As the first step in our process of analysis we identified the needs and challenges of elderly which were reported from the experts’ perspective (main category “Individual demand”). In the second step we identified the reported basic and advanced technologies and their contributions to organizational aspects for care service provider (main category “Technology for care”). The third main category (“Health and quality of life by AAL”) summarizes the findings of the individual’s benefits of AAL solutions.

Individual demand (C1)

This category defines two sub categories (see Table 2). It describes the most important individual needs and individual problems of elderly with demand for support by care giving organizations or their relatives.

Table 2 Categorisation of the results Full size table

Needs of elderly (C1.1)

In general the experts agree on the point that dependent elderly want to be treated as competent and sovereign individuals, regardless from the disabilities they are suffering from. They have the desire to be supported in a loving way. The individual’s needs are influenced by the personal circumstances of their life and social environment:

‘…we do have seniors who put make up on before the nurse comes to visit them. Often this is neglected.’ (R4/123)

‘…it sounds like a buzz phrase, but it is not a natural consequence to interact at an eye level with those people – no matter how disoriented they are. It is very important to take them serious and not giving them the feeling of obtrusiveness…’ (R2/101)

The need of continuity, familiarity and respect plays a major role for the dependent persons. If changes in their surrounding are necessary these things always must be done step by step.

‘…, I mentioned that familiarity is very important to cope with the daily life…’ (R2/122)

‘… the biggest possible degree of continuity by considering the individual’s needs in the surrounding conditions. This could be banal things, e.g. it is very important for a person to take the shoes off before entering the flat…’ (R8/33)

‘… my caregiver should come always at the same time, be on time, should be very friendly. (…) That’s it. The stability.’ (R9/479)

The elderly do have a strong desire for social interaction, especially with their family members. Also the fulfilments of their wishes is an important need and therefore to be considered by care giving staff and relatives. Two interviewees reported that consuming delicious food plays a major role for aged people because they love to enjoy indulgence as same as young people do. Here, talks about delicious experiences of meals are used as an instrument to create a level of joint interaction and social interactions. In the interviews, it was also reported that the experience of fun in old age is also an important need. But the fulfilment of this very important need is a rare phenomenon.

‘…The social interaction is an important thing. Gadgets do not fully replace this but they make fun…’ (R7/705)

‘…Food is the main topic, everything. What is the meal today and what will the meal be tomorrow and what did we have yesterday? For elderly food does play the same role as sex for pubescent…’ (R9/487)

The fulfilment of elderly’s′ individual needs like delicious food and the feeling of being secure in the familiar surroundings have positive impacts on QOL.

‘…the process of having meal as a manner of indulgence. It should have usually play this role for people… food enables social contact, it is living…’ (R9/502)

The experts agree that improving social and personal interaction does influence quality of life and can lead to improved health status by influencing mental health. Furthermore, the communication between relatives and seniors at the one side and between care givers and elderly on the other side does have influence on the well-being of the old person.

‘…if he goes to a day care centre, the lust for life and emotional appeal. Those minds are in good shape…’ (R7/100)

‘…we say … the social contact is the thing that really helps …’ (R9/169)

‘…we take care that relatives do visit the residents … that they communicate. But also when our care staff is visiting the assistive living accommodations they talk to them …’ (R10/18)

‘…autonomous and self-determined, but they have the possibility to be a part of our big team …’ (R10/30)

From the perspective of care staff or care giving relatives, a personal relationship and appropriate personal interaction as well as the possibility to cooperate with the dependent person is highly necessary. The necessity of personal interaction with a familiar assistant is also a main need, especially when the support is on a basic and intimate level of interaction (e.g. feeding, toilet support, personal hygiene).

‘…as often as possible the same care person. Being on time. Appearance. Reliability. These are the most important aspects…’ (R8/464)

‘…and the social element he does need. This is the aspect which is claimed by the most of them…’ (R7/722)

‘..the social dimension is one of the most important ones. In other respect it is “warm, to be full, clean”. Some people are embarrassed because of incontinency. They do not want to smell bad; they do not want to lie in a wet bed. Here simply the human being is needed…’ (R7/716)

The QOL can be improved by giving dependent people the possibility to act autonomously within their familiar surroundings. Autonomy can be facilitated and improved by equipping the home with barrier-free gadgets, helping aids and technical gadgets. The main objective is to facilitate the activities of daily living in the elderly (for example: bathing, dressing, etc.).

