person who requires a wheelchair because of a specific disability. Second, many older persons who experience problems with daily living in houses or apartments are not specifically handicapped or disabled. Because they don't view their problems as a disability, they don't accept the need for adaptive technologies. Finally, and most importantly, a disability-oriented view of functional impairment in activities of daily living tends to reinforce a view of functional impairment as a characteristic of the person, rather than what it actually is: a way of describing the performance outcome of a transaction between a person with given capabilities confronting an environment of given demands for the purpose of accomplishing a given task. The contribution of the environment and its demand levels to the observed problems in accomplishing the task is often a significant component of the problem.

The Role of Environment in Functional Impairment.

The design of spaces, products, and devices in residence environments is based largely on characteristics of human operators in younger and middle age. As a result, developmental changes in levels of capability, from those associated with mid-life, affect the ability to adapt to the often standard and unchanging demands of the residence environment. We do not view our children as disabled or handicapped. However, we routinely, produce smaller furniture for children in recognition of their shorter stature. We reduce force and grip requirements in recognition of their reduced strength and dexterity. We also trade on these reduced capabilities to create barriers to dangers (e.g., baby locks on cabinets) or employ other forms of safety, engineering in tons and other objects which children handle in recognition of behavior patterns or cognitive sets which might lead to incorrect and perhaps dangerous patterns of use. Yet we accord ourselves no similar, nonjudgmental consideration of our capabilities at other points in our development where design and engineering might have equally positive impacts.

When we assess the ability, of the older individual to perform particular activities of daily living tasks against criteria of needing or not needing assistance, we are asking the individual if (s)he can use the residence environment, as it is set up at that moment, to accomplish these tasks. When (s)he clearly cannot, the dominant response is to interpret the problem as being the person's impairment: for example, we might define the problem as shorter overall stature, reduced hand grip and lifting strength, reduced ability to make major postural changes (such as bending, stepping over a barrier), gradual losses in visual, auditory, and tactile senses (i.e., sensing both heat and pressure), or cognitive change, impacting on memory. We should begin to seriously, examine the extent to which the environment may be "impaired" in the sense that its design reflects an artificially, narrowly, view of appropriate users. Human engineering provides a means of approaching the environment as part of the problem, a nd solution, so that we might accord ourselves, in advancing age, the same considerations we so generously, render ourselves in our early years.

Human Engineering for Functionability.

The central thesis of human factors engineering, aptly stated by McCormick (1970) is that the human use of virtually any manmade thing can be enhanced, or, conversely, degraded by its design. The general approach, echoed in the gerontological literature (Lawton, 1977), views the ability, to perform particular tasks as being a function of the fit between relevant person capabilities and environment demands. In seeking the optimal fit, human factors emphasizes design of environments and behavioral systems that match human capabilities. In considering ways to adapt the environment, the central question is not what the individual can no longer accomplish relative to younger-populations. Rather, the question is what capabilities the older person still possesses and how to go about modifying the environment to support task accomplishment given these capabilities. While a particular capability, many, with advancing age, be less than what it was at a younger age, it may still be at a level commensurate with meeting relevant environment demands and thus still allow the person to function.

This distinction is illustrated in results from a preliminary, but instructive, application of a human factors approach to functional ability among older women in meal preparation (Faletti, 1984). Task analysis of meal preparation indicates that manipulative tasks are the most frequent type of activity. The ability to grip and handle objects is consistently employed in using the kitchen environment. Data on full hand grip force, one characteristic of grip capability, were collected from three samples of older women: those living independently in the community, those receiving community based assistance, and those residing in nursing homes. While independent older women averaged significantly greater grip force (11 Kg) relative to those receiving assistance (5 to 7 Kg) or those in nursing homes (4 Kg), these independent and functional olderwomen still averaged well below grip force measured in general populations of women (30-33 Kg). Thus, the line between function and non-function does not appear to be in reductions noted in the older samples relative to younger populations, but rather at some point between the average for the independent sample and non-independent samples; a point which may correspond to a demand level which can be met by some older women (the independent sample) and yet not by others (nonindependent samples).

