This part of the report describes data on the characteristics of elderly people and research on their information needs and provision of information to them. This literature survey enabled the study to be better informed and designed, provided a picture of the people the study set out to examine, and allowed comparisons of the findings of the present study with those of previous studies.

Chapters 1 to 3 in this part of the report examine demographics data and the characteristics of elderly people in the UK, that is, their health, how they live and how they are supported and cared for. Chapters 4 to 8 explore the topics on which they seek information, the information sources and channels of which they are aware, the problems they have accessing information they want, the sources and channels they already use, and those they prefer to use.

1 Demographics

1.1 World population

It is well known that the world's population is ageing, with more developed regions leading this trend. This is due to increasing survival to older ages as well as smaller numbers of births (United Nations Population Division, 1998 revision). The support of this ever-expanding elderly population has become of increasing concern. A consequence of this demographic shift is the need to give greater attention to the design of products and services to older consumers who now exercise the power of the so-called "grey pound" (The Henley Centre and DesignAge, 1997).

The proportion of older persons (aged 60 or over) in the world population increased from 8 per cent in 1950 to 10 percent in 1998, while the proportion of children (under 15 years old) declined from 34 to 30 per cent over the same period. The proportion of older people in the population will increase significantly in the future. By 2050 the proportion of older persons will have more than doubled, to 22 per cent, exceeding the proportion of children, at 20 per cent (United Nations Population Division, 1998). In more developed regions the proportion of older persons is projected to increase to 33 per cent in 2050, while the proportion of children will decline to 15 per cent. In 1998, 66 million persons in the world were aged 80 or over; in 2050 this age group is expected to be almost 6 times as large. (United Nations Population Division, 1998).

1.2 UK Population

In the UK, as with most of Western Europe, the population is ageing. In 1961, 12 per cent of people were aged 65 and over and 4 per cent aged 75 and over. By 1996 these figures had risen to 16 and 7 per cent respectively (Office for National Statistics, 1999).

In the UK the number of people aged 65 and over is projected to increase from 9.3 million in 1996 to 12 million in 2021, peaking at over 15 million during the 2030s. On the other hand, the number of people under the age of 16 will drop from 12 million in 1996 to 11 million in 2021 (see Figure 1).

Projections suggest that if current trends continue those aged 65 and over will exceed those under 16 for the first time in 2016 and about a quarter of the population will be aged 65 and over by around 2040 (Office for National Statistics, 1999).

Proportionally, the biggest increase has been in the 'oldest old', that is those over 85, who are more likely to have chronic illness and disability, and to need care at home, in residential homes or in hospitals. As they get older, women increasingly outnumber men until, for those aged 85 and over, there are three women to every man. In 1997, for people aged 60 to 89, the proportions of women and men were 57 per cent and 43 per cent, respectively (Office for National Statistics, 1999).

1.3 Summary and conclusions

The evidence is clear. The number of elderly people in the population is increasing, and projected to continue doing so and it is the oldest old that are showing the greatest increase in numbers.

2 Ageing and health in the UK

2.1 Life expectancy

A widely used indicator of a nation's health is life expectancy Since the beginning of the century there has been a fairly steady increase in life expectancy in the UK. In 1997 the expectation of life at birth was almost 75 years for males and almost 80 years for females, compared to 70 years for males and 76 years for females in 1977. This means that, for example, for females life expectancy has been increasing by about two years for every decade. This increase is projected to continue, but to slow to a rate of about one year for every decade (Office for National Statistics, 1999).

2.2 Illness and disability

Older people are more likely to experience multiple impairment such as both failing sight and hearing, and chronic conditions such as osteoarthritis. In the 1996-97 General Household Survey 59 per cent of people in the UK aged 65-74 and 66 per cent of people aged 75 and over reported having a long-standing illness or disability, compared with 35 per cent of people of all ages. Forty one per cent aged 65-74 and 52 per cent aged 75 and over said that they had a long-standing illness that limited their lifestyle (General Household Survey, 1998). However, intense medical and social care is required by only a minority of those aged 75 and over who have chronic, multiple conditions (Age Concern, England, 1999).

The fact that disability increases rapidly with age can be seen easily in Figure 2, a chart of the data on people reporting one or more disability (as defined by the Department of Health), collected in the 1995 Health Survey of England.

(Department of Health, 1998)

For people attending their doctor in 1996-97, data on self-reported problems with general health and daily activities shows that the likelihood of having these problems increases with age. For example, 50 per cent of males and 60 per cent of females aged 75 and over reported mobility problems compared with 6 per cent of males and females aged 16 to 44. Problems performing their usual activities were reported by 27 per cent of males and 40 per cent of females aged 75 and over compared to 5 and 7 per cent respectively of those aged 16 to 44. The most frequent problem experienced by people aged 75 and over was "pain and discomfort" (56% of males and 65% of females), followed by: mobility problems; problems performing usual activities; anxiety or depression; and problems with self care (General Household Survey, 1998; Office for National Statistics, 1999).

2.3 Summary and conclusions

It can be seen that the older people are the more likely they are to have a long-standing illness or disability, problems with general health, and difficulties with daily activities. In addition, it should be noted that the demographic data in Chapter 1 in this part of the report showed that, proportionally, the greatest population growth has been among the oldest old – those who are most likely to have these problems.

3 Providing support

3.1 How elderly people live

In the UK, most frail elderly people live in the community supported by family or friends (Age Concern England, 1999). Due to the cumulative effects of ageing and the existence of environmental barriers, elderly people can spend increasing amounts of time in their own homes (Clark et al., 1998). Often, the carers of very elderly people are themselves pensioners who are also likely to be frail, with limited and decreasing ability to provide care (Age Concern England, 1999). In 1996-97, 21 per cent of men and 39 per cent of women aged 65-74 lived alone. The corresponding figures for men and women aged 75 and over were 31 and 58 per cent respectively (General Household Survey, 1998). The proportion of people of all ages living alone is increasing and is predicted to continue doing so (Department of the Environment, Transport and the Regions, 1999). Women over 60 form the largest proportion of this group (Office for National Statistics, 1998).

3.2 Informal support

In the UK General Household Survey of 1995-96 it was found that informal care provided by friends, relations and others for those of any age who are sick or disabled is more likely to be carried out by women. Fourteen per cent of women were acting as carers compared to 11 per cent of men. The proportion of people providing care varied with age, rising to a peak among those aged 45 to 64, when a fifth of all people were providing care for a dependent person (General Household Survey, 1998; Office for National Statistics, 1999).

Another General Household Survey, for 1996-97 (Office for National Statistics, 1998), examined the percentage of adults aged 65 and over who needed help from someone else to carry out seven activities. The findings are shown below:

Climbing stairs	10%
Bathing/showering	9%
Dressing undressing	4%
Getting in and out of bed	2%
Getting around the house	1%
Going to the toilet	1%
Eating	0%

3.3 Formal support

Generally, the use of social services increases with age. The General Household Survey of 1994-95 (Office for National Statistics, 1997) examined the use of selected social services by people age 65 and over in the UK. About 9 per cent of people aged 65-69 received help from a local authority home help or care worker and this figure rose to around 30 per cent for people aged 85 and over.

