Developing a Framework for Digital Activities of Daily Living

Abstract

The emergence of digital technologies has shown a promising potential to enhance access to goods, services, and resources. Digital technologies and interfaces differ from mechanical and analog electronic technologies as they often require internet access and are dependent on a set of activities or actions for the user to successfully implement them in their day-to-day life. We describe this set of activities as digital activities of daily living (DADLs). Much like activities of daily living, instrumental activities of daily living, and enhanced activities of living, DADLs are critical to supporting well-being and healthy aging. For example, the digitalization of tasks such as health insurance (e.g., creating a Medicare account) or banking (e.g., making a utility payment via a web portal) are all DADLs. With a growing dependence on digital technologies to participate in day-to-day life, disparities in individuals’ ability to competently complete DADLs present major concerns for independence, quality of life, safety, and well-being. We developed a framework for understanding DADLs and their implication for daily life. Furthermore, we provide a guide for the development of interventions and outline implications for research, practice, and policy.

Supporting well-being and quality of life across the aging process is a critical societal aim. Rapidly shifting demographics are raising concerns for many communities, as they often lack the resources to meet the changing needs. In recent decades, technology innovations have shown potential in bridging the resource gap and meeting the needs of a growing older adult population with activities of daily living (ADLs; Camp et al., 2021). However, the role of technology in supporting daily life has expanded. For example, technology innovations such as cars and electric appliances play an integral role in how humans complete everyday activities and engage in everyday environments, such as one’s home and community. The evolution of technology tools, such as mechanical and analog electronic technologies, has enabled people to complete activities of daily life in a safer and more comfortable manner. Furthermore, the adaptation and implementation of technologies in both the home and the community has helped progress the ability to age in place and improve an individual’s overall well-being (Tural et al., 2021).

These improvements have been further enriched through the emergence and the rapid evolution of digital technology. Digital technology is defined as any tool, system, or device that can generate, process, and store data (Tulinayo et al., 2018). Digital technologies represent a diverse set of hardware (e.g., smartphones, tablets, computers, wearable devices, virtual reality, and sensors) and software (e.g., computer programs, online platforms, applications, artificial intelligence, virtual environments) that provide the ability to control and manage daily life activities (e.g., health management, banking, social connections, and vital resources; Rice, 2003). Humans can leverage digital technologies to improve resource access, enhance quality of life, and bridge resource gaps. For example, innovations in digital health technologies are reshaping how individuals receive medical services, preventative care, and access medical resources from their home (Kim et al., 2017).

The adoption and use of digital technologies often require that the individual be able to complete activities that are necessary to achieve their intended application. For example, using a smartphone to video-chat with family and friends requires the user to navigate through the device interface, download a video-chat application, create a user account, and use the application interface to make the call. These activities are prerequisite requirements for successfully using digital technologies, and in turn being able to use the devices to accomplish everyday activities, such as eating, managing medication and banking, and socializing, to name a few. These activities are an additional set of daily activities that differ from ADLs, instrumental activities of daily living (IADLs), and enhanced activities of living (EADLs), as they do not occur in the absence of digital technologies but are rather the result of our society’s continued digitalization. The scope of digital activities needs to be specified to determine individual levels of competency, digital literacy requirements, inform the provision of necessary support, and track their evolution across time. In this forum paper, we define digital activities of daily living (DADLs) for the first time. Additionally, we provide a conceptual framework for understanding these everyday activities and their implications on daily life that can guide future research.

Overview of Role and Implications of Digital Technology in Daily Life

Digital technologies have been closely studied with the aim of understanding how they may be harnessed to assist older adults throughout the aging process. This field of research, more broadly categorized as Gerontechnology, has driven forward the understanding of how technology can support a growing aging population (Huang & Oteng, 2023). Some of the technologies that have been the primary focus of this research include, but are not limited to, smart technologies (e.g., voice assistants, appliances, security systems, and home management systems), robotics (e.g., socially assistive robots, assistive robots, and social robots), videoconferencing (e.g., video-chat, smart displays, and telepresence robots), artificial intelligence, and extended reality (e.g., virtual reality and augmented reality).