‘…most important are low barriers, barrier-free surroundings, I mean in the flat and outside the flat and then the near infrastructure. But it is, this is a key point, the barrier-free, to have different helping aids in the flat which facilitate a lot of things…’ (R6/88)

The need for autonomy could be addressed by (non-technical) services which provide solutions for challenging situations for impaired people. They improve autonomy by giving situational support when it is needed (e.g. cleaning services and other tasks in the household). An expert said that moving to an assisted living facility can lead to improved autonomy, because of the additional services in those homes. Nevertheless, for dependent elderly it is crucial to stay motivated and activated by their care givers to do things on their own and keep them mobile as long as possible.

‘… it would be easier to open the oven like a wing from the side, like a door of a cupboard, and below of this I can pull out a place of deposit and take the baking tray on it…’ (R6/98)

‘… imagine the following: … You have problems with your legs and you have to clean up the flat. How could you do that? Impossible. But you are dissatisfied, because you see that your flat is not administered enough. This means you need someone to do it. … – this assisting person visits you and does this work with you together…’ (R10/68)

An interview partner said that the autonomy of making decisions about the own body and the home surroundings is a possible aspect, how health and QOL can be improved.

‘…or it (autonomy) is about the human being who lives here and can decide on his or her own if there is a spot of dirt or not. That is his right to say, “This spot I want to have here. And when I want to have bread crumbs on my table, I want it this way”…’ (R9/310)

Problems of elderly (C1.2)

The most important problems in elderly are physical caused, cognitive limitations, tremor and impairments in mobility. Especially the limitations in mobility lead to declining social interactions and sometimes feeling insecure and imprisoned at the own home. One interview partner stated that losing the mobility means being imprisoned at your own home.

Also mental changes in life of elderly due to dementia are part of the most crucial problems. They lead to disorientation and can have a huge negative impact on the activities of daily living.

‘…people are often able to walk around at one level of a building but they can’t get upstairs more than 3, 4 or 5 stairs and are therefore more or less prisoners in their own flat…’ (R8/57)

‘…another topic is the tremor …’ (R8/64)

‘…under some circumstances also the social surrounding is reduced because of the limitations in mobility , and furthermore the psychological changes which come along with ageing. Also in the direction of being disoriented, dementia diseases which impede activities of daily living…’ (R2/29)

‘…and for most of the elderly the fear of intrusion of strangers, fear to be alone, fear of isolation…’ (R9/163)

Another identified problem is the thinning of the social environment because of deceased family members and friends. Furthermore, from the expert’s view, in today’s common perception of society an old person seems not as valuable as a young person. Especially aged people feel this perception which leads to a feeling of not being needed anymore and depressive mood or psychological disorders.

‘…And then, the social losses, that people often lose their most important persons in this phase of life’ (R2/28)

‘…because the old person is unpresentable. In Austria, this aspect de facto does not exist (…)’ (R8/127)

‘…from the perspective of the old people you go to an assisted living home or a nursing home and hand over the individuality at the entry door. That’s the way it is, yes…’ (R9/284)

Another domain of problems for elderly was explained by the insufficient financial resources. This is especially a problem for old women and their relatives.

‘…Furthermore, there are the social problems; most of them do not have a good financial background, the pensions of old women are at the bottom limit …’ (R2/25)

‘…I do see it in my own family, we additionally paid, because it was not enough (money)… no problem for paying additional for our mother. They (the government) will not pay additional for it …’ (R7/876)

The next problem is the transition to the new situation of the need to be cared or supported in any way. For this new unfamiliar situation there are not enough institutions that have the possibility to give appropriate advice to elderly and their relatives.

‘…there is no good advisory service for old people!… it is all about “how do I motivate people to make use of assistance at home?”. They have to go a step forward and allow an unfamiliar person to get into the flat and I have to admit that I am not able to do it anymore. This is the crux of the matters in life…’ (R7/340)

Technology for Care (C2)

In this main category two sub categories were found (see Table 2). It describes the needed basic and advanced technological solutions in geriatric care that could support care giving services and aged people.