However, examination of other data available suggests that the picture is more complicated.

The General Household Survey of 1995-96 (Office for National Statistics, 1999) collected information from carers. Over one half of all carers said that the person they look after received no regular visits from health, social and voluntary organisations. Of those that received visits, the most common were by home helps (22%), community or district nurses (15%) and doctors (12%). Since 1985 the proportion of people receiving no regular visits has increased slightly and the proportion receiving home visits from the doctor has decreased by almost half.

Although the number of elderly people living at home in the UK is increasing, fewer are receiving formal support at home from Social Services. The number of contact hours of home help provision increased by about 50 per cent between 1993 and 1997, while the number of households receiving this help decreased by 7 per cent over this period (Department of Health, 1998). Since the early 1990s there has been a trend towards increasing intensive support for more heavily dependent people at home (Age Concern England, 1999; Office for National Statistics, 1999). However, there is a reduction in the number of people receiving less intensive help. Clark et al. (1998) noted that, due to pressure of resources, Social Services departments were making 'personal care' a priority over domestic help with housework, gardening, laundry, and home maintenance and repairs (Clark et al., 1998). However, their study suggested that that such 'low level' services providing domestic assistance both enhance the quality of life for older people and help them maintain their independence. The fundamental concern of the older people interviewed was to stay in their own homes where they had choice and control over what they did. Keeping a well-maintained house was found to be central to a sense of well-being and of being part of society, as well as to confidence about coping at home. Bowling et al. (1997) found that, for elderly people living at home, poor and worsening satisfaction with life was most clearly associated with some worsening ability to perform everyday tasks and with declining health, particularly for those aged 85 and over. Anxiety and depression were consistently associated with poor or deteriorating levels of ability to perform routine tasks.

3.4 Summary and conclusions

The figures relating to how elderly people live and the formal and informal support they receive suggest:

· most frail elderly people live in the community alone or with others who act as carers and can themselves be frail;

· the number of elderly people living alone is increasing;

· support for elderly people at home tends to be predominantly informal, i.e. from family and friends;

· the numbers of elderly people receiving formal support from social and health services is decreasing, while those with the greatest need are getting increasingly intensive support.

4 Information needs: what types of information do elderly people want to know?

4.1 Introduction

Few studies have examined the area of information needs with respect to elderly people in the UK. The information needs of disabled elderly people and their carers have perhaps been even more neglected. One of the first major studies was carried out by Epstein (1980), of the Research Institute for Consumer Affairs (RICA). This examined the information on benefits and services available to elderly people in England and how they used that information. At the time, Epstein stated: "....there has been no comprehensive or detailed study of information needs among different elderly groups across the country and no research attention to the information needs of care workers serving the elderly". Like the RICA study, most subsequent studies have focused on specific areas of information need of elderly people in particular areas of the UK (e.g. Troup, 1985; Tinker et al., 1993, who also reviewed work by Kocher, 1989; Mullings, 1989; Roberts et al., 1991; Steele, 1990; and Tester & Meredith, 1987).

In order to discover the topics on which elderly people seek information, researchers have obtained data on enquiries to organisations that provide information to elderly people and have asked elderly people themselves on what things they feel they need more information.

4.2 Enquiries to information providers

In an Age Concern study (Tinker et al., 1993), information was obtained on the enquiries made by elderly people to 18 local and national organisations producing and providing information. Five topics of enquiry emerged as the most common:

· Social security benefits and entitlement to them;

· Health (including specialist areas like arthritis and dementia);

· Residential and nursing home care and how to pay for it;

· Support and services for people at home;

· Housing.

Tinker et al. (1993) felt that elderly people take those enquiries that they consider appropriate to formal information providers.

The National Association of Citizen's Advice Bureaux (NACAB) does not classify enquires according to characteristics of the people making them. Thus, it is not possible to identify the types of enquiries made by elderly people. Troup (1985), in her Scottish based study, found that people over the age of 60 sought information from Citizen's Advice Bureaux (CAB) primarily on entitlement to benefit and personal problems, followed by accommodation. For people aged 50-59, 60-69, 70-79 and 80+, the greatest proportion of enquires to CAB Edinburgh Central came from the 60-69 age group. This could reflect the tendency of those approaching retirement or recently retired to seek information or (as the majority of enquirers were women) a change of circumstances through bereavement (Troup, 1985). NACAB classify enquires according to the type of problem and in 1997-98 social security benefits problems accounted for the largest proportion (29%), followed by consumer problems (18%) and housing problems (11 %) (National Association of Citizen's Advice Bureaux, 1998)

4.3 Asking elderly people

The RICA study (Epstein, 1980) included personal interviews with 900 people aged 65 and over in 6 areas in England. Interviewees were not asked directly what information they needed or wanted, but asked what their most worrying problem had been in the past year. The most common types of problems were health and financial, together accounting for 62 per cent of all problems.

In a study of the information needs of people aged 50 and over in Scotland, Troup (1985) conducted a questionnaire survey including a question to discover the broad areas on which respondents wanted more information. Just over 600 questionnaires were returned and 23 per cent of respondents said that they had no need for further information. For those that said they needed more information, the most frequent areas were money / housing (24% of responses), leisure opportunities (21 %) and health matters (21 %).Troup (1985) also carried out a series of group meetings involving some 40 people over the age of 50 in Scotland. She found general agreement among the participants that there was a great need for information for elderly people on a wide variety of topics. All aspects of finance, housing and benefits were considered to be the areas of most importance and where there was greatest need. Information on leisure opportunities was also considered important, but information on health was not.

In the Age Concern Study by Tinker et al. (1993), 50 elderly interviewees (age 60 and over) were presented with various situations where information needs could arise and where there may be uncertainty about what to do. In each of 5 towns, half of the people interviewed were judged to be "in touch" with information services (attended an Age Concern Centre) and half were " not in touch" (no involvement with clubs, day centres, voluntary work or additional church activities). What information was required, where it has been obtained, and whether it was adequate was determined for each situation experienced by an interviewee, otherwise a situation was treated as a "what if" scenario. It was found that, in the 6 months preceding the interview, the elderly people were most likely to have experienced or thought about becoming less capable (48% of interviewees). This was followed by the practical domestic problems of getting repairs done in the home (34%), buying something for the home (32%), and finding help with the garden (24%). Ninety three per cent said that their needs had been met when they had sought information about a specific concern.

The findings showed that, in general, the elderly people interviewed were fairly confident that their information needs could be satisfied as they arose. Tinker et al. (1993) stated that this does not mean that they did not have information needs, rather the elderly people "do not necessarily perceive these needs for themselves". The areas where one-fifth or more of the sample interviewed did not know where they would go for information if needed were:

· "legal rights" (42%);

· "if wanted to know income and benefits entitled to" (20%);

· "if lonely and depressed" (20%);

· "if looking after someone and unable to cope" (20%).