Older adults are interested in adopting and using these technologies to support their needs and to assist them with activities of daily life. For example, findings from the PRISM(personalized reminder information and social management system) Randomized Controlled Trial showed that the implementation of a technology-based intervention that provided older adults with a desktop computer, internet access, and a set of applications improved perceived social support and well-being over 6 months of use (Czaja et al., 2018). Moreover, studies of socially assistive robots (e.g., PARO) have indicated the potential to support individuals with cognitive declines (Hung et al., 2019). Other studies have leveraged video conferencing and indicated a promising potential in increasing opportunities for social engagement and reduction in the experience of loneliness (Mois et al., 2022; Nguyen et al., 2019). However, although technology holds the potential to meet and address the needs of older adults, there are concerns regarding privacy, security, autonomy, cost, and resources required to support use (e.g., network accessibility; Andrews et al., 2019; Mace et al., 2022; Reyes et al., 2023; Schroeder et al., 2023). Furthermore, personal factors, such as cognitive ability, physical impairments, psychological stressors, and overall competency on how to control a device and navigate through menus are just a few elements affecting adoption of digital technologies. Environmental factors are a vital area of consideration when discussing the adoption and implementation of digital interfaces to support the needs of older adults (Rice, 2003). These can include internet coverage, financial support resources, technology training programs, and other community-level programs that aim to support successful implementation and the use of digital tools and resources by older adults.

Theoretical Underpinnings

The changes that are occurring in everyday activities of daily life can often be linked to the increased adoption of digital technologies and the rapid digitalization of the society we live in. These rapid changes can be interpreted through the application of the theory of technology determinism, in which technology serves as a force that is continually shaping the nature of society and how it exists (Hess, 2015). Technology determinism explains the extent to which everyday actions are influenced and affected by factors associated with technology. For our purposes, we apply a soft technology deterministic approach to explain how digital technologies are reshaping society, and the dynamic role they have on everyday activities (Lawson, 2006; Smith & Marx, 1994), such as activities of daily living, independent activities of daily living, and enhanced activities of daily living. Furthermore, we provide areas of consideration on the evolution of digital technologies and the dynamic nature of DADLs.

Activities of Daily Living

Activities of daily living are fundamental activities required for an individual to take care of oneself independently. These skills include feeding, bathing, continence, ambulation, and dressing (Katz et al., 1970). The inability to complete these activities can affect an individual’s well-being, quality of life, and the ability to age in place successfully (Rosenberg et al., 2019). Challenges in one’s ability to complete ADLs can decrease one’s sense of independence and require support from a caregiver. Assessments of ADLs are essential and critical in guiding the development of plans to support and meet the needs of the individual, and they aim to identify resources that may reduce the impact of the declines an individual may be experiencing.

Technology tools, such as electric wheelchairs, motorized spoons, and assistive robot arms (see Figure 1) are examples of digital technologies that can support individuals experiencing challenges in completing ADLs. The introduction of these technologies may not address all the challenges an individual may be experiencing, but they can mitigate the challenges, as well as support autonomy and independence. Such technologies often utilize complex interfaces to allow adaptability and customizability to meet the individual’s specific needs. For example, using a robotic arm to support with dressing may require the individual to first create a user account, setup a user profile, and then control the robot through a dashboard that may be unfamiliar or complicated.

Instrumental Activities of Daily Living

Instrumental activities of daily living are activities that support individuals’ ability to live independently in the community (Cahn-Weiner et al., 2002; Lawton & Brody, 1969). The major categories of IADLs include preparing meals, transportation, cleaning, managing medications, and personal finances. Unlike ADLs, IADLs are not required functional activities, but they play an important role in ensuring an individual’s quality of life (Hopkins et al., 2017). Challenges in one’s ability to complete IADLs indicate potential concerns pertaining to the individual’s ability to maintain independence. Measuring IADLs informs the level of support and assistance an individual may require to maintain independence. Inability to complete IADLs may result in changes to an individual’s living arrangement and may require implementation of support strategies.

