Technology for Health and Wellbeing

Aging deteriorates cognitive and physical abilities. Besides this, social activities decline in older ages. However, it is possible to slow down the deterioration of these abilities and to prolong the time elders live independently at their homes by proper training plan exercises. Existing tools offer very limited support as their design does not take into account elders as target users and the motivational factors that following training plans poses on them. In this paper we present a unified platform that hosts training games and physical exercises and leverage them with social, motivational and monitoring instruments.

When we go to the museum, we see many interesting objects that have fascinating stories related to them. However, visitors do not often share these experiences with people that have not visited the exhibition. Sharing is beneficial both because it can create interest and attract people to the museum, and because it can help people who cannot attend the visit (for example, is physically unable to do so) to still enjoy it. We were interested to understand the extent and motivation behind sharing (or not sharing) and test how to encourage visitors to do so. We conducted and are conducting various surveys and trials, for which we report the preliminary results in this paper. Initial findings show that i) people today rarely share their visits for lack of content to complement their storytelling, and ii) by providing visitors with a simple and easy-to-create virtual photobook with their dearest memories from the visit we can significantly enhance this sharing.

In this paper we introduce a system, namely Virtual Social Gym (VSG), that aims at increasing the physical and social well being of elderly people. It does so based by i) allowing elderly people at different level of capabilities to train independently from home, while still getting the feeling of training within a fitness class with the other training members, ii) exploiting social interactions and the feeling of being part of a community (a gym) as a motivational factor for performing regular training.

The paper describes the design process and a preliminary study of a novel interface (digital booklet) for facilitating sharing of museums experiences and specifically for helping older adults to participate remotely to museum visits done by friends or relatives. We design in particular for people that for cognitive, physical, or logistic limitations are not able to visit museums, or for which it is very challenging to do so. We performed a user study with a total of 30 older adult participants, 21 in care home (10 of which with significant cognitive decline), and 9 participants in daily center (all of them without degenerative health problems). Our main hypothesis was that given the right set of tools for supporting the visitor during and after the visit we could increase sharing and reach wider audiences, including older and cognitively impaired adults. We compared the performance between healthy and cognitively impaired older adults on four tasks: open the booklet, browse the booklet, zoom in/out a picture, close the picture after being zoomed in/out. Our results showed that the booklet metaphor was well accepted by almost all the participants and they were able to consume and enjoy the content; the more complex and less intuitive functions like zooming and closing a picture were found to be more difficult for the the cognitively impaired group of participants. Our results can contribute the ongoing research in the field of interfaces for older adults and the challenge of intergenerational communication.

Background. Regular physical activity can substantially improve the physical wellbeing of older adults, preventing several chronic diseases and increasing cognitive performance and mood. However, research has shown that older adults are the most sedentary segment of society, spending much of their time seated or inactive. A variety of barriers make it difficult for older adults to maintain an active lifestyle, including logistical difficulties in going to a gym (for some adults, leaving home can be challenging), reduced functional abilities, and lack of motivation. In this paper, we report on the design and evaluation of Gymcentral. A training application running on tablet was designed to allow older adults to follow a personalized home-based exercise program while being remotely assisted by a coach. The objective of the study was to assess if a virtual gym that enables virtual presence and social interaction is more motivating for training than the same virtual gym without social interaction. Methods. A total of 37 adults aged between 65 and 87 years old (28 females and 9 males, mean age = 71, sd = 5.8) followed a personalized home-based strength and balance training plan for eight weeks. The participants performed the exercises autonomously at home using the Gymcentral application. Participants were assigned to two training groups: the Social group used an application with persuasive and social functionalities, while the Control group used a basic version of the service with no persuasive and social features. We further explored the effects of social facilitation, and in particular of virtual social presence, in user participation to training sessions. Outcome measures were adherence, persistence and co-presence rate. Results. Participants in the Social group attended significantly more exercise sessions than the Control group, providing evidence of a better engagement in the training program. Besides the focus on social persuasion measures, the study also confirms that a virtual gym service is effective for supporting individually tailored home-based physical training for older adults. The study also confirms that social facilitation tools motivate users to train together in a virtual fitness environment. Discussion. The study confirms that Gymcentral increases the participation of older adults in physical training compare to a similar version of the application without social and persuasive features. In addition, a significant increase in the co-presence of the Social group indicates that social presence motivates the participants to join training sessions at the same time with the other participants. These results are encouraging, as they motivate further research into using home-based training programs as an opportunity to stay physically and socially active, especially for those who for various reasons are bound to stay at home.