There was also evidence that when information was given, it was welcomed. The "in touch" group had the same information needs as the "not in touch", however, those "not in touch" tended to have less physical disabilities so were able to seek out their own sources of information rather than rely on an Age Concern centre.

4.4 Summary and conclusions

The main information needs for elderly people are concerned with: finance (especially benefits); health; housing and other accommodation; and support and services at home.

5 Information provision

5.1 Introduction

The studies on information needs of elderly people also examined different aspects of information provision: sources and channels of information; elderly peoples' awareness of these; the characteristics of poorly and well informed elderly people; the sources and channels that elderly people used most often and those that they preferred.

In some cases it is possible to make a clear distinction between sources of information and the channels by which that information is communicated. For example, the organisation Age Concern produces and provides information for elderly people and is therefore a source of information. Age Concern also uses various channels of distribution by which elderly people can access the information, such as fact sheets and books, a telephone help line, an Internet site, and local walk-in centres. In other cases the distinction is not so apparent, for example the GP can be a source of information, but also a channel for information produced by other sources in the form of leaflets located in the Surgery.

5.2 Information for elderly and disabled elderly people

The potential sources and channels of information available to elderly and disabled elderly people are summarised in Figure 3 (adapted from Tinker et al., 1993).

A formal source of information is any organisation or agency (statutory or voluntary), that is set up to provide information. Formal sources available to elderly people include agencies that provide general information and advice to all members of the public (e.g. Citizen's Advice Bureaux) and organisations that concentrate on provision to elderly people (e.g. Counsel and Care) or disabled people (e.g. Disablement Information and Advice Lines, DIAL). There are organisations that further specialise, offering information and advice to elderly and disabled people on a specific topic, such as housing, equipment and products, or a particular illness or disability. Government departments can provide specific information on benefits (Department of Social Security, DSS) and housing and mobility (Department of the Environment, Transport and the Regions, DETR). Other formal sources of information, that can also act as communication channels for information produced by others, are the staff of the social and health services (e.g. GPs, district nurses, social workers, and home helps). Informal sources or channels of information and advice include family, friends, neighbours and local social clubs for elderly people.

The RICA study (Epstein, 1980) identified a substantial number of national and local agencies that provide information on benefits and services for elderly and disabled people. The study found that the distribution of information by these agencies relied heavily upon leaflets, available at central points for viewing and collection. Media, such as television, radio, newspapers and experimental forms of provision such as 'information-on-wheels' were rarely used as channels for communicating information (see Todd, 1984, for a summary).

Tinker et al. (1993) pointed out that there was still a high reliance on the written word as a channel for communicating public information. This is still the case, with literally millions of leaflets and posters on the services and benefits available to elderly people produced and distributed annually.

How aware are elderly people of the sources and channels of information available to them? What barriers to accessing information exist for elderly people? Which methods of provision do they prefer? How do they tend to obtain information in practice? Literature relating to these issues is examined in Chapters 6 to 8 in this part of the report.

5.3 Information for carers

The main source of information, advice and support to non-professional carers in the UK is the Carers' National Association (CNA), a charity that provides information booklets, a telephone help line and local support centres where carers meet regularly. Information about the CNA is available at the Boots retail chain of chemists. The Carers Impact Team (1998) found that work is being done by the NHS to support carers, but evidence from carers shows this is often variable and uncoordinated. In many areas carer support is seen as the responsibility of social services alone or an issue for the voluntary sector (Carers Impact, 1998).

For carers who look after elderly people with dementia who live at home, it is vital to have information and advice at an early stage (National Consumer Council, 1990). Carers need information, not only about the services and back-up support available to them, but also about financial, legal, medical and other issues. (National Consumers Council, 1990; Tinker et al., 1993). Unfortunately, it seems that this information is often lacking, and, in the words of the Carers' National Association: "when they (carers) start, they know no more than anyone else about what should be available, where to go, who to see, what to ask....no one thinks to tell them and they are left to muddle through as best they can" (Carers' National Association, 1988-99).

Carers Impact (1998) proposes that information be provided to carers via a joint health and social services information strategy, developed with carers, and should:

· recognise the importance of one-to-one information;

· be up-to-date;

· include a dissemination strategy;

· target the right information at critical times (e.g. at hospital discharge);

· provide easily accessible information at public venues (e.g. GP surgeries and hospital outpatients) and in a range of formats and languages.

It seems that carers have a great need for support and information, particularly when they begin caring, and this has not been consistently met.

6 Awareness

6.1 Knowledge of support and information available

In the RICA study, interviewees were not very knowledgeable about the various services and benefits available to them and were confused about what services were offered by which agencies (Epstein, 1980). Later studies reviewed by Tinker et al. (1993) also found confusion and lack of knowledge among elderly people concerning services and benefits (e.g. Allen et al., 1992; Kocher, 1989; Tester & Meredith, 1987) and where to get help with making important life decisions concerning residential care (Moore & Steele, 1991).

There exists a vast number of free and low cost leaflets and fact sheets, and several free or locally charged telephone help lines giving information on government benefits for pensioners. How aware are elderly people of these? When shown sample leaflets very few of the elderly people in the RICA survey had seen them and still fewer had actually read them. This very low use of leaflets applied to the general population of elderly people, whereas those with a specific problem were 2 to 3 times more likely to have used the appropriate leaflets (Epstein, 1980). Thus, a 'need to know' principle was in operation (Todd, 1984).

The Department of Social Security (1998) estimated that, in 1997/98, between 27 per cent and 37 per cent of pensioners who were entitled to Income Support, between 0 per cent and 12 per cent who were entitled to Housing Benefit, and between 20 and 31 per cent entitled to Council Tax Benefit did not claim. This indicates that these percentages of elderly people were unaware that the information existed, or were unable to access it, or did not want the benefit. Organisations concerned with the welfare of elderly people say that large numbers of elderly people are still not claiming the financial help they are entitled to.

In the Age Concern study, the interviewees were presented with "potential information situations" covering the areas of: health; housing; financial/legal; social issues; and others. It was found that the elderly people simply did not realise that help was available in certain areas, or that their circumstances could be improved (Tinker et al., 1993).

6.2 Characteristics of poorly informed elderly people

The RICA study (Epstein, 1980) identified three groups of particularly poorly informed elderly people. These were: older elderly people (those over age 74); immobile elderly people; and rural elderly people. This was mainly due to the fact that the information distribution system relied on peoples' ability to get to the central points where the information (leaflets) was available and all three groups had restricted mobility. However, it was found that when access problems were reduced, that is when information was presented on television, radio or in newspapers, the disadvantages of the immobile elderly people disappeared. The worst informed were very often being seen by a social worker, district nurse, health visitor, or home help. Apart from the services they received from these sources they had little awareness of what else existed. As Epstein pointed out, such people were those that were less able to cope, but her findings suggested that care workers could play a more informative role. Social clubs for elderly people and GP surgeries were found to be poor providers of information for elderly people. Attending a club and frequent visits to the GP did not make people better informed. Listening to the radio and watching television were also not factors in being informed. Elderly people with hearing problems were no less informed about benefits and services than those without. However, elderly people with a visual impairment were found to be less informed than those without.