Support strategies can include the use of digital technology to assist with the completion of an IADL (see Figure 1). Individuals may receive support from a caregiver or a digital management system that provides a reminder of when and how to take a medication. For example, when using a robotic smart pill dispenser to support medication adherence, an individual may need to download an application, create a user account, setup a user profile (e.g., entering medication regimen), connect the pill dispenser to a mobile device (e.g., smartphone), and make updates through the user interface whenever there are changes to their prescription. The use of technologies such as smart pill dispensers is just one of the ways in which technology can support individuals with IADLs and reduce caregiver burden, address gaps in access to caregiving resources, and maintain individual independence.

Enhanced Activities of Daily Living

Enhanced activities of daily living are advanced activities of everyday life that are not necessarily required to support independent living but play an important role in supporting a meaningful life (Rogers et al., 1998). EADLs are the activities that an individual participates in to support fulfillment, well-being, quality of life, happiness, and social engagement. EADLs include leisure activities, social activities, physical activities, intellectual pursuits, and cultural activities (Rogers et al., 2020). These categories reflect the diverse set of everyday activities a person may engage in to maintain a healthy and active lifestyle. Participation in these types of activities is essential in maintaining social relationships and community engagement (Rogers et al., 1998, 2020). Inability to complete EADLs may negatively affect health outcomes and quality of life.

Digital technologies, such as information and communication technologies, are often a requirement for being able to complete EADLs successfully (see Figure 1). For example, a person may use videoconferencing to connect with a group of friends who live across the country or use an online learning platform to learn more about a hobby (e.g., online photography workshops). Technological tools are powerful aids in helping to reduce costs and increase access to participation in EADLs, including persons living in communities that may have limited access to social resources (Hodge et al., 2017; Ma et al., 2023).

Bridging the Physical With the Digital

Emergence of DADLs

The ever-expansive societal digitalization has created a new category of activities that we have designated as DADLs. The term DADLs has only been mentioned passively in existing literature but never discussed or conceptualized (Fry et al., 2022; Valverde-Berrocoso et al., 2020). We define DADLs as tasks that are required to complete to access, use, and control digital platforms (e.g., mobile banking, online applications, patient portals) and digital technologies (e.g., smartphones, robots, motorized spoons). Unlike ADLs, IADLs, and EADLS, DADLs are not functional abilities required for daily life; they are a direct result of our society’s rapid adoption of digital tools to support everyday life. Digitalization makes such activities critical to one’s ability to maintain independence, quality of life, well-being, and support participation in everyday life. Digital technologies can have a critical role in assisting individuals to complete ADLs, IADLs, and EADLs (Benge et al., 2024; Mendoza-Holgado et al., 2024; Rogers et al., 2020). However, to leverage digital technologies, the individuals may be required to first complete a set of DADLs (e.g., setting up a user account, updating information, and reconnecting a Bluetooth mouse). For example, a person who is aging in place and is experiencing some difficulty in remembering when to take their medication may rely on digital technology to receive support with medication adherence. However, in addition to general usability challenges (e.g., adoption, perceived ease of use and usability, instructional materials; Albrecht et al., 2018; Reyes et al., 2023) and individual factors (e.g., vision, hearing; Haase et al., 2021; Remillard et al., 2023; Xu et al., 2023), the ability to complete the set of DADLs (e.g., access a wireless network, setup a user profile, adjust device and application settings to meet individual preferences) may determine if the individual is able to leverage digital technology to support their needs. The inability to complete such activities can hinder an individual’s functional ability and quality of life, and may have implications on individual safety, finances, security, independence, and overall access to goods and services.