Most museums try to find with different ways to prolong the museum experience outside of the museum environment and facilitate its sharing after the visit. The main reason is two-fold: it can create interest and attract people to the museum, and it can help people who for various cognitive or physical limitations cannot attend the visit, to still enjoy it. We conducted couple of surveys and we designed a possible platform for facilitating sharing, for which we report the preliminary results in this paper. Our findings show that i) although visitors claim that they would like to share their visit, the number of the actual sharing visitors is significantly low, ii) most of the visitors use only verbal narrations in order to share their experience with friends and families, and iii) visitors do not share emotions “virtually” (e.g., facebook or twitter) during the visit. Guided by these results we developed a potential solution through which sharing can be facilitated. It includes various ways to bookmark or “save” and share artifacts during the visit, catering different types of visitors. It also includes a way for people at home to consume the shared content.

In this paper we describe the design and validation of a virtual fitness environment aiming at keeping older adults physically and socially active. We target particularly older adults who are socially more isolated, physically less active, and with less chances of training in a gym. The virtual fitness environment, namely Gymcentral, was designed to enable and motivate older adults to follow personalised exercises from home, with a (heterogeneous) group of remote friends and under the remote supervision of a Coach. We take the training activity as an opportunity to create social interactions, by complementing training features with social instruments. Finally, we report on the feasibility and effectiveness of the virtual environment, as well as its effects on the usage and social interactions, from an intervention study in Trento, Italy.

In this paper we aim at understanding if and how, by analysing people’s profile and historical data (such as data available on Facebook profiles and interactions, or collected explicitly) we can motivate two persons to interact and eventually create long-term bonds. We do this by exploring the relationship between connectedness, social interactions and common life points on Facebook. The results are of particular importance for the development of technology that aims at reducing social isolation for people with less chances to interact, such as older adults.

Recent technological advances have created enormous opportunities for developing applications that support training from home - particularly for older adults, who often are socially more isolated, are physically less active, and have fewer chances to train in a gym. In this article, the authors review current fitness applications and their features alongside the design challenges and opportunities of fitness applications for trainees at home.

Background. Intervention programs to promote physical activity in older adults, either in group or home settings, have shown equivalent health outcomes but different results when considering adherence. Group-based interventions seem to achieve higher participation in the long-term. However, there are many factors that can make of group exercises a challenging setting for older adults. A major one, due to the heterogeneity of this particular population, is the difference in the level of skills. In this paper we report on the physical, psychological and social wellbeing outcomes of a technology-based intervention that enable online group exercises in older adults with different levels of skills. Methods. A total of 37 older adults between 65 and 87 years old followed a personalized exercise program based on the OTAGO program for fall prevention, for a period of eight weeks. Participants could join online group exercises using a tablet-based application. Participants were assigned either to the Control group, representing the traditional individual home-based training program, or the Social group, representing the online group exercising. Pre- and post- measurements were taken to analyze the physical, psychological and social wellbeing outcomes. Results. After the eight-weeks training program there were improvements in both the Social and Control groups in terms of physical outcomes, given the high level of adherence of both groups. Considering the baseline measures, however, the results suggest that while in the Control group fitter individuals tended to adhere more to the training, this was not the case for the Social group, where the initial level had no effect on adherence. For psychological outcomes there were improvements on both groups, regardless of the application used. There was no significant difference between groups in social wellbeing outcomes, both groups seeing a decrease in loneliness despite the presence of social features in the Social group. However, online social interactions have shown to be correlated to the decrease in loneliness in the Social group. Conclusion. The results indicate that technology-supported online group-exercising which conceals individual differences in physical skills is effective in motivating and enabling individuals who are less fit to train as much as fitter individuals. This not only indicates the feasibility of training together despite differences in physical skills but also suggests that online exercise might reduce the effect of skills on adherence in a social context. However, results from this pilot are limited to a small sample size and therefore are not conclusive. Longer term interventions with more participants are instead recommended to assess impacts on wellbeing and behavior change.

