Exploring Videoconferencing for Older Adults with Cognitive Concerns Using a Dramaturgical Lens
Ruipu Hu, Ge Gao, Amanda Lazar · 2024 · Proceedings of the 26th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS '24) · doi:10.1145/3663548.3675647
Summary
This paper examines how older adults with cognitive concerns — ranging from subjective cognitive complaints to diagnosed mild cognitive impairment (MCI) and early-stage dementia — experience videoconferencing platforms like Zoom. Using Erving Goffman's dramaturgical framework from sociology, which analyses social interaction as a performance with frontstage (what others see), backstage (private preparation), and role management, the researchers conducted a qualitative study with 17 older adults aged 65 to 93. The study used three complementary methods: technology discussion groups where participants discussed videoconferencing experiences together, individual semi-structured interviews, and direct observations of participants using Zoom. Participants had varying levels of cognitive concern, from self-reported memory difficulties to formal MCI diagnoses, and most had adopted videoconferencing during or after the COVID-19 pandemic. The dramaturgical lens allowed the researchers to unpack not just usability problems (which previous accessibility research has covered) but the social and emotional dimensions of videoconferencing — how participants managed their self-presentation, navigated new social roles, and dealt with the anxiety of performing competence in a technology-mediated environment while experiencing cognitive changes.
Key findings
The findings are organised around three dramaturgical dimensions. In "performances and roles," participants described adopting new social identities through videoconferencing — becoming remote participants in previously in-person activities like book clubs, religious services, and support groups. Some found this liberating (they could participate without the physical demands of travel), while others felt the technology forced them into a diminished role where they were "just a face on a screen" rather than a full participant. Several participants described the cognitive load of simultaneously managing the technology and engaging socially as overwhelming, leading them to disengage from one or the other. In the "backstage," participants revealed extensive hidden preparation work — rehearsing how to join calls, writing step-by-step instructions for themselves, relying on caregivers or family members to set up the technology, and carefully arranging their physical environment (lighting, camera angle, background) to present a desired impression. This backstage labour was often invisible to other call participants and represented significant cognitive and emotional effort. On the "frontstage," participants struggled with managing audio (knowing when they were muted, unmuting to speak), interpreting the gallery view of faces (difficulty tracking who was speaking in multi-person calls), understanding turn-taking conventions, and dealing with the cognitive dissonance of seeing themselves on screen. Several participants described the anxiety of visible technological struggles as a threat to their identity — fumbling with Zoom controls in front of others felt like public evidence of cognitive decline. Participants also reported that the lack of full-body nonverbal cues and the delay in audio made conversations feel unnatural and tiring.
Relevance
This paper makes an important contribution by examining videoconferencing accessibility through a social rather than purely technical lens. For accessibility practitioners, the key insight is that the barriers older adults with cognitive concerns face are not primarily about button size or interface complexity — they are about the cognitive load of managing technology, social interaction, and self-presentation simultaneously. Design recommendations include reducing the number of visible controls during active calls, providing clearer speaker identification (highlighting who is talking), simplifying the join process, offering persistent on-screen reminders of mute status, and designing for the backstage by providing setup guides and rehearsal modes. The dramaturgical framework itself is a valuable analytical tool for any accessibility domain where social performance and technology intersect — video calls, social media, VR, and other mediated communication. Limitations include the primarily white, educated, female participant demographic, and the focus on Zoom specifically, though the social dynamics identified are likely platform-agnostic. The paper also highlights the role of caregivers as invisible accessibility support — an underexplored design space.
Tags: cognitive accessibility · older adults · videoconferencing · mild cognitive impairment · dementia · social participation · ageing