Conversely, Epstein (1980) found the well informed to be:

· younger elderly people (under age 74) who lived in built-up areas and suffered no serious mobility restriction;

· those who were receiving a cash benefit from the DHSS (except mobility benefit);

· those with a lot of social contact, not restricted to other elderly people;

· those that had used formal information sources (e.g. Age Concern, library, etc.);

· those that read newspapers and books.

The study showed that the older people were, the greater were the number of problems they experienced, yet the less likely they were to find information or even to be looking for it (Todd, 1984). Other studies, identified by Tinker et al. (1993), also found that elderly peoples' awareness decreased and their need for information and help increased with age (e.g., Tester & Meredith, 1987).

In their review of the relevant literature, Tinker et al. (1993) found that elderly people from black and minority ethnic groups, and those for whom English was not their mother tongue, could have extreme difficulties obtaining information and advice. According to Cornwell (1989), as cited in Tinker et al. (1993), the trend towards translating all printed information into other languages for the benefit of elderly people in black and minority ethnic groups was not seen as helpful by the Standing Conference Ethnic Minority Senior Citizens. The reasons given were: the elderly people may not be literate; there is no guarantee of follow-up; and these elderly people need face-to-face interaction to convey effectively their needs.

The evidence seems to suggest that the passive 'come and get it' approach to information provision discriminates against a considerable proportion of the elderly population. That is, those who cannot 'come and get it', either because they have mobility problems or they are not aware that there is something to come and get (Epstein, 1980; Todd, 1984).

6.3 Summary and conclusions

In summary, the literature suggests that elderly people in general lack awareness of the various types of support available to them and of the vast amount of information on this support. The poorly informed elderly people are those with restricted mobility (such as older elderly people, the immobile and those living in rural communities), with little social contact with people of other ages, with a visual impairment, and those who are from black and minority ethnic groups.

7 Barriers to information access

7.1 Introduction

It can be seen from the characteristics of the poorly informed groups of elderly people, examined in Section 6.2 in this part of the report, that there are a number of barriers to information access. In a review of research on information needs of elderly people, Tinker et al. (1993) identified several barriers, real and imagined, to accessing and using information, that fall into three groups:

· characteristics of elderly people

- attitudes e.g. resistance to becoming reliant on others

- lack of perception of need

- negative past experiences in seeking help

- restricted mobility

- social isolation

- visual impairment

- poor literacy

- language difficulties

· characteristics of the professionals who provide information

- withholding information to prevent overloading of services

- lack of knowledge

· characteristics of the organisations that provide information.

- problems with physical access

- out of date information

- fragmented approach to information provision

- lack of co-operation between information providers

The remainder of this Chapter examines in greater detail those characteristics of elderly people that have implications for the wording, design and presentation of information in paper or electronic format. It focuses on the effects of ageing on various sensory, perceptual, cognitive and communication abilities. Declines in these abilities can be a barrier to accessing and using information if the information has not been designed or presented in a way that takes these changes into account. Literacy of elderly people in the UK is also examined.

7.2 Effects of ageing on various abilities

Laboratory studies have shown age-related declines in a range of abilities including:

· visual and auditory perception;

· divided and focused attention;

· sustaining attention;

· information processing in working memory,

· recall from semantic memory;

· language understanding and production.

(Morrow & Leirer, 1997).

These declines in ability are examined, under slightly different headings to the list above, in the following subsections (7.2.1 to 7.2.9).

Performance is more likely to reflect these changes under complex task conditions (Morrow & Leirer, 1997). While it is useful to note areas of declining ability, it is important to remember that there are marked individual differences in the rate and magnitude of deterioration and older people often find ways to compensate for these deficits (Howell, 1997). The changes described below relate to the normal ageing process and do not take into account impairments due to illness or injury (this being the case for some of the elderly participants in the Disability Information Trust study described in this report).

7.2.1 Sensory and perceptual abilities

There are a number of normal age-related losses in the ability to detect, interpret and respond to visual and auditory information that can adversely affect performance of daily tasks. Declines in visual performance have implications for the design of printed or electronically presented materials for older people and deficits in speech perception play a role in situations where spoken communication is vital. In terms of the research techniques used in the Disability Information Trust study these declines in visual and auditory perception have implications for the typographical design of questionnaires and for performance of older participants in focus group discussions.

7.2.2 Visual perception

Kline and Scialfa (1996 and 1997) summarised the effects of ageing on the visual system and visual perception. Due to changes in the ocular media, most notably a decline in the resting pupil size (senile miosis) and increasing opacity of the lens, the amount of light entering the eye and reaching the retina is reduced, more greatly scattered and altered spectrally. Such age-related changes are most likely to affect adversely performance under conditions of low illumination or low contrast. The range and speed at which the lens can adjust its focus declines. Ageing is associated with a decline in static visual acuity, particularly in low light levels, and a decline in contrast sensitivity.

Thus, for older people, increased illumination and contrast enhance legibility (Kline & Scialfa, 1996). While older people can benefit from increased light levels, they have increased susceptibility to glare and a longer recovery period after exposure, so care should be taken with directed light (Kline & Scialfa 1996 and 1997). Loss of visual acuity and contrast sensitivity has implications for the design of printed materials for use by older people.

7.2.3 Auditory perception

Kline and Scialfa (1996 and 1997) summarised age-related changes in the auditory system and auditory perception. In older people collapse of the auditory canal can cause hearing loss at some frequencies in the speech range. Excess wax often diminishes pure tone sensitivity. Reduced elasticity of the eardrum and calcification of the ossicles also reduces sensitivity. The basilar membrane becomes less compliant and a loss of hair cells may be responsible for age-related deficits in high frequency pitch discrimination, absolute sensitivity and speech recognition. The loss of sensitivity to higher frequencies with advancing age (a loss known as presbycusis) is greater for men than women – this difference increases with age and is not related to differences in intensity of noise or duration of exposure. Frequency discrimination, important in speech perception and many auditory tasks, also seems to decline with age. There is a loss in the ability to localise sound with age. In studies using dichotic listening tasks, older people have difficulty repeating the information presented in one ear if competing information is presented to the other ear (e.g. Barr & Giambra, 1990). This suggests a divided attention deficit. Older people also need more time to switch attention from one ear to the other, causing them to miss information that younger people hear (Wickens et al., 1987). These difficulties have important implications for the performance of older people in noisy environments or conditions where more than one person is speaking at the same time (Kline & Scialfa, 1997). Age-related deficits in speech perception, demonstrated by many researchers, are small when the speech occurs in a quiet environment, but increase markedly in noisy or reverberant environments (Kline & Scialfa 1996 and 1997; Tun & Wingfield, 1997).