In this paper, we report an extensive analysis that we performed in two scenarios where the care relation between doctor and patients are mediated by the relatives of the patients: Pediatric Palliative Care (PPC) and Nursing Homes (NH). When the patients are children or very old adults in the end of life, the provision of care often involve a family caregiver as the main point of contact for the health service. PPC and NH are characterized by emotional complexity, since incurable diseases expose the family caregivers to heavy careload and human distress. In this paper, we discuss our findings with a novel perspective, focusing on: information, coordination and social challenges that arise by dealing with such contexts, the existing technology as it is appropriated today to cope with them, and what we, as software researchers, can do to develop the right solutions.

Introduction. Stimulation of a physically active lifestyle among older adults is essential to health and well-being. The objective of this study was to evaluate the feasibility and user opinion of a home-based exercise program supported by a sensor and tablet application for frail older adults. Methods. Community-dwelling older adults (aged ≥70 y) living in The Netherlands were recruited in 2014. Participants exercised 3 months with and 3 months without supervision from a remote coach. Feasibility was operationalized as adherence to exercise (percentage of 5 exercise bouts per week completed) and to wearing the sensor (with 70% defined as sufficient adherence) and the number of problems reported. User opinion was measured with a questionnaire addressing ease of use of the technology and opinion on the program. Results. Twenty-one of 40 enrolled participants completed the trial. Adherence overall was 60.9% (average of 3 bouts per week). Adherence among completers (69.2%) was significantly higher than adherence among dropouts (49.9%). Adherence was sufficient among completers during the 3 months of supervision (75.8%). Adherence to wearing the sensor was 66.7% and was significantly higher among completers than among dropouts (75.7% vs 54.2%). The rate of incidents was significantly lower among completers than among dropouts (0.4 vs 1.2 incidents per participant per week). Connectivity-related incidents were prominent. On a scale of 1 to 5, completers gave ratings of 4.3 (after 3 months) and 4.2 (after 6 months). Conclusion. A home-based exercise program using novel technology seems feasible when participants are given a stable internet connection. This program shows promise for stimulating physical activity among older frail adults, especially if it offers regular coaching.

Social isolation and loneliness have a strong negative impact on health and happiness. The correlation is present at all ages, but the risk of loneliness and isolation is particularly high in later life and when transitioning to residential care settings, where keeping in touch with the family, making new friends and integrating with the community in a new social context can be very challenging. In this note we report on our preliminary studies on the opportunity and feasibility of using custom, printed magazines for increasing feelings of connectedness and promoting meaningful interactions in nursing homes. The content and layout for the magazine are generated in an automatic or semi-automatic way and emphasize aspects that could lead to discovering connections or starting conversations. Initial findings point to the potential for such a magazine and lead to content guidelines that we elaborate in the paper.

In this paper we describe the design of a reminiscence-based social interaction tool, namely Collegamenti, that aims at stimulating conversations and a sense of mutual awareness in residential care. Unlike previous work, Collegamenti focuses on stimulating the different types of relationships that are relevant to the quality of life in residential care: interactions with primary family caregivers, contacts with the larger family, friendships with peer residents and interactions with the nursing home staff. We explore the needs and challenges of this scenario in terms of social interactions but also in terms of how to make the technology sustainable and well integrated with care practices and initiatives, and report on the findings from the qualitative studies and concept validation.

