Social, cultural and historical context
Magda is 88, originally from Poland. She moved to the UK 62 years ago following World War 2. Her childhood was spent on the family farm in Poland but at the age of 14 the Russians invaded and she was taken to a labour camp in Siberia with her family (Monastirok) where she spent several months (June 1940-December 1941); her sister died in this camp of pneumonia. Many families and ex-servicemen were sent to this labour camp during this time. She joined the Polish army at 16 and spent the war driving supplies to the troops in Poland and Italy. These early years of her life history are a major part of her identity. She married a Polish army officer; they had 6 children and 11 grandchildren, 4 great-grandchildren. In the UK, she worked as an interpreter until she was 79. She has been widowed for 23 years and now lives with one daughter, Wera, in the family home, a large terraced house where they have been for over 50 years. In 1956 she and her husband founded a Polish school near to where they lived. She is Roman Catholic.
Participant's experience of ageing and ill health
Magda has visual impairment due to macular degeneration in both eyes (one is particularly poor, and she relies on the other). Until recently she has had regular injections into the back of the eye for this, but these have stopped as they were not working. She also has arthritis and is on warfarin to thin her blood following a heart attack; this necessitates blood tests every couple of weeks at the clinic. She had to remember to take less warfarin when she was due for an injection in her eye. She has had low back pain since a fall three years ago when she slipped on the ice.
Magda was attacked at home a few years ago. She was robbed, beaten up and tied up. The attack left her with broken and dislocated arms. She now has pain and restricted movement in both arms and shoulders, as well as pain in her right (dominant) wrist. This was not helped by the fact that, because of a mix-up in arranging hospital follow-up, her arms were in plaster for too long and became wasted and stiffened as a result. She also experiences a cold sensation in one wrist (she has to place it under her arm pit when it's cold).
The attack also affected her memory. Whilst she is fluent in English (her second language) and remembers her own address and mobile number with no problem, she finds it hard to recall new things, but can reminisce about the war years.
Magda takes a large number of medications, which are supplied in a dosette box.
People in this participant's life
Magda lives with her daughter Wera, who works shifts in a local care home. Her five other children live in the UK and abroad. They visit regularly, though her main source of company and support is her live-in daughter. Her other contacts are various longstanding Polish friends with links to the army regiment in which her late husband served.
Dosette boxes for Magda's medication
What matters to this participant?
Home and family matter to Magda. She brought up her six children in this house. On one of the research visits, various children and grandchildren were staying for the holidays. Magda still enjoys cooking, and prepares traditional Polish meals; her daughter has to help with heavy pots and pans but otherwise Magda is independent in the kitchen. There is a formal front room, which is rich with war memorabilia, and a back living room with comfortable chairs and a TV.
The house also has a conservatory, containing numerous plants; it takes Magda a long time to water these because of her painful arms. Magda still grows plants and fruit in her garden, of which she is proud. She takes the researcher into the garden to pick plums. Magda used to keep bees in her back garden to make honey. It was her hobby ("Other people would go on holiday and I would stay with the bees"). She stopped keeping the bees five years ago (she had been doing it for 30 years), but her son continues to keep bees.
Memories of her life in the army matter enormously to Magda. She has an extensive collection of photographs and press cuttings dating as far back as 1937. She is an active member of the British Legion and its Polish equivalent, Italy Star, and still goes on trips to army reunions and memorial ceremonies in Poland and Italy. She donated her husband's war medals to a museum in New York. In the later years of her life she has written many articles for newspapers, magazines and books about her war experiences, and has been interviewed for a BBC history programme about her experiences ("it's important to tell people about the past").
Technologies in participant's home and life
Magda has a telecare unit and pendant alarm; she wears the pendant when Wera is out but otherwise she hangs it up in the kitchen. They have a landline telephone and a TV in the back living room. She uses the main landline phone to talk with her family, friends and other organisation members. Magda keeps a mobile phone in her handbag for when she goes out. Rarely does she use this, only when she needs to call her daughter to get something if she is in a shop.
Magda has a computer in her bedroom, which she uses to write articles, keep up to date with the news, and stay in touch with friends and relatives by email.
Computer and printer in Magda's bedroom
Materiality and capability
Despite her poor vision, Magda still reads and uses the computer if she wears her glasses. The computer is quite useful as she can enlarge the text on the screen to help her read, and can type, rather than holding a pen (which is now difficult). The glare from the screen can sometimes be too strong, so she wears sunglasses whilst working. She uses a magnifying glass with smaller text, such as newspapers. She can see large font (size 14), but cannot read the small print on letters, such as bank and hospital letters. He daughter is available at home to help read letters and emails on the computer. She is worried about how her sight might deteriorate, and lose her ability to use the computer. This is her main activity and means of staying connected with the organisations that are important to her.
She also relies on sense of touch to compensate for her poor vision, but this has become a problem since the attack as she cannot use her hands as much, and she has lost some sense of touch in her right hand. She says she can move her arm but not very well. It's painful to move or lift things. She said that when they took the plaster off, they could not put the elbow in the right place. She has some difficulty picking up and arranging the tablets in the dosette box due to pins and needles in her fingers. The memory loss since the attack is also troublesome.
