Co-creation, older adults & Covid: six learnings

by Marije Blok| Reading Time: 3-4 Minutes

We would have loved so much to add it to our New Year’s resolutions: innovating together with older people – like in the good old days. But after almost a year with COVID, it doesn’t look like we can go back to normal yet. So… postponing again? That would be a shame! With a little flexibility and creativity, more is possible than you might think. Flexibility when it comes to the older adults; the methodology as well as the innovations itself. I am happy to share six learnings from the past year! 

The older adults

1.     Think close

Instead of recruiting participants, I engaged in a conversation with my own grandmother about how she had experienced the process after my grandpa passed away – something that, as a granddaughter I was reluctant to do at first and as a researcher I was reluctant to burden her with. Not only did my grandma not mind at all, it also resulted in a nice personal conversation.

You often don’t need to search far for good stories. The threshold for diving into the depths with close others is sometimes higher than with strangers, but it is worth it and saves a lot of (travel) time.

2.    Join what already exists

It was not easy: recruiting individual older adults for a focus group. Moreover, participants had to meet several conditions and had to be willing to come to our office in these insecure times. The solution? We looked to join an existing bereavement group.

Joining an existing group has many advantages. The group is already complete; people know and trust each other; location is already arranged; meetings are already in the agenda of participants and the (COVID) rules of the external organization can be followed, which makes everything a lot easier.

3.    Nothing new under the sun

Older people remain older people. For example, one lady showed up an hour early in an online group session while my colleague and I were still making preparations. Still, older people like to arrive on time. Another lady called me the day before her participation in an online test because she was in need for some social talk. Even, or perhaps especially, in COVID times, social contact is often an important motivation to participate in research.

Much has changed. Yet much has also remained the same. Do not expect older people to suddenly behave completely differently online. So, don’t do that yourself either. 

The methodology

4.    Don’t wait

A planned focus group was replaced by individual phone interviews in order to get to know our target group. Crying, a lady who had recently lost her husband, answered the phone. The anonymity of the phone made her feel safe in her vulnerability. We would never have achieved this extra layer of depth in a focus group session.

Of course, it is a pity if you cannot carry out the activities as planned. But what a pity even more to wait without doing anything? You can learn so much in the meantime!

5.    Learning by (just) doing

‘Are older people able to do that, online research?’ Why not just try? My test-user had a tablet, but meeting me through TEAMS, sharing the screen, opening the app with camera and microphone, was too much to ask for. Both for her and for the tablet. But she was clever – and so were we. With the camera on and the lady in front of the mirror, we could still look at her screen. And by calling her by phone, we could even hear each other.

Trying something new requires creativity and perseverance. But it is very rewarding! Not just feedback on a new idea, but also insight into the research method itself: win-win.

The innovation

6.    A flexible service design

We tested a toolkit to support older people in sharing stories. The pilot, which resembled the real service as much as possible, consisted of some online activities and two physical sessions. Just before the second session, the COVID measures were tightened. The pilot was put on hold.

If this crisis has taught us anything, it is the importance of (user-friendly) digital solutions for older adults.  So if the implementation of our innovations needs to be postponed because of social restrictions,  are these then actually ready for the new normal? The new normal requires innovations with a flexible service design in which a group activity can easily be exchanged with one-on-one sessions, online or telephone activity; in which family members or caregivers play a role, if we have difficulty meeting the elderly; or by having the intervention fit in with activities that continue even with limitations, such as therapy or a care trajectory.


I am convinced that we will only come up with more sustainable solutions if we continue to involve older people in our research in creative ways. I am curious about your most important lesson from the past year!


Marije Blok (MSc) is an (external) PhD candidate studying ageing and technology at the Sociology department (VU). She works as a researcher at Leyden Academy for Vitality and Ageing, studying the use of narratives to optimize the quality of residence care for older adults. Here she will share the experiences on her journey through science and society.

What we can learn from older adults in this crisis

by Marije Blok| Reading Time: 5 Minutes

What we can learn from older adults in this crisis

Whereas in February we were still joking about the situation in China – only one month later we found ourselves in the midst of a global crisis. Fierce restrictions and containment made our world smaller overnight, forcing us to make the best of our daily life in a different way than we were used to. We needed coping strategies to deal with all of that, but no one seemed to have any previous experience we could take lessons from.