In this paper we draw attention to the challenges of managing software projects for vulnerable populations, i.e., people potentially exposed to harm or not capable of protecting their own interests. The focus on human aspects, and particularly, the inclusion of human-centered approaches, has been a popular topic in the software engineering community. We argue, however, that current literature provides little understanding and guidance on how to approach these type of scenarios. Here, we shed some light on the topic by reporting on our experiences in developing innovative solutions for the residential care scenario, outlining potential issues and recommendations.

Background: Regular physical activity has a positive effect on physical health, well-being, and life satisfaction of older adults. However, engaging in regular physical activity can be challenging for the elderly population because of reduced mobility, low motivation, or lack of the proper infrastructures in their communities. Objective: The objective of this paper was to study the feasibility of home-based online group training—under different group cohesion settings—and its effects on adherence and well-being among Russian older adults. We focused particularly on the technology usability and usage and on the adherence to the training (in light of premeasures of social support, enjoyment of physical activity, and leg muscle strength). As a secondary objective, we also explored the effects of the technology-supported intervention on subjective well-being and loneliness. Methods: Two pilot trials were carried out exploring two different group cohesion settings (weak cohesion and strong cohesion) in the period from 2015 to 2016 in Tomsk, Russian Federation. A total of 44 older adults (59-83 years) participated in the two pilots and followed a strength and balance training program (Otago) for 8 weeks with the help of a tablet-based virtual gym app. Participants in each pilot were assigned to an interaction condition, representing the online group exercising, and an individual condition, representing a home-based individual training. Both conditions featured persuasion strategies but differed in the ability to socialize and train together. Results: Both interaction and individual groups reported a high usability of the technology. Trainees showed a high level of technology acceptance and, particularly, a high score in intention to future use (4.2-5.0 on a 5-point Likert scale). Private texting (short service message [SMS]) was used more than public texting, and the strong cohesion condition resulted in more messages per user. Joint participations to training sessions (copresence) were higher for the social group with higher cohesion. The overall adherence to the training was 74% (SD 27%). Higher levels of social support at baseline were associated with higher adherence in the low cohesion condition (F1,18=5.23, P=.03), whereas in the high cohesion, such association was not found. Overall improvement in the satisfaction with life score was observed between pre and post measures (F1,31=5.85, P=.02), but no decrease in loneliness. Conclusions: Online group exercising was proven feasible among healthy independently living older adults in Russia. The pilots suggest that a physical training performed in a virtual environment positively affect the life satisfaction of the trainees, but it does not provide support for a decrease in loneliness. High cohesion groups are preferable for group exercising, especially to mitigate effects of low social support on adherence. Further research in motivating group interactions in training settings is needed.

In this paper we describe the requirements and early system design for a smart conversational agent that can assist older adults in the reminiscence process. The practice of reminiscence has well documented benefits for the mental, social and emotional well-being of older adults. However, the technology support, valuable in many different ways, is still limited in terms of need of co-located human presence, data collection capabilities, and ability to support sustained engagement, thus missing key opportunities to improve care practices, facilitate social interactions, and bring the reminiscence practice closer to those with less opportunities to engage in co-located sessions with a (trained) companion. We discuss conversational agents and cognitive services as the platform for building the next generation of reminiscence applications, and introduce the concept application of a smart reminiscence agent.

In this paper we explore the feasibility and design challenges in supporting co-located and virtual social interactions in residential care by building on the practice of reminiscence. Motivated by the challenges of social interaction in this context, we first explore the feasibility of a reminiscence-based social interaction tool designed to stimulate conversation in residential care with different stakeholders. Then, we explore the design challenges in supporting an assisting role in co-located reminiscence sessions, by running pilot studies with a technology probe. Our findings point to the feasibility of the tool and the willingness of stakeholders to contribute in the process, although with some skepticism about virtual interactions. The reminiscence sessions showed that compromises are needed when designing for both story collection and conversation stimulation, evidencing specific design areas where further exploration is needed.