Much in the same way an individual attempting to complete ADLs may receive assistance from a caregiver or a care partner, an individual who is unable to complete a DADL may require assistance from a digital caregiver or a digital support partner (Czaja, 2016; Piau et al., 2023; Quinn et al., 2019; Zheng et al., 2016). Our use of these terms is different from previous uses in the literature, which have utilized the terms such as digital caregiver and virtual caregiver to describe the application of digital technologies to provide support care for patients or assistance with health monitoring (Hallqvist, 2022; Hossain & Ahmed, 2012). We developed the labels digital caregiver and digital support partner with the intent to illustrate the emergence of a new type of caregiver. These labels refer to any individual who helps another person complete a DADL. Digital caregivers and digital support partners can be both informal (e.g., friend and family member) and formal (e.g., specialized professionals and technology support specialists), and require specialized knowledge related to digital technologies and network connectivity, while also understanding the delicate relationship of compatibility and stability across the two.

Toward a Framework to Guide the Understanding of DADLs and Their Role in the Implementation of Digital Technologies for Activities of Daily Life

Considering the societal dependence on digital technologies, the ability to complete DADLs may become an increasingly critical component of participating in everyday life. Understanding how DADLs should be considered in the development of digital technology-based interventions, programs, resources, and policies is timely and essential in ensuring their implementation success. To support this understanding, we propose a framework that outlines fundamental DADLs (e.g., configuring devices and setting up user accounts), the requirements for completing those DADLs (e.g., network accessibility, digital interfaces, compatibility, and stability), and the role of those DADLs on applying digital technologies to assist with ADLs, IADLs, and EADLs (see Figure 1). In our conceptual framework development, we considered the trajectory of technology evolution (e.g., user-friendly technologies and artificial intelligence) and aimed to identify core DADLs that will retain a role in how individuals interact with technology. Although the ways in which humans complete DADLs will continually evolve, DADLs will remain a critical component of daily life as long as digital technology retains its role to participate in daily life. Much in the same way an individual completes an ADL has evolved over the course of time (e.g., bathing), the way an individual completes a DADL (e.g., create a user profile for a home robot) will evolve. For example, the use of AI and other technology-enabled strategies to support the user will influence how individuals use technologies(s); however, the requirement for human-in-the-loop and the DADLs to support it will always play a role in ensuring successful technology implementation. These requirements are twofold—first, humans need to be able to control how technology is being used to ensure their autonomy and sense of control, and second, humans need to work in tandem with technology to complete everyday activities (e.g., ADLs, IADLs, and EADLs).

Fundamentals of DADLs

Compatibility and stability

Understanding the proposed framework requires careful consideration of the requirements to engage and complete DADLs. Rudimentary requirements for completing a DADL include network access, digital technologies, and assurance of their compatibility and stability (Jones, 2015; Lynn et al., 2022). These requirements mimic those that may be observed in other types of everyday activities. For example, an ADL such as bathing, requires the use of a shower and a stable flow of water to be completed. If the individual is to shower on their own but is not able to control the shower (e.g., turning the shower knob), they would require the assistance of a care partner to turn it on for them. Much in the same manner, the intertwined application of digital technologies (e.g., smartphone) and network access (e.g., cellular network connection) allows an individual to complete a DADL (e.g., create an email account). However, the relationship between digital technologies and network access is delicate, and disturbances in that relationship can have negative implications on the ability to complete DADLs (Lai & Widmar, 2021). For example, drops in network access can disable individuals from accessing functionalities through a digital device, thus affecting a person’s ability to complete a DADL. Thus, even though an individual may be able to complete DADLs, the inability to establish a stable connection between device and network would result in the individual not being able to use the technology to support them in completing an ADL, IADL, or EADL.

Digital technologies

Digital technologies are diverse, quickly evolve, and can have many functions (e.g., entertainment, productivity, and home controls) and capabilities (e.g., network and accessory support). The types of digital devices an individual interacts with to complete DADLs include both personal devices and public devices (Neves & Vetere, 2019). For example, a person can use a mobile application or a digital bank kiosk to complete various banking activities. The types of digital interfaces an individual engages with daily, both in the home and in the community, are diverse (e.g., computers, tablet, ATMs, grocery store check-out, and restaurant self-ordering kiosk) and pose a variety of user competencies and requirements. Along with a growing number of digital interfaces, many of the daily activities that traditionally did not require a digital interface to complete (e.g., banking, medical appointments, and check-out kiosks) are slowly being supplemented or entirely replaced through digital interfaces (e.g., city parking, rideshare, and Medicare).