No one? No. There ís a group we can learn from in this extraordinary time: the older adults. This population, in this crisis often considered a vulnerable group, can be seen as a source of inspiration, as older adults already have experience in dealing with limitations in life.

I’m referring here to what is known as the paradox of ageing. Although older people are often confronted with physical, mental, and cognitive challenges, they score surprisingly high on quality of life. Theories in the field of social and emotional ageing describe the coping strategies older people follow to ensure these levels of quality of life, despite decline (Charles & Carstensen, 2009). Coping strategies we all can benefit from in this exceptional era.

Forced to choose 
In the crisis, we suddenly had to choose and select. We were asked to only travel with public transport if strictly necessary, and only to meet-up with a limited number of friends. Striking – and somewhat confusing –  was the RIVM’s call to limit social contacts to only one sex buddy; a message that was already revised shortly.

Whereas most of us were overtaken by these restrictions, the older ones among us were already familiar with limitations before the crisis, as both their energy level and time left are limited. The socio-emotional selectivity theory (Carstensen et al, 1999) explains that older adults are particularly good in choosing and selecting. They focus on most valuable relations – family members, close friends – and activities in life. And guess what? It turns out to be a successful strategy to maintain wellbeing.

Early in the crisis, my grandfather passed away. We had no other choice than only invite the closest relatives to his funeral. After the disappointment, we embraced this extraordinary setting. It was more intimate than we could ever have achieved in a packed church service. I learned to appreciate the restriction, as it helped us to focus on most important things and persons in life.

Alternative strategies
For almost everything that had been totally normal in daily life, we suddenly needed alternative strategies. Skype meetings, walking routes, queue management, disinfection routines. Whereas some of us dealt very well with it, others had more difficulties in getting used to new strategies such as working from home.

New strategies for older adults? Been there done that! The theory of Selection Optimization & Compensation (Baltes & Baltes, 1990) explains how older adults, more than younger ones, are good in finding alternatives. When getting older, they continuously have to deal with physical and cognitive decline and restrictions. Although the COVID restrictions are of a different kind, older adults seem to know how to handle this. Selection refers to selecting the relevant goals that, realistically, can be achieved in the particular circumstances. Optimization is defined as optimizing the own capabilities to achieve these goals. Compensation includes the alternative strategies where objectives cannot be achieved in the usual way.

Being able to develop compensation strategies can be very beneficial these days. Personally, I needed the crisis to say goodbye to my gym. I’ve become a happy runner over the previous months, but I’m pretty sure that wouldn’t have happened without the gym closing its doors. My grandmother, instead, easily switched to the church service on her Smart TV, because at her age she didn’t always visit the service live anyway.

Everything under control
Control, what’s that? Over the previous months, we have lived our lives week by week. We started counting down towards April 7, soon that became 1 Juno. At first only the terraces would open, then the restaurants and bars followed. Will my appointment at the hairdresser take place? My vacation? Most of us found it hard to accept this uncertainty.

According to the lifespan theory of control (Heckhausen & Schulz, 1995) older adults are better in accepting things they cannot influence or change. Due to cognitive and physical decline, they are more used to this. My team at the National Foundation for the Elderly has worked hard setting-up a corona panel, consisting of 500 older adults whom we asked for their opinion on crisis related issues. Remarkable was that the eldest group, aged 75+, turned out to feel less mentally effected than the younger group, who indicated to feel more lonely than before. We may explain this by the fact that older adults already before the crisis learned to accept things they cannot change. Facing age-related decline, they got used to adapting their expectations in daily life.  

Take-away’s
Many of us have successfully developed new habits during this crisis. Others are still doubting and considering whether and how they want to go back to their – stressful- pre-COVID lifestyle. Older adults learn us that Fear Of Missing Out won’t make us happy but focussing on most important things in life will do so instead. So, the next time you don’t know how to handle a crisis? Ask some older people (stay safe at six feet :)) to share their experiences. Because most of all we need to do this together.