Friendships and social interactions are renown contributors to wellbeing. As such, keeping a healthy amount of relationships becomes very important as people age and the size of their social network tends to decrease. In this paper, we take a step back and explore reconnection –find out about or re-contact old friends, an emerging topic due to the increased use of computer-mediated technology by older adults to maintain friendships and form new ones. We report on our findings from semi-structured interviews with 28 individuals from Costa Rica and Poland. The interviews aimed to explore whether there is a wish to reconnect, and the challenges encountered by older adults to reconnect. We contribute with design considerations for tools allowing older adults to reconnect, discussing opportunities for technology.

Social participation is known to bring great benefits to the health and well-being of people as they age. From being in contact with others to engaging in group activities, keeping socially active can help slow down the effects of age-related declines and reduce risks of loneliness and social isolation and even mortality in old age. There are unfortunately a variety of barriers that make it difficult for older adults to engage in social activities on a regular basis. In this chapter, we give an overview of the challenges to social participation and discuss how technology can help overcome these barriers and promote participation in social activities. We examine two particular research threads and designs, exploring ways in which technology can support colocated and virtual participation: (i) an application that motivates the virtual participation in group training programs and (ii) a location-based game that supports colocated intergenerational ICT training classes. We discuss the effectiveness and limitations of various design choices in the two use cases and outline the lessons learned.

Having a sense of purpose is one of the tenets of well-being, at any age. Here, the authors review technologies that could help older adults remain active in society – in particular, those who can’t leave their home regularly or easily. The authors also discuss areas that current research and practice haven’t yet addressed satisfactorily.

This paper presents our preliminary investigation and approach towards a mixed physical-virtual technology for stimulating social interactions among and with older adults in nursing homes. We report on set of surveys, apps and focus groups aiming at understanding the different motivations and obstacles in promoting social interactions in institutionalised care. We then present our approach to address some of the key themes found, e.g., the technological disparity, lack of conversation topics and opportunities to interact.

The goal of this paper is to understand if older adults can participate in remote museum visits with virtual environments, and which design factors would be crucial for remote participation system success. We report on a study with 30 older adult participants, identifying strong and weak points of different designs for remote participation and identifying future design directions. Our results illustrate that different designs can change communication dynamics, exploration and navi- gation patterns, and we describe the design features that led to this. An interaction-free design was found to be the easiest to use, while virtual environments are perceived as aesthetically appealing. Implications for developers are discussed.

In this paper we explore the challenges and opportunities of designing information systems in healthcare with an emphasis on informational needs of family caregivers and work practices of professionals. We focus particularly on the context of Nursing Homes (NH), where family members and care professionals are often faced with challenging situations that can affect their ability to communicate and collaborate effectively, and thus, leading to the episodes of conflicts or mismatch of expectations. We report on two sets of user studies with staff and residents’ family members in four nursing homes, studying current information practices, factors that influence them, and explore design alternatives that could target identified issues.

Background: Intergenerational relationships are beneficial for both grandparents and grandchildren. A positive grandparent-grandchild relationship can improve the psychological well-being of older adults and be a source of social support, family history, and identity development. Maintaining meaningful interactions can be, however, a challenging endeavor, especially as life events lead to relocating geographically. Grandparents and grandchildren can have different preferences in terms of communication mediums and different assumptions about the real conversational needs of the other. Objective: In this study, we will investigate the feasibility and effect of sharing memories of older adults with their grandchildren in social media. This intervention focuses on bringing snippets of the lives of the grandparents into the grandchildren’s social media feed and analyzing the potential effect on relational quality, relational investment, and conversational resources from the perspective of the grandchildren. Methods: A randomized controlled trial will be used to measure the effectiveness of sharing family memories through social media on intergenerational relationships from the perspective of the grandchildren. The study will be implemented in Mongolia among 60 grandparent-grandchild pairs who will be assigned to either a control or intervention group. Pictures and stories will be collected during reminiscence sessions between the researchers and the grandparents before the intervention. During an intervention period of 2 months, grandchildren in the intervention group will receive pictures and stories of their grandparents on their social media account. Pre- and postintervention questionnaires will measure relationship quality, relationship investment, and conversational resources and will be used to assess the effectiveness of the intervention. Results: We conducted a pretest pilot from January to April 2018 among 6 pairs of participants (6 grandparents and 6 grandchildren). The validation of the protocol was focused on the process, instruments, and technological setup. We continued the study after the validation, and 59 pairs of participants (59 grandparents and 59 grandchildren) have been recruited. The data collection was completed in November 2019. Conclusions: The results of this study will contribute to strategies to stimulate social interactions in intergenerational pairs. A validation of the study process is also presented to provide further operational recommendations. The lessons learned during the validation of the protocol are discussed with recommendations and implications for the recruitment, reminiscence sessions, technological setup, and administration of instruments. International Registered Report Identifier (IRRID): DERR1-10.2196/16315