Basic technologies for care (C2.1)

The role of simple supportive devices, like nursing beds, can help care staff to activate bed-ridden people. Also physical actions like relocation and mobilisation of clients can be done easier with available assistive aids and technologies like grab handles and patient lifts.

‘…we have high dropout quotes. If a client is heavy and bedded low, 3 times a day turning him around, changing diaper and mobilizing is not possible. The bed is the next important thing in mobile care…’ (R7/236)

‘…this is an interesting example…if I can transform a bed into a chair and reversed…’ (R1/77)

‘… yes, it should simply be barrier-fee. This means beginning with the size of the grab handles, to be able to put a stool under the shower or simply a shower without barrier…’ (R6/138)

One assistive basic technology to facilitate the work of nursing staff is the adaption or adaptability of the sanitary environment. The needed technologies are helping aids in bathrooms that make the care process less stressful for the staff and could decrease the risk of falls, too. Technical solutions for relocation and movement of clients are always useful to prevent the back of the nursing staff of injuries. These kinds of helping aids are very rarely available at the customer’s homes. Furthermore, assistive devices that help elderly to stand up and mobilize, are needed.

‘…electrically adjustable toilets and wash-bowls would influence care positively…’ (R3/48)

‘…the whole topic “transport, transfer, embedding”. This is one thing that is bad for the back of the people, if I can say so…’ (R4/85)

‘…another thing that would be great, the electrical mobilization aids to stand up…’ (R5/214)

Another technology that could help care givers is a door opening system for flats without an electrical door. This technology is simple and very important because often key-safes are not allowed by property management or not wanted by the clients. Also video systems to open doors remotely would be very useful for clients and care staff.

‘…The most important thing we would need, and I think the clients too, would be the opening of the doors. It is always a dilemma to get into the flat. If someone is bed ridden… without going to the door, opening the door…’ (R6/110)

‘…a system… for example a camera in front of the door. So she is able to see who will enter…not the key-safe … in reality it is not expensive, but it does not exist…’ (R7/535)

One interviewee explained that technical solutions for cleaning up incontinence products could be supportive for care giving staff.

‘…if I do not need anyone who helps to clean up the incontinency material. If there would be a technology that supports in this action…’ (R1/70)

Advanced technologies for care (C2.2)

General the experts stated that an appropriate way is needed to get informed regarding technical solutions which are already available. Therefore, the experts advised to establish an AAL-platform for information dissemination.

‘…a platform for AAL-products should be established (the platform for helping aids of the ministry seems to be not suitable for this purpose)…’ (R3/99)

‘…regardless if there w different providers – but accessible on one platform.’ (R8/431)

In future intelligent assistive technology will be used to foster autonomy of dependent elderly and give relatives the opportunity to have additional spare time in their lives.

‘…spare time for relatives will be enabled to have the possibility to get out half a day without having fear. There is a huge deficit and here I see the big chances for AAL…’ (R4/42)

An often mentioned area of gadgets needed is the technology with reminder functions. For example medicine dispensers that detect, if a drug had been taken or not would be a valuable assistance. Also devices which have reminder functions for water intake do make additional sense in geriatric care.

‘…to the automatic medicine box, when taking out the medicine it does not necessarily mean that I took the medicine. Therefore it could also trigger an alarm with the same technology…’ (R1/13)

‘…a device which stands beside the bed like a little television and shows a glass of water; … a television…that says “Mrs. Mayer, please drink a glass of water”…’ (R7/429)

The experts explained that possibilities to interact with the devices more easily are recommended. One approach is the manipulation of the systems via speech recognition. Most experts declared that a remote control via speech recognition is strongly needed to give impaired elderly an appropriate chance of interaction with assistive devices. Because of their declining cognitive abilities, it would be useful to manipulate television, windows, jalousies, lights, and phones via speech control.

‘…When looking at old people I recognize that there should be much more possibilities of speech recognition. When I become older I will not see the remote control (buttons) as good as now. It would be better if I could give commands to the television…’ (R1/373)

‘…a phone … that is dialling via voice recognition. None of our clients has such a thing…’ (R7/293)

Experts also described solutions to improve social interaction. One method is the video-communication facilitated by television.