Self-reports of hearing difficulties have shown age-related problems with temporal resolution, hearing in background noise, understanding distorted speech and hearing high pitched sounds (Slawinski et al., 1993). People's perception of the extent of their auditory handicap is partially determined by non-auditory factors such as other sensory losses, health, educational level, social support and living arrangements (Kline & Scialfa, 1997).

7.2.4 Attention

Older people exhibit declining attentional capacities (McDowd & Birren, 1990). Elderly people show:

· a lowered ability to focus attention and inhibit or suppress irrelevant information, in both auditory and visual tasks (Morrow & Leirer, 1997; Tun & Wingfield, 1997);

· increased difficulty in dividing attention, especially for activities that require monitoring of complex or novel information, such as driving while reading road signs (Tun & Wingfield, 1997);

· increased difficulty in sustaining attention and performance over long periods of time (Vercruyssen, 1997).

7.2.5 Cognitive ageing

A popular theory is that age related declines in ability are associated with a gradual reduction in processing speed (e.g. Salthouse, 1991). Slowing occurs for both peripheral or sensorimotor processes and central or cognitive processes. Researchers appear to agree that the effects of ageing are greater on cognitive components of performance than on perceptual-motor components and a slowing of response speed with age is due more to central than peripheral factors (Vercruyssen, 1997). For older people speech processing is affected by speech rate. As speech rates increase, older adults are less able to discriminate, comprehend and recall spoken material than young adults (Kline & Scialfa, 1996; Tun & Wingfield, 1997).

In terms of general cognitive abilities, fluid intelligence abilities, such as inductive reasoning, problem solving, and speeded responding begin to decline as early as age 25 or 30. Crystallised abilities, such as vocabulary and general knowledge remain stable well into the 60s and 70s, showing minor declines only in very old age (Rogers, 1997; Willis, 1996).

7.2.6 Memory

Older people tend to report that their memories have become worse with age (Ryan, 1992). A large number of laboratory studies have confirmed this. Short-term memory tests that require people to retain small amounts of information for small periods show little or no age differences. However, working memory capacity (information stored and currently being used for an ongoing task) shows an age-related decline. Tests of working memory that require people to simultaneously manipulate or process the information show a performance deficit for older people, particularly when the processing demands are heavy (Howard & Howard, 1997). Thus, it is the processing component of working memory that is important in understanding age-related deficits.

The difficulty in inhibiting task-irrelevant information means that this information competes with more relevant information for working memory capacity and makes older people more susceptible to disruption of material in working memory by interference when attention is diverted (Morrow & Leirer, 1997). Failure to inhibit irrelevant information results in: increased activation of material in working memory that is not directed toward the goal of the ongoing task; inefficient allocation of attentional resources; and comprehension and memory deficit for the target information (Tun & Wingfield, 1997). Older adults also seem to keep irrelevant information activated for longer than younger adults (Hamm & Hasher, 1992).

Working memory plays an important role in many activities, including visual and speech processing. As the complexity of both verbal and spatial working memory tasks increases, older adults show greater performance deficits than younger adults (Morrell & Echt, 1997).

Recall from semantic memory (our store of world knowledge) can be difficult for older people if processing time is limited (Howard Jr. & Howard, 1997). While elderly people may have more so called "Tip-of-the-Tongue" experiences (when a person is unable to retrieve a familiar word), if they are given time their accuracy of recall is as high as that for younger people (MacKay & Abrams, 1996; Howard Jr. & Howard, 1997).

7.2.7 Speech processing

The ability to comprehend and use information conveyed by language is important in maintaining independence. Thus, it is not surprising that elderly people express concern about declines in their ability to communicate (Jacobs-Condit, 1984). In this "information age", this ability is becoming more important as a person encounters automated written and spoken instructions daily, for example from banking machines and lists of options presented over the phone (Morrow & Leirer, 1997).

In elderly people speech processing is affected by:

· declining ability to perceive auditory information;

· deficits in focused and divided attention;

· slowed information processing;

· working memory limitations.

The working memory limitations of elderly people have important implications for spoken language communication. Sentences with especially complex syntax cause problems (Tun & Wingfield, 1997). In addition, although speech recognition and memory in older listeners is helped by linguistic context, context cues that arrive after the poorly perceived speech have limited usefulness due to the burden of keeping the ambiguous speech in memory while awaiting the potentially clarifying information (Tun & Wingfield, 1997). Background noise and reverberant conditions can cause additional problems for elderly listeners (Tun & Wingfield, 1997). Care must be taken not to overload the working memory of older people in situations that require simultaneous maintenance and manipulation of spoken information (Tun & Wingfield, 1997).

In relation to many other cognitive abilities, speech comprehension and memory are well preserved in old age due to the ability of older people to compensate for deficits in lower level sensory or memory capability (Tun & Wingfield, 1997). In addition to using context cues, older people benefit from the rich linguistic structure of natural speech, especially in difficult listening conditions (Wingfield, Tun & Rosen, 1995). The prosodic patterns of speech also aid in comprehension and recall (Tun & Wingfield, 1997). Older people also compensate for deficits in sensory abilities ("bottom-up" input) by relying more on the predictability of communication and use their knowledge of past experience to provide cues for comprehension and memory ("top-down" processing) (Tun & Wingfield, 1997). However, this processing style means that elderly people often inappropriately apply top-down processing and personalised knowledge as routine (Willis, 1996).

7.2.8 Language production

In terms of language production, older people exhibit deficits in two fundamental areas: word retrieval and planning what to say and how to say it (MacKay & Abrams, 1996). Older adult often report problems with retrieving familiar words (Burke et al., 1991) and studies have shown that the spontaneous speech of older people contains more pronouns and ambiguous references and is slower due to both word lengthening and longer and more frequent pausing (MacKay & Abrams, 1996). From about age 37 the frequency of Tip-of-the-Tongue experiences increases with age, both in naturally occurring speech and in laboratory settings (Burke et al., 1991). Occurrences of disfluencies in speech (hesitations, false starts and word repetitions) also increase with age, indicating deficits in language planning (MacKay & Abrams, 1996).

7.2.9 Processing of printed information

Age related declines in visual perception, spatial abilities and working memory have implications for the processing of written or printed information.

It has been suggested that there is an increased reliance on memory to compensate for the decreased quantity and quality of the information entering the elderly visual system (Morrell & Echt, 1997). Age-related deficits in working memory, described above, are well documented. A number of studies suggest that spatial abilities increase during adolescence, reach their peak during the second or third decade of life, then decrease steadily (Morrell & Echt, 1997). Performance declines have been shown to exist in old age for spatial visualisation ability, integration of spatial information, memory for spatial location and visual-spatial characteristics (Morrell & Echt, 1997).

As with other abilities, the performance of older adults is adversely affected by high working memory or information processing demands. Studies suggest that older people have little difficulty with typographically simple text or text that is familiar to them, but experience considerable problems with typographically complex text which deals with unfamiliar material (see Hartley, 1994, for a summary).