Network access

The network requirements needed to support functionality and connectivity of digital technologies have expanded greatly over the past couple of decades (Santis et al., 2023). Access to stable networks that are compatible both with new and older digital devices can play an integral role in supporting the needs of a diverse set of users and their ability to complete DADLs. The types of networks being used to support existing and emerging digital devices (e.g., Wi-Fi, 3G/4G/5G, and Bluetooth) range in functionalities (e.g., device-to-device communication, data sharing, and accessory connectivity) and capabilities (e.g., 4G vs 5G network speeds and range of service). Digital technologies can often depend on multiple types of simultaneous network connections, both synchronously and asynchronously, to support continuous communication. For example, a person controlling a smart home appliance when on vacation may rely on the connectivity of their smartphone to a cellular network (e.g., 4G and 5G), while their smart appliance is connected to the Wi-Fi network located in their home. Networks, such as Bluetooth and Near Field Communication (NFC), are enabling device-to-device communication through data sharing and rapid connectivity. For example, an individual may use Bluetooth to connect their tablet or smartphone to wearable devices, headphones, or smart speakers. Additionally, individuals may utilize an NFC connection to use a mobile payment application to purchase groceries at a supermarket, simply by placing their smart watch near a digital payment terminal. The rapid evolution of networks along with significant improvement in their stability, speeds, and access are evolving how humans interact with the world around them.

Role of DADLs

Harnessing digital technologies and networks requires that persons be able to complete DADLs. DADLs such as accessing a digital interface, configuring device accessories (e.g., connecting a wearable device to a smartphone), creating an email account, personalizing a device (e.g., security and privacy settings), creating a device user profile (e.g., Google, iCloud, and Microsoft), or connecting to a wireless network represent broad activities that may evolve in how an individual completes them (e.g., artificial intelligence support). However, the ability to complete these activities will potentially play a determining factor on the overall ability to leverage digital technology required to support and complete other everyday activities (see Figure 1). An example of this evolutionary process can be observed in how individuals setup access to devices such as smartphones (e.g., evolution from on-screen password to fingerprint scanner to face recognition). Although the process of how someone sets access to their device changed due to progress in technology development, the need to setup access remains. The types of DADLs required to support everyday life are diverse and can evolve depending on personal (e.g., health) and external (e.g., devices updates) factors. For example, a person experiencing hearing loss may purchase a Bluetooth-enabled hearing aid that requires them to complete a series of DADLs (e.g., download a mobile application, create a user profile, connect their hearing aid to a mobile device, and navigate through the application menus to customize the device to fit their individual preference) to successfully utilize the digital device to support their hearing. The inability to complete these DADLs can negatively affect healthy aging and quality of life (Baraković et al., 2020; Yen et al., 2022). Therefore, developing strategies to support older adults with DADLs through the development of resources, equipping, and training formal and informal digital caregivers may be an important step toward adapting to an ever-growing digitalized world.

Implications for ADLs, IADLs, and EADLs

Digital activities of daily living can have significant implications on an individual’s ability to leverage digital technologies to complete ADLs, IADLs, and EADLs. For example, a person who is no longer able to feed themselves independently due to a physical disability may use an assistive robotic arm to feed themselves. However, to leverage this technology successfully, the person may need to complete a series of DADLs, such as accessing the robot interface and customizing controls through a robot dashboard, to adapt it to their use preferences. In this instance, the digital technology presents the solution that can enable the person to complete the ADL (e.g., feeding); however, the DADLs requirements for using the digital technology become the determinant of its assistive ability. A tech support specialist may serve the role of a formal digital caregiver to assist with initial setup and adaptation of the system to meet the user’s preference. Take, for instance, a person who is having difficulty cleaning their floors due to a fall that resulted in a broken hip. The person may adopt a robotic vacuum to assist with completing the IADL. However, to successfully utilize the digital technology, they will need to successfully complete multiple DADLs (see Figure 2). A family member may serve the role of an informal digital caregiver to assist with completion of the DADLs.