‘…visual communication is a topic…Two models: a client has the possibility to get in contact with the organization actively via web – regardless if by television or something else. Via camera… Because the client wants to get a brain-training or a nutritional advisory service…’ (R8/257)

The next approach how technology could improve the interaction of care organisations and elderly is to have the possibility to call the service provider on demand. If advice for daily challenges is needed, the qualified staff could give it just in time to the supported person.

‘…it would be an ideal solution if I could say, “I offer this”, as mobile care service provider. The people press a button and we visit them only when they really need us…’ (R5/139)

The experts reported that measuring activity and behaviour via monitoring systems could help the care service provider to optimize its supportive tasks based on the individual’s perceptions and habits.

‘…I could imagine that – before providing care services – to make a technical supported activity check over 3 weeks; what does he or she do on his or her own? What is he or she not able to do? Aiming to provide optimal services to him/her. Because we are supporting in these fields where the human being is not able to act on his or her own anymore…’ (R1/156)

There is also demand for automatic light adaption, which would be useful to prevent falls.

‘…one topic is light, when getting up at night, there are products of company XY and so on. Guidance systems that recognize activity and turn on the lights…’ (R4/95)

The most important solutions include products which enable monitoring of vital parameters of dependent persons. Here telemedicine and telecare do play a major role for the interaction between care giving institutions, physicians and emergency services. Fall detection systems, location detection and autonomous behaviour recognition solutions with automatic interpretation were mentioned in context with telemedicine solutions. Today, available emergency-call systems can also be coupled with fall detection systems. For disoriented persons systems can be useful that are able to detect their location more easily (stand-alone-locations detectors).

‘…fall detection systems, these things we do not have at the moment in our organization… This is a very good thing, because it gives the client a feeling of being secure…’ (R7/148)

‘…fall detection systems are in use in our emergency call devices. With wristbands and neckbands…’ (R10/160)

‘…it would be beneficial, if not only we (the care provider) would get the data. Also the physician should have access…’ (R1/331)

‘…do you know the emergency call systems? There is a box with a voice speaking out of it. This is a very important contact person for a lot of clients. …they wake up at night and are a little bit of perplex…’ (R7/189)

‘…a location detection system for disoriented persons who got lost…’ (R2/233)

Emergency-call systems do have a positive influence on caregiving services, because in situations where disoriented persons need support personal contact can be realized.

‘… and these systems tell us: did he go outside? … The new systems are able to do more, e.g. it could inform: “client leaves the house”…’ (R7/63)

As mentioned it is very important for care services to gather and record vital parameters in the field of telemedicine. AAL could play a supportive and activating role by enabling people to do their daily measurements of e.g. blood pressure on their own. By enabling dependent elderly to do these necessities on their own the resources of care providers can be preserved. Nevertheless this information is not enough for providing professional care services. The data has to be supplemented with additional information about the client’s day and the personal situation while doing the measurement, e.g. an exciting talk before measuring blood pressure could increase the values.

‘…I think telemedicine and telecare will be a topic. For support at home…’ (R1/101)

‘…the vital parameters. For example blood pressure. This is strongly connected to the agility of the person…’ (R8/86)

‘…the transmission of vital parameters and other data relevant to medicine or care. …this would be a benefit, if transmitted, to a call centre…’ (R8/220)

‘…Every person is able to measure blood pressure on his own. What is relevant for us? For us the following is relevant: Did he measure blood pressure? And additional: What happened? What did he do the whole day? So we are able to draw conclusions. The numbers and values as on its own do not represent anything…’ (R10/108)

Health and quality of life by AAL (C3)

This category summarizes the findings how intelligent assistive technologies, smart homes, and AAL solutions can influence health and QOL of aged people.

Technologies can impact health and quality of life in elderly in various dimensions. When providing technical solutions, it is necessary to focus on and address the individual needs of elderly and also to offer products that provide additional benefits for elderly.