"My letters are very bad, my signature goes up and down. If someone is giving me his phone number, I don't know what I write and can't read it. And my feeling with fingers, money, I feel because I can't see. Bigger one I know, it is 50p, £1, and that's now very difficult. Anything what I do, often dropping things because I have pins and needles in my fingers...I have no strength at all in that arm. Mostly it's my hands that he [the attacker] ruined me."
Her daughter accompanies her to go shopping, and does the packing and carrying the bags ("Once I got a bottle of milk and bread, but couldn't carry - so painful" ).
She can carry small things, and can still dress and bathe herself, only occasionally asking her daughter for help. But all activities are slow and can only be done for a short time. She can still do a bit of gardening, but only for brief periods. She uses her left arm to hold her right arm and lift it up while holding the watering can. Also, she can only concentrate on one thing at a time:
"I used to move very fast, but now have to do things slow. And I could do many things. I could speak and hear what was saying, and watch television and do many things. But now I have to watch television or talk."
Magda has to be organised because of all her hospital appointments. She puts all her appointments on a large calendar that hangs in the living room. She also has to be organised for booking the dial-a-ride minicab service. It has to be booked 2-3 days before - not a day before, otherwise you have to pay. Once she was late booking the taxi and had to pay £3 each way. She also uses the blue badge parking scheme and congestion charge relief. She is very grateful for the various transport schemes available.
Real incidents of using (or choosing not to use) an ALT
Magda activated her alarm once when an intruder broke in and demanded money. He was pushing, holding and shouting at her - she pressed her pendant alarm, which was hanging round her neck. This made him angry. He pulled the pendant off her. He pulled her arms around her back, dislocating her left arm, and tied her hands behind her back. He started punching her in the face and hurting her arm by stabbing the end of a USB key into her arm, demanding money. The pendant alarm didn't work. When she pressed it the call went through, but the person on the other end said "We can't locate you" - at which point the attacker pulled out the plug and used the wires to tie up her hands.
She told the intruder to take the money from the handbag - there was £40 in there - he took the money, mobile and threw the handbag over the garden fence. He pushed her over on her back. This was when she seriously damaged her arms, as she landed on them (tied up behind her). She recalls this being particularly painful, and thinks she must have passed out from the pain. She was grateful that he did not draw blood as she was on medication to thin the blood and so it would not clot, and was left on the floor for 3 hours before her daughter found her.
Later the police said the device was faulty. She thinks it's strange that all the times she had accidently pressed it and apologised to the operator, the one time she needed it, it didn't work.
Magda knows about the options for telehealth and discusses these with the researcher. She could use equipment to make various measurements of her health status, thereby avoiding making regular visits to the clinic. She does not think such an arrangement would be good for her, certainly not right now, because getting out of the house is something she needs to do, and the trips to the clinic give her that reason.
"I think I should move [around], I don't want to stay all the time in the doors. I go shopping with the trolley but I go because I must go. Everything is not that far you know. I think that [telehealth] again...If I couldn't move it would be [useful]...But I can walk with a walking stick."
Like many cases in this series, Magda illustrates the benefits of extensive family support in maintaining independence and a sense of purpose in old age. She has significant impairments from illness and injury, but her daughter is there to do things she cannot do, such as lifting heavy pans, carrying shopping home or reading small print. These small inputs effectively extend Magda's own physical and cognitive capabilities - supplementing her own failing arms, eyes and memory. Despite her deteriorating health and the slowness and feebleness that results from it, Magda is still busy 'doing things and making things' and has a strong sense of fulfilment.
Unusually for her age, Magda is highly computer literate. She has not had a university education but is clearly very intelligent and has used the computer for many years in her hobby of writing for publication. She is already skilled at using some 'accessibility functions' on the computer (enlarging the font), though she appears unable to modify the screen brightness to accommodate her sensitivity to the glare. With targeted support, she may be able to adapt her use of the computer (for example by gaining an audio feed for emails and web pages) if her vision deteriorates further.
The failure of the telecare alarm just at the time it was most needed is of great concern. The more symbolic safety risk - that the attacker was "made angry" by the presence of the alarm or by Magda's attempted use of it - is also of concern. Other participants in this study choose not to carry a mobile phone because they feel it makes them vulnerable to physical attack. The design challenge may be to produce a pendant alarm that will not be perceived as such by an attacker.
Finally, Magda illustrates the ambivalence shown by many older people about telehealth as a substitute for face to face visits to the GP. Magda wants to get out of the house; she feels it does her good to stay mobile and active, and a visit to the clinic is one way of doing this. In addition, the face to face contact with a health professional surely has great symbolic value to a woman who is feeling vulnerable and in pain after a terrifying physical attack. Whilst telecare can (potentially) collect data on her blood pressure, it cannot substitute for the role of the doctor or nurse as 'witness to suffering'. However, Magda herself acknowledges a time in the future when she will be unable to get out to the doctor, and there is potential for Skype or similar technology to bring health professionals to her for this kind of support.