7.3 Literacy

In a 1994 small scale survey of the basic skills of different age groups in England and Wales by Gallup (Basic Skills Agency, 1996) the oldest age group (72-74) performed worse on average than the younger age groups. However, in a self report part of the study, this age group had the fewest reported difficulties. The report suggests that it is likely that the poor performance of the oldest age group in the literacy tests is due to the effects of ageing, although there is no way of knowing whether the people were more competent when they were younger.

A 1996 Office for National Statistics small scale survey of adult literacy in Britain (Carey et al., 1997), found that the highest incidence of poor literacy is among those age 55-65 (the oldest group examined). In this survey younger people were more likely than older people to describe themselves as 'very satisfied' with their reading and writing skills.

7.4 Summary and conclusions

When preparing information intended for elderly people it is important to consider not only the content but also the way it is presented. This Chapter has described a number of sensory, perceptual and cognitive effects of ageing that need to be taken into account in the wording, design and provision of information, in paper or electronic format, for elderly people. There is no point in giving people the information they want if they cannot access or understand it due to the way it is presented. Presenting information so that it is easier for elderly adults to read, hear, and understand will ensure that it is also easier for younger adults to read, hear, and understand.

8 Information sources and channels: use and preferences

8.1 Introduction

Chapter 5 in this part of the report introduced the various sources and channels of information available to elderly people. As was discussed in Section 5.1, the distinction between sources of information and the channels by which the information is communicated is not always clear. This Chapter examines literature on the sources and channels that elderly people prefer and those that they use most often in practice. Sections 8.2 and 8.3 below cover formal sources of information, that is information providing organisations and health and social services staff. Section 8.4 is concerned with informal sources, mainly family and friends, who could also be considered as informal channels for communicating information. Sections 8.5 onwards examine how elderly people use, and what they feel about, different channels of information communication.

8.2 Organisations providing information and advice

The RICA survey (Epstein, 1980) found that the Citizen's Advice Bureau was not a significant source of help to elderly people, accounting for only 2 per cent of sources named. Troup (1985) found that 28 per cent of the people aged 50 and over in her Scottish based survey had never visited an agency for information or advice.

Based on the volume and type of queries received by the organisations investigated in the Age Concern study, Tinker et al. (1993) concluded that the role of these formal information providers was very important. A need for information services was apparent, with the organisations reporting:

· a rapid growth in enquiries once a service was up and running;

· current resources being overloaded;

· a significant number of people asking for help for the first time, yet were in considerable need;

· a relatively small number of people receiving help compared to the potential numbers that could well need help.

Local access was considered essential by the organisations and most stressed the need for a combination of methods of providing information. In the case of national organisations, enquirers were very often referred to a local source of help, in conjunction with both written and telephone advice. Enquiry by telephone was found to be a growing area (Tinker et al., 1993).

8.3 Health and Social Services

Doctors, social workers, home helps, day centre staff and other health services and social services staff are in frequent contact with elderly people. However, Epstein's (1980) findings suggested that they were not fulfilling their role as potentially useful providers of information. General Household Survey data for 1996-97 showed that the very young (those aged 4 and under) and the elderly (those aged 65 and over) consulted a GP more often than other age groups (General Household Survey, 1998).

Based in a review of the relevant literature and their own interviews with elderly people, Tinker et al. (1993) concluded that the health services, particularly the GP, have an important role in giving advice. They stated, however, that "not all were equipped or inclined to provide such information".

8.4 Family and friends

Informal sources or channels of information are the most accessible to elderly people. The research suggests that these sources, in particular family and friends, are the most heavily used, although frequently not the most satisfactory.

Elderly people in the RICA survey relied largely on informal sources for information on all problems. Family was found to be "far and away" the single most common source of help. Tinker et al. (1993) identified two relevant studies (Roberts et al., 1991, and Allen et al., 1992) in their review. When asked what they thought was the best way of informing elderly people about services, the group of elderly people in the study by Roberts et al. (1991) felt that asking friends was very important. Allen et al. (1992) found that elderly people living in residential care homes had obtained most of their information about the home from informal sources, most commonly their carer or a relative.

Tinker et al. (1993) presented elderly interviewees with various situations where information needs could arise. They found that, if it was not obvious how to get the required information, elderly people were most likely to look for help within their social environment, from family, friends and neighbours.

Evidence suggests that although elderly people rely heavily on family for information, they do not find this source helpful for problems of a complex nature (see Tinker et al., 1993, for a review). For example, elderly people in the RICA study were unhappy with the help they received from family on financial and housing issues, whereas formal information sources, though rarely used, were considered helpful (Epstein, 1980).

Thus, it seems elderly people prefer to get their information from informal sources or channels such as family and friends but can find these providers unsatisfactory for providing particular types of complex information.

8.5 Television and radio

To elicit the attitudes of elderly people towards various media for communicating information, interviewees in the RICA survey were asked whether they thought leaflets, radio and television were a good or bad way to inform elderly people, and in what way. Television was most often considered to be a good way (by 76% of people), followed by leaflets (66%) then radio (64%). Television was considered a good way mainly because most people watch it and it has a strong impact, being both visual and aural. The negative aspects of television were due to its fast pace and lack of a permanent record. The problem with radio seemed to lie in its familiarity. Many elderly people said that it was always on and they did not really pay any attention to it (Epstein, 1980).

Troup's (1985) questionnaire survey in Scotland included a question to determine how often elderly people used television, radio, books and newspapers. Television was used the most often: 91 per cent watched television at least once a day. This was followed by newspapers (86%), then radio (65%), and books (65%). Television was also most frequently chosen as the channel via which respondents felt that they got most information (39% of respondents).

The Broadcasters' Audience Research Board (BARB) data on the television viewing habits of different ages in the UK showed that those in the older age groups watched the most television per week in 1995 and 1996 (Office for National Statistics, 1998). Time spent listening to the radio also increased with age, with those in the 65 and over age group spending the most hours per week listening to the radio. However, radio was less popular than television for all age groups, with those age 65 and over spending about a half as much time listening to the radio as they did watching television in 1996. In addition, the amount of time spent listening to the radio was less in 1996 than in 1993 for all age groups (Office for National Statistics, 1998).

Watching television is currently the most popular home-based activity for all age groups, from age 16 and over. The UK data for 1996-97 showed that, in the four weeks proceeding interview, 98 per cent of people aged 65 and over participated in watching television, followed by 92 per cent taking part in visiting / entertaining and 79 per cent listening to the radio (Office for National Statistics, 1998).

It appears, then, that television may be a good medium for providing information to elderly people. However, both television and radio have the disadvantage that they cannot convey detailed information (Tinker et al., 1993). In addition, like the radio, the television can be on as 'background noise', but not attended to.