Background. This review studies technology-supported interventions to help older adults, living in situations of reduced mobility, overcome loneliness, and social isolation. The focus is on long-distance interactions, investigating the (i) challenges addressed and strategies applied; (ii) technology used in interventions; and (iii) social interactions enabled. Methods. We conducted a search on Elsevier’s Scopus database for related work published until January 2020, focusing on (i) intervention studies supported mainly by technology-mediated communication, (ii) aiming at supported virtual social interactions between people, and (iii) evaluating the impact of loneliness or social isolation. Results. Of the 1178 papers screened, 25 met the inclusion criteria. Computer and Internet training was the dominant strategy, allowing access to communication technologies, while in recent years, we see more studies aiming to provide simple, easy-to-use technology. The technology used was mostly off-the-shelf, with fewer solutions tailored to older adults. Social interactions targeted mainly friends and family, and most interventions focused on more than one group of people. Discussion. All interventions reported positive results, suggesting feasibility. However, more research is needed on the topic (especially randomized controlled trials), as evidenced by the low number of interventions found. We recommend more rigorous methods, addressing human factors and reporting technology usage in future research.

Previous work has focused on designing and evaluating information communication technology (ICT) tools for improving the coordination, organization of care practices, and to a less extent, the mediation of care communication among various involved actors. Our work contributes to addressing this gap with a specific emphasis on aged care, exploring communication practices, related challenges and design principles that should guide the design of technology-mediated information sharing. We do this by conducting three sets of user studies iterating on design mockups of increasing fidelity, through semi-structured interviews and workshops with nursing home (NH) staff and residents’ family members in four Italian nursing homes. The qualitative and quantitative results point to the potential of computer-mediated information sharing in this context, and to the importance (and challenges) of tailoring information and presentation to people’s needs and traits, and assisting care professionals in managing the information flow and proper communication.

Chatbots are emerging as a promising platform for accessing and delivering healthcare services. The evidence is in the growing number of publicly available chatbots aiming at taking an active role in the provision of prevention, diagnosis, and treatment services. This article takes a closer look at how these emerging chatbots address design aspects relevant to healthcare service provision, emphasizing the human–AI interaction aspects and the transparency in AI automation and decision making.

In this paper we describe the design and development of a route training system for individuals with cognitive impairments (CIs) living in residential care facilities. Learning to move autonomously in public spaces is a fundamental skill for people with CI, who face several challenges to independently and safely move around. Yet, exploring opportunities for route training support, especially in residential settings, has received very little attention. To explore these opportunities, we followed a design and development process based on inclusive design practices that considered the organisational context and aimed at involving people with CI in the software design. To ensure our solution addressed the identified needs and abilities of this heterogeneous population, we further framed the route training definition as a design process that is enacted by the system, making the trainer and user co-creators of a personalised training. In this paper we report on the needs and challenges for mobility training in residential settings, introduce the design and formative evaluation of the route training system, to conclude with reflections and considerations on our methodological approach.