Results from this same set of data illustrate the potential impact of environmental characteristics on functional capability. Specifically, the grip dynamometer used to assess force also had an adjustable handle such that each of five grip surface sizes could be presented. For most subjects, both independent and nonindependent, lower average forces were exerted when the handle size was set to the smallest (standard utensil handle) and largest (large jar) positions. The highest force exertions were obtained with the handle set to middle positions (the size of a pot handle). Dynamometer handle size is only a crude simulation of object size, and object size is only one factor in handling ability. However, these and other results (Rohles, 1983) suggest that the simple choice of size for a handle, jar, can, or other product can affect the degree of effective force which a person can employ in handling an object. Given the narrow differences in capabilities associated with meeting environment demands and retaining function, it is sobering to consider that features of the environment can further impact the already reduced capabilities of many older users. This is especially true when these features (e.g., designer handles, oversize jars) reflect esthetic choices, not functional absolutes. We must recognize that other choices are possible. The ways in which we currently accomplish daily tasks have been, and will continue to be, changed by tastes and by new technologies; the microwave oven and food products designed for it being one example. While more hard data on person capabilities and environment demands are needed, there are some other activities of daily living areas where the level of environment demand might be reduced via design engineering and technological support to assist the older person.

Age-Response Environments for Daily Living.

The community, environment presents a range of demands for physical and mental capability, to accomplish the many tasks involved in daily living. Demands for physical activity are clearly present in a number of areas. Providing for nutrition involves access to and transport of goods to the home, menu selection, preparation of meals, and consumption of meals. Transport of goods to the residence often requires lifting and carrying, weightlifting a demand which can be alleviated by the use of a wheeled cart. However, distances and obstacles between the residence and stores often require significant strength and stamina if the person does not drive a car. The use of a computer technology, can, given a delivery system, allow shopping from home. However, a small powered cart, operated with existing remote control technology can allow one to make trips outside the residence for the purpose of shopping. (This is also often an important source of social contact.)

Accessing goods from storage shelves in stores and kitchens demands major changes in posture (reaching up and bending down). For example, the lower shelf in most kitchens is 6 inches from the floor and high shelves are about 72 inches. While remote grip devices can grab an object out of reach, they often require considerable arm strength to support the object until it is placed on a surface. Add-on shelves which swing up (or down) can be mounted within existing cabinets to bring the shelf and its contents to the user for easier location and retrieval of objects. Spring loading could reduce the force required to operate such a shelf.

A majority of manipulative tasks in meal preparation (e.g., cutting, chopping) involve coordinated action and/or exertion of force; this often taxes the strength and dexterity of the aging hand. While convenience foods can moderate these demands, the types of packaging used with many such products may not improve, and may actually degrade, the situation. The boiler bag, for example, is a difficult technology to use; forcing the person to handle a hot item while trying to open it and remove contents. New shelf-stable, minimum preparation food systems (e.g., Rhodes, 1977) are one option. However, improvements in product packaging to make opening, resealing and general handling easier would help; so would improved engineering of mechanical devices such as can openers to require less force and provide greater cushioning at the point where hand pressure is applied.

Personal care includes bathing, grooming, dressing, and use of the bathroom. Bathtubs and even some showers require stepping over barriers, often where footing is unsure. This has been an area of long-standing concern and a range of add-on chair lifts to assist the person in and out of tubs have been developed. Grab bars are also used, although they probably help more with balance than actual movement of the body using upper arm strength. There is also a range of devices currently targeted to personal care tasks (Breuer, 1982). In addition, clothes hanger bars placed at a lower height would provide more ready access to clothes for older users and Velcro closures on clothes could minimize manipulative tasks involving buttons and zippers. Using a bath towel for drying the body requires postural change - reaching and bending to contact all parts of the body. While sitting makes the task easier, an air dryer with a large enough flow to dry the body would only require some standing movement rather than major body movements.

Getting in and out of bed involves major changes in posture (i.e., lying to sitting to standing). Because grab bars and trapeze devices may require arm strength beyond the capability of many older adults, a bed that raises the upper part of the body would assist in bed transfers. A more radical approach might employ a contoured bed/chair that would be entered/exited like a chair and then recline back for sleep. Contouring might provide better support for the aging body in addition to minimizing entry and exit problems.

Cleaning/maintenance of the home includes heavy cleaning of floors, walls and work surfaces as well as laundry and waste disposal. Improved surfacing materials which are more easily cleaned and resistant to soil could reduce demands for bending and scrubbing. Easily disassembled appliances (i.e., toaster ovens, refrigerator shelves) could minimize physical force and activity required to clean and maintain these devices. Small, lightweight vacuum cleaners that work on all surfaces and are easily stored can reduce the bending and carrying required by many, current models. In general any features of the task environment that require dexterity postural change, and weight transport can be modified by technology, to reduce demands on physical capabilities that decline with advancing age.