References

  • Baltes PB & Baltes MM. (1990). Selective optimization with compensation. In: Successful Aging: Perspectives from the Behavioral Sciences. New York: Cambridge University Press.
  • Carstensen LL., Isaacowitz D. & Charles ST (1999). Taking time seriously: a theory of socioemotional selectivity. American Psychology Journal, 1999 54(3), 165–81.
  • Charles, ST & Carstensen LL. (2009). Social and Emotional Aging. Annu. Rev. Psychol. 2009. 61:383–409
  • Heckhausen J & Schulz R (1995). A Life-Span Theory of Control. Psychological Review 1995, 2(2), 283-304.

Marije Blok (MSc) is an (external) PhD candidate studying ageing and technology at the Sociology department (VU) and a project manager in the Innovation department at the National Foundation for the Elderly (Nationaal Ouderenfonds). Here she will share the experiences on her journey through science and society.

Wearing two hats?

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Serving seniors or serving science: a dilemma game

MarijeBlokBubble1 by Marije Blok | Reading Time: 3-4 Minutes /

Serving seniors or serving science?
Loneliness is a serious problem among older people. My organization, the National Foundation for the Elderly, aims to tackle this challenge through different activities. My team works on innovations to support ageing in a meaningful way. We investigate wishes of older people in interviews; explore their ideas in co-design sessions and test prototypes. I love my job! And it only got better when I succeeded in creating a PhD position to enrich it: now I would even be better able to serve the elderly! However, soon I discovered that serving science is not always the same as serving seniors and I started to face ethical challenges.

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Dilemmas of a double role
All researchers face ethical challenges. Lucky us: there are guides to help us out. The Netherlands Code of Conduct for Research Integrity – the integrity Bible for (Dutch) researchers – provides methodological and ethical standards. It introduces a set of ‘virtues’ for good scholars, including honesty, scrupulousness, transparency, independence, and responsibility.

As a researcher working for an employer outside the university, I’m also supposed to take principals of my organization into account, including making a difference, being involved, flexible, connecting and distinct. However, both sets of principals sometimes conflict. I often feel like I’m wearing two hats, as values of my organization and science are not always aligned.

The Erasmus University developed the Dilemma Game, supporting researchers in practicing with hypothetical dilemmas. Inspired by playing this game in a course at the faculty, I reflect in this blog post in a playful way on dilemmas I faced in my work. Next to exploring what to do when interests of seniors and science seem to clash, I hope to motivate fellows operating both in science and society to reflect on their work as well. All blocks contain a dilemma (left) and the considerations I made (right).

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Representing a wellbeing organization, I felt responsible to make participating a pleasant experience for the older people (B). However, I also found the value of scrupulousness important and didn’t want to be flexible at the cost of this scientific value (A).  I choose A, as including new persons would anyway affect the reliability of the results (A+C). Unfortunately, this was not a happy-ending story. The collaboration was disturbed and another participant left because her friend wasn’t welcome.

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This dilemma forced me to choose between being flexible and connecting (A) – according to my organization’s values – or scrupulous and independent (B) – following scientific principles. C was a successful mix: beneficial for my organization without ignoring scientific standards.

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As an elderly organization, we joined this project to make a difference in older people’s lives and considered this approach (B) suitable for this. Our partners considered replacing participants at the cost of scrupulousness and not in line with ethical standards (A). We considered B, but first discussed this with the partners once again. This worked out surprisingly well, so we ended with C.

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Considering what would be most honest from a scientific point of view (A, B) I decided to be transparent in reporting, but to not use their input (A). Instead of interviewing her husband I spent additional time having coffee with the lady, as I felt responsible after her sharing her story (C). This mix was a good strategy and in line with both my organization and research

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A beautiful hat
I am not a talker at all, but I feel you really listen to me and that makes me share my story’ – an 85-year old lady when I finalize my interview. For a moment I feel guilty, as my primary interest was a valuable dataset. But then I realize that a valuable encounter can be valuable for my research at the same time. Reflecting on my dilemmas taught me that although my organization’s values are not always similar to those in science, decisions aren’t necessarily black or white. Am I wearing two hats, in my position? No, I’m not. I’m wearing a very special one and will do this with pride!


Marije Blok (MSc) is an (external) PhD candidate studying ageing and technology at the Sociology department (VU) and a project manager in the Innovation department at the National Foundation for the Elderly (Nationaal Ouderenfonds). Here she will share the experiences on her journey through science and society.