8.6 Leaflets

Leaflets are a cheap means of providing detailed information and can be kept for future reference. The disadvantages of leaflets (or any printed information) are:

· the information may rapidly become out-of-date;

· old editions are hard to eliminate or replace;

· often, the places where leaflets are available do not offer follow-up information;

· the information is frequently inaccessible due to the way it is written, with small print sizes and language that is hard to understand;

(see Tinker et al., 1993, for a review).

One of the main problems with printed information is that it can be written in such a way that it is difficult to read and understand. In the RICA survey leaflets were considered by interviewees to be a good medium for communicating information less often than television, but more often than radio. Leaflets were felt to be good because people could study them at their own pace and bad because "nobody reads them" and they are "too difficult" (Epstein, 1980). In addition, a sample of 11 leaflets evaluated by a panel of experts in graphics, textbook design and typography, was severely criticised for presentation.

Epstein's (1980) findings also suggested that elderly people in general ignored leaflets (see Section 6.1, Part 2). She made the point that the leaflet distribution system is sometimes more of a leaflet retention system. Both Epstein (1980) and Tinker et al. (1993) stressed that not only is the wording and design of written information important but it needs to be targeted and timed appropriately: leaflets provided where and when they are needed have a better chance of impact.

In Troup's (1985) questionnaire survey only just over 1 per cent of respondents said that they got most information via leaflets.

When Roberts et al. (1991) asked a group of elderly people what they felt to be the best way of informing elderly people about services, printed information was very unpopular. The reasons were that this source of information was seen as difficult to understand, was not seen as applicable to the individual's circumstances, led people to believe they were entitled to something when they were not, and usually required further discussion with informed people (see Tinker et al., 1993).

8.7 Books, newspapers and magazines

The study of the library and information needs of elderly people in community day centres ("Do books still matter?", Simes, 1980) showed that reading is one of the few activities that does not decline with age. This study was a limited one, based on interviewing elderly people in three Day Centres. Nevertheless, it highlighted the difficulties many elderly people have in using information services, in this case the public library, because of mobility problems or because the library was inaccessible (Todd, 1984).

Data from the Office for National Statistics on the library book borrowing habits of people in the UK in 1995, showed that females were more likely than males to hold a library ticket. Of those people with a ticket, women between age 65 and 74 and men between age 55 and 64 were the most likely to borrow books. Forty eight per cent of women in the 65-74 age group and 33 per cent of men in the 55-64 age group borrowed books at least monthly. For men and women older than this, book borrowing showed a decline (Office for National Statistics, 1997).

Troup (1985) admitted that her finding that 65 per cent of Scottish people age 50 and over claimed to read a book at least once a day seemed a large percentage. She speculated that respondents may have been including magazines with books, as these were not offered as an separate option in the question. Only 2 per cent of questionnaire respondents said that they got most information via books and magazines. However, 30 per cent thought that they got most information via newspapers, second only to television.

The National Readership Survey for July 1997 to June 1998 found that 60 per cent of people aged 65 and over claimed to have read at least one daily newspaper, compared to 56 per cent of all adults aged 15 and over (Office for National Statistics, 1999). The effectiveness of newspapers in providing information to elderly people and their carers probably depends on the particular newspaper used. A DHSS carer campaign was much more effective at reaching carers through one particular Sunday newspaper than through others (Epstein, 1980). For the period July 1997-June 1998, the most popular daily newspapers with elderly people were The Sun and The Mirror, with 15 per cent of people aged 65 and over reading each of these newspapers (Office for National Statistics, 1999).

Books, as with other printed information, can provide detailed information but have associated problems with access and keeping up-to-date. A newspaper can provide more up-to-date information, but in less detail than a book and is restricted to a particular readership.

8.8 Telephone

Telephone help lines are a fairly recent development in the provision of public information and the telephone is a convenient, quick and confidential means of getting advice (Tinker et al., 1993). However, Hildrew (1990) noted that complicated advice is not easy to give by telephone and telephone help lines need to refer callers to face-to-face advice provision (cited in Tinker et al., 1993). Nevertheless, in such situations, telephone help lines can provide an easy means of making first contact with sources of information, advice and help (Tinker et al., 1993).

Telephone use by the elderly seems to be changing. In 1980, 38 per cent of the elderly people in the RICA study (Epstein, 1980) said that they would not use a telephone enquiry service, mainly because they did not have easy access to a telephone. The elderly people in Kocher's (1989) study considered the telephone to be by far the easiest way to obtain information, with 40 per cent saying they would like to use it. In this case, 90 per cent of the elderly respondents owned a phone, and 98 per cent could access one and call for information. In addition, Kocher's findings suggested that elderly people would be willing to tackle their own information searches if they had the names, address and phone numbers of whom to contact (see Tinker et al., 1993). In the Age Concern study a review of research on information sources and channels led Tinker et al. (1993) to conclude that elderly people had positive attitudes towards use of the telephone. In interviews with elderly people, Tinker et al. (1993) found that over 80 per cent of the interviewees had a telephone and 68 per cent were willing to use a telephone information service if it were available.

8.9 Personal contact

The interviewees in the Age Concern Study (Tinker et al., 1993) were asked "when you want information now, do you use the telephone or do you tend to talk to people face-to-face?". The majority of those who had access to information through attendance at an Age Concern group said that they would talk to people face-to-face. People who did not attend a centre showed an equal tendency to use the telephone and talk to people face-to-face. Thus, while their findings suggested that elderly people are becoming more willing to use the telephone to get information, they prefer face-to-face contact if they have access to it.

In a series of 4 group meetings with people over the age of 50 in Scotland, Troup (1985) found that personal contact was considered by many of the participants to be a particularly good way of getting information, particularly for isolated and housebound people.

Around half of the interviewees in the RICA study (Epstein, 1980) liked the idea of regular personal visits from someone to find out if they needed anything, but many said they only wanted this service if the person were invited to come. A special post office enquiry counter was rejected by 42 per cent, mainly because of lack of privacy, inability to get to get there, or because they just didn't need it.

8.10 Computers and the Internet

The most recent development of the information age is the Internet, giving millions of people access to up-to-date information on a global basis. There is a very large number of web sites devoted to information and advice for elderly and disabled people, including education and leisure, useful products, housing design, home modification, sources of advice, agencies and services, self help and support groups. The major UK organisations concerned with elderly people and carers (e.g., example Age Concern, Help the Aged, Counsel and Care, Saga, Anchor Trust, Carers National Association) have web sites, as do many organisations that inform disabled people.

The U.S. is widely considered to lead the way in Internet use. Enough American households own a home computer (42%) and are connected to the Internet (26%) to enable comparison between different demographic groups to be made (NTIA 1999). The December 1998 population survey of 48,000 households by the U.S. Department of Commerce Census Bureau included questions added by the National Telecommunications and Information Administration (NTIA) concerning use of telephones, computers and the Internet. The data show that more American households are connected to the nation's information infrastructure than ever before. Households headed by the oldest group (age 55 and over) are the "most connected' in terms of owning a telephone, but fall behind all other age groups with respect to computer (PC) ownership and Internet access. Twenty six per cent of households in the 55+ age group own a computer and 15 per cent have Internet access, compared to 55 per cent and 34 per cent, respectively, of households in the middle-age group (age 35-54) (NTIA, 1999).