While providing support for sensory and cognitive functions is more difficult, two approaches using voice synthesizer technology offer promise. Auditory, stimulation is more intrusive than visual stimulation and does not require as much attention to the source. For example, many, subjects in the meal preparation admitted to not noticing a control light on a stove. An add-on "talking control" to provide auditory feedback for ovens and stoves would provide a more intrusive cue as to the status of these devices.

As we increasingly confront the problem of cognitive disorientation as a source of functional problems, we can envision a system providing orienting information about the environment via micro-processoractuated voice synthesis. The system would require only a basic physical motion from the user and be cued by the user's movement through, and use of, the environment. While much more task analysis work with activities of daily living confronts us in even developing a first approach to such a system, it could be of use in cases of mild to perhaps moderate disorientation. In a sense, the technology is designed to mimic some of what we do now; reminding ourselves and repeating information slowly to assist with information processing.

Technology and the Continuum of Care: High Tech and High Touch.

These and other possible uses of technology and engineering to develop more assistive environments do not imply either an exclusive attention to high technology or a complete substitution of technology for human services. Those concerned with development and application of technology increasingly use the term "appropriate technology," to emphasize technological complexity at the level of the problem, not for the sake of complexity. The "churchkey" can opener is not high technology - but it is an elegant piece of engineering. It is simple (no moving parts), reliable, and requires the minimum operator force to accomplish the task, requires no special training, and is inexpensive to make and sell.

However, the pace of microprocessing and robotic technologies does appear to offer more appropriately complex solutions to more complex problems within certain limits. Many manipulative tasks required for daily living primarily involve coordinated motion by two hands handling a range of object types. The development of robotic technology to interface an older user with severely reduced manipulative capability (i.e. reduced hand flexion and strength) would, for the above task, require a voice commanded device with two arms and grip devices capable of coordinated movement in three dimensions with visual and touch sensors capable of discriminating object size, shape and texture to control target object approach and grip jaw force application. Even the most optimistic technologists would have to admit that there is currently only one operational device sophisticated enough in design to have these biomechanical and information processing capabilities -- the human.

Martin V. Faletti, Ph.D., is Director, Research Division, Stein Gerontological Institute, Miami Jewish Home and Hospital for the Aged, Miami, FL. This article is based on human factors research supported by NIA Grant #RO1-AG-02727 and contributions by M. Cberie Clark, Human Factors Project Manager.

REFERENCES

Breuer, J. M., 1982. "A Handbook of Assistive Devices for the Handicapped Elderly: New Help for Independent Living." Physical and Occupational Therapy in Geriatrics, 1:2, pp. 1-77.

Faletti, M. V., 1984. "Human Factors Research and Functional Environments for the Aged." In I. Altman, J. Wohlwill, and M. P. Lawton (Eds.). Human Behavior and the Environment: Vol 7. The Elderly and the Environment. New York, NY: Plenum Press.

Lawton, M. P., 1977. "The Impact of Environment on Aging and Behavior," In J. E. Birren & K. W. Schaie (Eds.). Handbook of the Psycholoogy of Aging. New York, NY: Van Nostrand Reinhold, pp. 276-301.

McCormick, E. 1970. Human Factors Engineering. New York: McGraw-Hill, Co.

Rhodes, L., 1977. "NASA Food Technology: A Method for Meeting the Nutritional Needs for the Elderly." The Gerontologist, 17, pp. 333-340.

Rohles, F., 1983, October. "Opening Jars: An Anthropometric Study of the Wrist-Twisting Strength of the Elderly." Proceedings of the 27th Annual Meeting of the Human Factors Society, 1, pp. 112-116.

Saxxon, S. and Etten, M., 1978. Physical Change and Aging. New York: The Tiresias Press.

Taeuber, C. M., 1983. America in Transition: An Aging Society. (U.S. Bureau of the Census, Current Populations Reports, Series P-23, No. 128), Washington, DC: US Government Printing Office.

US National Center for Health Statistics. 1983. B. Feller: Americans Needing Help to Function at Home - Advance Data from Vital Healtb Statistics, No. 92. Washington, DC: DHHS Pub. No. (PHS) 83-1250.

Western Gerontological Society (WGS) and Gerontological Society of America (GSA). 1981. Conclusions and Recommendations from the First National Conference on Technology and Aging, Wingspread Conference Center, Racine, WI. Washington, DC: Conference Report.

Reprinted with permission from Generations, Journal of the American Society on Aging, Summer 1984, pp. 35-38. Copyright ASA.

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