‘…products… which are adapted to the need of the particular person…’ (R8/287)

‘…by looking straight forward perhaps intelligent solutions will essentially contribute to quality and well-being and also for preservation of health…’ (R8/506)

The main objective of assistive technologies is to influence QOL of the individual by enabling elderly to live in their familiar surroundings as long as possible.

‘…the biggest wish of all of them is to stay at home. And the longer I can stay at home by technical aids, the more my quality of life grows and I can stay at home gladly…’ (R1/188)

The experts explained that it is necessary to provide only as much technical and non-technical assistance as necessary because “over-supported” people tend to retreat themselves.

‘…at the time he gets support, this is our experience – he tends to retreat and does nothing anymore…’ (R1/159)

‘…it (AAL) would enable them to stay in their familiar surroundings for a long time. If a lot of things are done automatically I am able to stay at home for a longer time. That’s it…’ (R7/286)

The QOL and health can be influenced via devices which enable people to improve social contact and interaction. Technologies can have health impact by giving elderly the possibility to participate in societal actions and therefore decrease their loneliness. Another way of improving health and QOL was found in the possibility to communicate in emergency-situations directly with emergency- and care services. The health status can be positively influenced by advices from medical staff or care service providers for after-treatment questions.

‘…I think that the intelligent devices promote health in a (health) promoting way. Especially by communicating with external contacts…’ (R1/119)

‘…I think, for me the social inclusion is one key point … the technology enables me to live the social inclusion in that way that I can be involved more intense, then it operates like in a health promoting way. Here the technology can be supportive…’ (R6/333)

‘…(communication) with old friends who are, for whatever reason, are not mobile, etc.…’ (R8/20)

‘…we have to recognize AAL as a platform for social contacts. Why it is negative to communicate with the grandchild over a distance of 25.000 kilometres? I see the videoconferences. We don’t have to say ‘videoconference’; it is a personal call…’ (R10/553)

‘… It could be hospitals, care service provider, perhaps emergency services, …’ (R8/293)

Another way of in influencing health and QOL was found in the impact on the physical dimension. Stimulating the activity of elderly people improves the mobility of them. This aspect is important because also depression and sleep disorders can be influenced positively by physical mobilization. Some AAL solutions could be used for physical training and exercises. They could increase, or at least retain, the existing mobility.

‘…And sophisticated and medical assured with sports science etc., programs for movement- and training in old age…’ (R8/510)

‘…the systems that are developed will contain the stimulus to get outside. Health, well-being and also less depression, sleep disorders and so on. I think that technology can be supportive…’ (R1/132)

The experts explained that technology based reminders and warning gadgets and functions (for medicine intake, measurement of vital data, food or liquids) are able to improve physical health as well as individual wellbeing. Therefore, the compliance of medicine intake and the feeling of not being thirsty can be influenced. Reminders, warning functions and advisory functions do play an important role in prevention of diseases and other health threatening events.

‘…but when I do not open it (the medicine dispenser) within the span between 07:00 and 08:00 a voice comes out of the television “I would like you to remind you that you didn’t take your medicine”…’ (R8/177)

‘…the medicine dispenser because does remind you. It supports you with the prescribed medicine. This supports health. Because I keep my abilities at this level. This is why I got my medicine…’ (R7/604)

‘…measurement of blood glucose. If it is at 300: “hello, something has to be done!” … Thereby the care staff, the relatives, the medical doctor arranges reactions…’ (R10/497)

‘…I think of emergency situations. And of course, if I would say I have warning systems like these that tell me: “drink, take the medicine”, whatever, I could have an impact (on health)…’ (R9/525)

‘…and if the milk is not free of lactose: “warning!”, and this is the advantage…’ (R10/671)

The elderly’s QOL can also be influenced by “technical helping hands” like robots, intelligent adaptable tables or seats which help the dependent person to stand up.

‘…and the other would be a helping hand. This is the direction of care- and robot systems which are currently under development…’ (R6/62)

‘…here it is the topic of handling mobility… if the table rolls away … to have support in that way, however it may be realized…’ (R7/616)

Health and QOL can also be affected by AAL solutions by compensating mental disabilities. Experts mentioned that reminder functions can have positive effects at the self-determination by reducing their daily mental stress of forgetting something important. Here, item-related reminder functions (for example: to find things/ forgetting keys) or space related reminder functions (for example: checklist when leaving flat) were described.

