Medical alert buttons seem to be a no-brainer. Push a button, and help comes; such simple technology can save a life when time is critical, but many families experience surprising resistance when trying to convince elderly parents/grandparents to wear an alert button.
It generally isn’t the technology that makes seniors balk; most seniors get how a button works. More often than not, the resistance runs much deeper, threatening fundamental questions of independence, dignity, and how human beings want to envision their own future selves as they age.
Recognizing these psychological barriers will help seniors make decisions that are in their best interests, rather than families checking the safety box for peace of mind.
The Paradox of Independence
For many seniors, agreeing to wear a medical alert button means they cannot care for themselves. It is a concrete symbol that their bodies are going to fail, and they are going to need help in situations that have previously been manageable.
When seen through the lens of lifetime experiences, this makes perfect sense. These are individuals who raised families, started businesses, navigated careers, solved problems on their own, and did lots of other things without difficulty. Wearing something that broadcasts “you might need help” strikes at their self-identity as people who can care for themselves.
The paradox here is that a help alert button for older adults can actually allow for independence for longer. Research has shown that the seniors who know they can get help at the push of a button feel more competent to live life and to continue to live independently. However, the entry point through this psychological barrier is understanding the seniors’ unique definition of independence. Some older adults emphasize the value of making all of their own decisions, and others emphasize their own physical self-sufficiency. A device that is considered appropriate for one person for independence of the first concern will potentially create negative feelings for those focused on self-sufficiency, regardless of whether or not it accomplishes both concerns.
The Stigma Factor
Emergency buttons start to exist as social artifacts housing a stigma, a purpose beyond the signal, and practical work. In the social consciousness map, they live in a certain cultural view as an indication of frailty/decline, reinforcing the stereotype of older persons as helpless/victims or burdens to their families or society.
Further to the stigmatizing factor that accompanies emergency buttons, communications are far worse by other advertising that situates emergency buttons within a fall, a medical emergency, or some miraculous rescue. Yes, these situations do happen, but the advertising only reinforces that feeling of victimization versus some form of empowerment.
As older adults adapt and engage with hitting the emergency button, they will begin the process of re-framing its meaning and conceptualizing the button as safety and not weakness. They come to understand eventually that hitting the button is like hitting an existing safety connective device like a chicken smoking detector fire or a common sense safety plan, so they can start to shift their framing from ‘I have this because I am vulnerable’ to ‘I am smart enough to have a plan’, which connects to it the personal stigmatization of wearing or having to use an emergency button, it is not without some embarrassment but it is much more than being a victim bad connection.
A social factor is operative as well. If older adults have peers who own buttons, they seem to easily take on thinking of wearing and using the buttons in general terms, rather than if they have to now think of an older adult using the button in a community or social group that is not on board with buttons, or there is a peer stigma associated with the button. In the latter case, they may decide not to use the button just to not be different than their peers.
Changing Older Adult Concerns Related to Control and Autonomy
A frequent concern on the cognitive checklist of many older adults is that they do not want to be the signal of a lack of control or autonomy of their lives by wearing or engaging the emergency button. They envision scenarios where family members or emergency responders react too strongly to false alarms, and their potential reactions, including interference or asking about their ability to live on their own.
These are not entirely unfounded issues. Sometimes, family members and friends are overly protective when there is an emergency system in place and interpret any activation as a signal that they should be providing increased monitoring of their loved one. This is precisely the loss of autonomy that many older adults are most afraid of.
Systems that allow for protocols that include a, do a nice job addressing these issues by solidly involving seniors in how to respond and how they want their family members informed of each type of emergency. When seniors feel they have control over the process, they are much more likely to adopt these systems.
The key is to make sure that emergency buttons enhance seniors’ decision-making rather than exercise it. Systems that call family members for every activation may feel invasive. Systems that give in setting (or have others set inspiration of seniors) options for response types feel more respectful of seniors’ autonomous decision-making process.
Previous Experiences Influence Current Beliefs
Seniors’ previous experience with medical emergencies, use of medical service technology, and their family dynamics are all relevant to their beliefs about using emergency alert systems. For example, someone who had a bad experience with an unreliable medical alert system from five years ago may participate in resisting newer, more beneficial options, while not realizing their medical alert systems have changed considerably over the years. Seniors who have seen their parents face the loss of independence may be particularly sensitive to anything that indicates declining ability. They remember how their ability declined from a small adaptation to a major lifestyle change and want to avoid that pathway.
Conversely, seniors who have seen friends or family adopt an emergency alert system are often quick to jump into the technology. Personal anecdotes and experiences are far more compelling than abstract data on safety or sales presentations.
The influence of timing and delivery
When and how emergency buttons are discussed matters greatly in acceptance. For example, after a health scare or a fall is often met with defensive responses, even if the health scare or fall demonstrated the “need” for a device.
Introducing the concept of an emergency button when the senior is calm and thinking through options they may be open to considering it, rather than being defensive, can give greater opportunity for acceptance. Framing the option as a means of continuing independence, rather than reducing risk of disaster, means the shift in thinking is from one of threat, to having opportunities.
The messenger is also an important factor. When a family member suggests an emergency button, it often contributes to dynamic issues between parents and adult children, which can prompt negative parent/child issues. In general, messaging or recommending from the family dynamic creates open possibilities when suggesting from a doctor, friend, or trusting source outside the family hierarchy.
Building acceptance over time
Seniors who eventually do adopt emergency buttons do so rarely in the time of a conversation. The psychological shift does occur, but it is typically a slow process that reverses any stigma relating to the device as they consider and evolve their concerns, and then think about how it might integrate into their lives, without redundancy as a person or values.
Successful adoption often occurs in small steps – to initiate testing, factors have to be reconsidered (e.g., trailing something for a time period, starting in one service (such as a simple alert), to allow for gauging what they might assume it or not be – personally, and socially).
Family members who deal with supporting seniors’ goals, and are not preoccupying with the risk or confronting their own worry tend to have more success in discussing options with the senior. When the conversation shifts to what goals the seniors themselves would like to achieve – including in their own homes over time (or that they are actively living their own lifestyle, or reducing family worry) – the emergency button becomes a potential tool to identify achievement, rather than a datum of limiting independence.
The psychology surrounding emergency buttons is layered within the universal and ongoing conversations regarding aging, independence and family relationships. Understanding these overt and covert issues ultimately allows everyone to be about problem-solving around actual issues of meaning and value, rather than reacting based on fears or assumptions regarding expectations of an aging senior’s safety.