Implications of DADL on Research, Practice, and Policy Daily Life

DADLs and Research

Although much research has focused on the adoption and implementation of digital technologies to support the aging process and other everyday activities (ADL, IADL, EADL), little research has focused on understanding the overall impact of a growing dependence on technology to support everyday life. The ever-growing requirements for technology to complete critical components of daily life can have both positive and negative implications for older adults. For example, the ability to use technology to complete everyday activities can promote independence and limit a resource gap. However, an expanding reliance on technology can further exacerbate the implications of the digital divide and increase the need for digital caregivers. Development of a standardized measure for DADLs is an important next step to understand their implications for participating in a rapidly digitized society. In our framework, we identify DADLs (e.g., access and personalize device settings) that can broadly be applied for existing and emerging technologies that may support ADLs, IADLs, and EADLs (see Figure 1; e.g., access). Furthermore, our framework provides considerations for how DADLs should be considered in the deployment of digital technology interventions. Our framework can be applied in the context of existing frameworks, such as the Prevent, Rehabilitate, Augment, Substitute (PRAS) framework (Charness, 2020), to better understand the range of DADLs and the digital care support required to successfully implement technology interventions to promote successful longevity.

DADLs and Practice

DADLs, and their growing implications on everyday life, need to be closely considered in both the training and the service delivery provided by gerontologists. Our framework provides practitioners with a roadmap to support their understanding of the implications of DADLs on everyday life and the types of supports that may need to be considered to assist their clients to complete DADLs. Awareness surrounding the significance of DADLs can shape the development of community-level awareness campaigns, resources, and programs that can enhance access to training (e.g., computer proficiency training) and digital care support (e.g., formal digital caregivers). Practitioners can leverage our framework to serve as advocates for their clients and educate legislators on the importance of enhancing access to resources to support older adults with DADLs.

DADLs and Policy

Educating policymakers on the growing importance of DADLs can inform the development of policies to support and assist with their completion. Awareness surrounding the importance of DADLs in everyday life underline the impact of the digital divide and internet deserts on older adults’ quality of life and well-being. Advocating for policies that enhance access to digital technologies, affordable wireless networks, and digital support systems (e.g., training formal digital caregivers) at both the local and national level can be an important step to support successful longevity of a growing older adult population. Additionally, the digitalization of local, state, and national level government-related programs (e.g., Medicare) needs to take into consideration DADLs requirements and how they may affect participation and accessibility. For example, programs delivered exclusively through online portals may need to provide access to digital caregiver support to ensure successful participation by the recipients.

Conclusion

With a growing dependence on digital technologies to participate in day-to-day life, gaps in access to digital technologies, network connectivity, and disparities in individuals’ ability to competently complete DADLs present concerns for well-being, quality of life, and successful longevity. This forum paper outlines the conceptual framework that provides an important step toward classifying and understanding the role of DADLs to participate in daily life. The considerations outlined in our paper provide important next steps toward expanding the application of our framework to inform future directions for research, practice, and policy.

Funding

This research was supported in part by the National Institutes of Health (National Institute on Aging) grant [P01AG073090] under the auspices of the Center for Research and Education on Aging and Technology Enhancement (CREATE; www.create-center.org).

Conflict of Interest

None.

Data Availability

This article does not report data and therefore the preregistration and data availability requirements are not applicable.

Author Contributions

George Mois (Conceptualization [Equal], Investigation [Equal], Visualization [Equal], Writing—original draft [Lead], Writing—review & editing [Equal]); Wendy A. Rogers (Conceptualization [Equal], Funding acquisition [Lead], Investigation [Equal], Visualization [Equal], Writing—original draft [Supporting], Writing—review & editing [Equal]).

References