‘…aids to remember in the household or in the flat. That can take away the stress a little bit: “did I do this and that, did I turn off the stove?” These things that support me by remembering and organizing the daily life…’ (R2/81)

‘…the key that tells me “take me with you” if I leave the flat. The key wouldn’t tell me that, the system does… and applications to stimulate and help me to remember, I mean applications with touch screens for memories, pictures, music…’ (R2/234)

‘… with RFIDs (computer chips for radio-frequency identification) that help the people to find things they lost or cannot remember the place where they left it…’ (R2/245)

Mental health can also be improved by reducing fear, enhancing the feeling of being secure and thereby improving a more relaxed behaviour. AAL solutions can reduce fear by providing reliable emergency-systems that automatically react in the case of emergency. This is important, because people tend to be less mobile after falls which improves the physical degradation anyway. Another possibility is to enable memory trainings for people with dementia.

‘…these reminders shall facilitate human beings to be self-determined and active. It is worthless, if a machine takes over all activities…’ (R10/206)

The mental well-being and fear can also be reduced by security-systems (in terms of automatically switching electronic devices) that are convenient for elderly because they don’t need to be worried about any switched on devices while being not at home.

‘…the systems which provide security…’ (R9/35)

‘…then it would be the security topic, all these things like switching off the stove…’ (R4/62)

‘…if I forget to switch off the stove. After a defined time it switches off automatically – that’s it.’ (R6/184)

‘…for them the aspects of being secure is not bad. I think, they feel a bit more relaxed and less anxious…’ (R6/342)

‘…these things help because they take away the anxiety… If I would fall to the ground two times, I am afraid. When I am afraid I will fall again more easily…’ (R7/116)

One expert explained that AAL solutions could increase social and psychological wellbeing by giving elder persons duties and responsibilities.

‘…If I would have an AAL-system, that tells me “good morning mister XY”, and furthermore shows me the activities. And then I measure the blood pressure and it tells me “thank you for your data”… this sounds strange… but sometimes it could be an essential activity. And this could be the task of AAL…’ (R10/520)

Another aspect is that self-confidence can be improved by offering AAL services which can be planned by elderly on their own and therefore make them less independent (e.g. transport services, shopping via television).

‘…to be valued again. Imagine you do not have a duty. You are sitting around the whole day and looking into the sky. What would happen to your self-esteem? …’ (R10/531)

The experts explained that applying security solutions can have positive influential aspects to the relative’s conscience. Emergency and security solutions are often bought by elderly to calm their relatives.

‘…yesterday, I saw a movie about residential care. And there is an old woman that says: “my daughter is calmed since I have this emergency wrist band, this is great”…’ (R9/269)

The (partially) manipulation of the home environment could enhance QOL by providing more comfort at home. The elderly’s comfort could also be enhanced by giving them the possibility to remote control/trigger (for example: via voice recognition) lights, radiators and windows. Another comfort improving technology is an automatically assistive device which enables impaired people to take a bath independently.

‘…for me the ecologic components (radiators) of smart homes are more important…’ (R9/254)

‘…or if I lie in my bed and lower the jalousies without standing up, this is…, let’s say, if we are in need of care, and this has a particular benefit…’ (R6/180)

The experts stated that there could be also negative impacts on QOL and health by AAL. For example the electro smog that comes along with technologies could have bad consequences for health.

‘…in our thoughts, we want less electronic devices where we sleep. And with this (AAL), I will have it exactly there. If the old person lives in one or two rooms, then I will have it (electro smog) there…’ (R9/329)

Monitoring systems could prevent people from living a risky life on their own by being over-supervised by a technical system. This means that the right of living risky and self-determined could be undermined by AAL.

‘…there is the aspect of controlling someone. And I, as an old person, have the right to live risky. … the surrounding environment (AAL) limits them (their liberty)…’ (R6/209)

‘… and I don’t want to be put under tutelage by a smart home only because it wants me to drink a litre. Then I simply don’t want this. I think I can decide on my own where I want to go…’ (R9/281)