A closer examination of Internet use by individuals, as opposed to households, shows the same pattern: people aged 55+ have the lowest level of Internet use at home and elsewhere (see Figure 4).

(NTIA, 1999)

Evidence suggests that older computer owners represent a select segment of older people. A 1995 survey conducted by SeniorNet (a national network of computer using "seniors" in the U.S.) employed telephone interviews with a random sample of just over 600 older adults. The survey found that 53 per cent of college graduates aged 55 to 75 owned a computer, compared to 30 per cent of all people in this age group (Adler, 1996).

Thus, it appears that a large segment of the older generation does not have access to important sources of information, advice, communication and help.

There is little systematic evidence to support the claim that older people are more resistant to learning to use computer technology than younger people or that they experience insurmountable problems when using new technology in general (Morrell & Echt, 1997). Several studies, reviewed by Morrell & Echt (1997), have found that that computers have been introduced successfully to elderly people in a number of environments, including adult day care centres (Fisher, 1986; Zemke, 1986), senior residential and community facilities, as well as into the private homes of older people (Czaja et al., 1993). Researchers have demonstrated many uses and benefits of computers in the everyday lives of elderly people. For example, electronic communication (bulletin board) systems, such as that provided by SeniorNet, giving access to other users of the system as well as to information and services may provide a means of social interaction and mental stimulation (Czaja et al., 1993). Such systems can also minimise isolation and loneliness for elderly people with restricted mobility (Furlong, 1989). It has been observed that computer training and use can result in increased social interaction and increased feelings of accomplishment, self-confidence, autonomy, competency and self-esteem in elderly users (see Morrell & Echt, 1997).

So why do older adults use computers and the Internet less than younger adults? In the December 1998 U.S. population survey, computer owning households in the 55+ age group gave "don't want it" as the most common reason for not having internet access (36% of households), followed by "cost, too expensive" (12%) and "can use elsewhere" (5%) (NTIA, 1999). This, however, does not explain why older computer users did not want Internet access, and the reasons were not investigated further.

It could be that the requirements of this section of society have not yet been taken into consideration in the design of information technology (IT). In addition, hardware and software marketing have focused on leisure and educational activities of younger people and on business applications (Morrell and Echt, 1997). These authors argued that instructional materials for computer use are not "elderly friendly". It could also be simply due to lack of opportunity to learn – traditionally computer training and instructional materials have been geared towards the younger learner (Morrell and Echt, 1997).

In a letter to The Times newspaper (cited in Age Resource, 1998-99), the director of Age Concern pointed out that, given the opportunity, older people are just as eager and capable of learning about new technology as their children and grandchildren. She stated that all older people, irrespective of age or circumstances, should be given the chance to learn about IT. This prompted a great number of responses from older people complaining of the lack of suitable IT programmes. Many responses were from people living in residential or sheltered accommodation who wanted to learn about IT but felt that they were not given the opportunity (Age Resource, 1998-99). Age Resource, a branch of Age Concern England, believe that the solution is to train active elderly volunteers in the use of computers and the Internet. These volunteers could then take their skills out into the community and share them with more frail, isolated elderly people, living in residential accommodation or using Day Care Centres (Age Resource, 1998-99).

Older people risk being left behind in a rapidly changing world of web sites and electronic mail (Age Resource, 1998-99). However, things are changing. There are various projects underway that aim to break down the barriers that exclude older people from the information society and to use information technology as a means for improving older peoples' quality of life. Various Internet training programmes, targeting the older population, are now starting up in the UK (e.g. the "Hairnet" course and Age Resource's "Internet Taster Sessions", both for the over 50s).

Changes in computer and Internet use can be seen among elderly Americans. Among all American households the trend over recent years has been rapid growth in the numbers owning a computer and accessing the Internet. For households in the 55+ age group, just over 2 per cent owned a computer in 1984, compared to 26 per cent in 1998 (NTIA, 1999). More significantly, this oldest group is catching up with younger groups, showing the greatest increase in PC ownership and Internet use. In 1984 the 35-44 age group owned six times more PCs than the 55+ group; this ratio dropped to double in 1998 (NTIA, 1999). Internet use is measured in terms of modem possession and e-mail use. Between 1989 and 1997 the 55+ age group showed an elevenfold increase in modem ownership, compared to sevenfold for all age groups. For the shorter, more recent period 1994 to 1998, e-mail use grew by at least 4.5 times for all age groups. Again, the oldest age group showed the most rapid growth rate, with a sevenfold increase in Internet use for the same period (see Figure 5).

Despite this rapid growth, the Internet is still underused by the oldest age group, compared to all younger groups. The middle-aged group (aged 35-54) currently leads all others in modem possession, at 35 per cent, whereas 13 per cent of households in the 55+ age group possess modems. Nine per cent of the 55+ age group have e-mail, compared to 24 per cent of those aged 25-54 (NTIA, 1999).

(NTIA, 1999)

Thus, the U.S. experience shows us that elderly people currently use the Internet far less than younger age groups, but they demonstrate the greatest growth in use over recent years.

8.11 Cautions

What people say they would do in a particular situation and what they actually do is not the same. Epstein (1980) found a difference between the sources of information people said they would use if they needed it and the sources they actually used. For example, for the elderly people who did not have a financial problem, two thirds said that they would go to the Department of Health and Social Security (DHSS, now the DSS) if they did have a problem. However, only 10 per cent of those who did have a financial problem actually went to the DHSS.

Some researchers have concluded that no one medium is totally effective and promote the use of multiple media for the provision of information to elderly people (Epstein, 1987; Tinker et al., 1993; Troup, 1985). Mullings (1989), cited in Tinker et al. (1993), suggested that duplication of information in different forms can provide a backup that can particularly benefit those at risk of being poorly informed, such as those with restricted opportunities to obtain and use information.

8.12 Summary and conclusions

· Formal information providers have an important part to play.

· Elderly people prefer to get information from informal sources, such as family and friends. However, these sources can prove unsatisfactory for providing particular types of complex information.

· Social and Health Services staff in regular contact with elderly people, and social clubs for elderly people, are not fulfilling their potential as important providers of information.

· Elderly people are willing to use the telephone to get information but prefer face-to-face contact if possible.

· Of the media, television is the most popular and considered the most useful for providing information. However, television is not suitable for communicating detailed information.

· Printed information can convey detailed information and be kept for future reference, but becomes rapidly out-of-date and is ignored by elderly people in general. It can be inaccessible in terms of the way it is written and actually getting to where it is available.

· The Internet is, as yet, underused by elderly people. This may be changing with the emergence of transgenerational design of information technology and instructional material and greater opportunity to learn to use new technology.

· No one medium is completely effective for communicating information to elderly people.