Rakel Poveda Puente (1), Ricard Barberà i Guillem (1), Heidrun Becker (2), Inge Schädler(3), Arno Wienholtz (4), Carlos de Castro Lozano(5), Laura Martínez Gómez(1).
- Instituto de Biomecánica (IBV). Universitat Politècnica de València. Edificio 9C. Camino de Vera s/n. (Valencia, Spain).
- ZHAW: Zürcher Hochschule für Angewandte Wissenschaften (Switzerland)
- VASOS: Vereinigung aquiver Sonoran- und Selbsthilfe-Organisationen der Schweiz (Switzerland)
- KASSAM: Kaasa health GmbH (Germany)
- CPMTI: Centro de Producción Multimedia para la Televisión Interactiva S.L.(Spain)
The Instituto de Biomecánica (IBV) has been coordinating the WETAKECARE project (WTC) for three and a half years. The project has produced an interactive and multimodal system focused on the needs of the over-fifties. The know-how of the consortium’s multidisciplinary team (gerontology, social innovation, social work, usability, occupational therapy, development of ICT and engineering) and the active participation throughout the project of potential users of the system have been key to our being able to present a functional, efficient and usable system for seniors and their non-professional caregivers.
The WTC system, intended for persons over 50 years-of-age with a mild to moderate loss of functional capabilities, encourages active aging through the practice of games and the learning of new strategies that allow such individuals to carry out their Activities of Daily Living (ADL) in a more autonomous manner.
INTRODUCTION
Physical activity and learning new strategies are essential to prevent situations of dependency and to promote healthy aging. In 2017, the WHO pointed out that healthy aging should be an essential part of any response to an aging population, allowing people to live longer in good health and free from disability in their own homes.
The senior population will continue to increase in the coming years. The projections suggest it will rise from 18.5% in 2014 to more than 20% in 2025 and to 28.7% in 2080 (Eurostat, 2016).
Functional capacity depends on the physical, mental, sensory and psycho-social capacities that each person’s life history modifies in specific ways. The reduction of a person’s functional capabilities leads to difficulties in carrying out one’s Activities of Daily Living (ADL), which are measured at between 6.8% and 14.1% in the elderly population. In addition, when the elderly find it hard to carry out their ADL by themselves, this can place an extra burden on caregivers which can in turn affect their physical and psychological health.
The WETAKECARE (WTC) project, developed to provide a response to these needs, has produced an interactive and multimodal system that enhances the functional capacities through the practice of serious games, also referred to as training games, and facilitates the introduction of new strategies for performing ADL through training materials. In this way, it helps the elderly to slow down the loss of their capacities, making them more independent and therefore reducing the physical and psychological burden on caregivers.
The project has been developed by the Instituto de Biomecánica (IBV) (which has contributed its experience with the elderly and in functional assessment, biomechanical models, social work and in people-oriented design); KAASA (a company that specializes in the development of games for health); VASOS FARES (the Seniors’ Association), ZHAW (the Institute of Occupational Health which has provided its knowledge of Occupational Therapy) and CPMTI (a technological company in charge of the development of the platform).
WETAKECARE (www.wetakecare.ibv.org) has been co-financed by the AAL program (Call AAL-2012-5 ref.: AAL-2012-5-036) and by the Ministry of Industry, Energy and Tourism.
MATERIAL AND METHODS
The methodology for the development of the WTC system was based on design conceived by and for people. The potential users of the system and the project participants represent three levels:
♦ Primary users (n=88): healthy seniors, with mild to moderate difficulty in carrying out their ADL.
♦ Secondary users (n=59): non-professional caregivers, including the spouses of older people, their children and other members of the family or friends.
♦ Tertiary users (n=35): an advisory group made up of people to whom we referred, including members of the VASOS Seniors’ Association and professionals from different fields related to the scope of the project: occupational therapy, gerontology, social work, nursing and sports science.
The following is a description of the methodology and the objectives pursued during each of the WTC system’s development phases, which involved the active participation of the users.
Phase 1: Identifying needs and concepts
In the first phase, we identified the needs and difficulties of older people (grouped by profile type), as well as those of their non-professional caregivers in the performance of ADL and we defined the best strategies to support them using the WTC system.
Phase 2: First concept validation
Once we had defined the features of and the criteria for the system design, based on the needs of the potential users and on usability and accessibility criteria, we designed the first conceptual prototype which was assessed by a total of six discussion groups (three in Spain and three in Switzerland) comprising seniors, elderly people with mild to moderate functional limitation, caregivers and professionals.
Phase 3: Functional validation
A second functional prototype was developed in line with the results of the conceptual validation. In this case, the validation was carried out with potential users in laboratory conditions, where they discussed possible ways to improve usability with SIMPLIT methodology (www.simplit.es), the level of acceptance and satisfaction, and the complexity of the navigation and the cognitive load. This was achieved using different technologies such as Eyetracker, which allows you to track the pupil and hence the visual strategy users employ when performing a specific task (Figure 1).
Figure 1: Map of visual tracking by Eyetracker during the second validation.
Phase 4: Validation in actual use
During this phase, the end users and their caregivers used the WTC system in their own homes. In this period of use, validated scales were used to characterize users, the evolution in their functional capabilities, stress levels in caregivers and the usability aspects of the system. At the end, we made a comparative study of the initial state vis-à-vis the final state. This pilot study allowed us to identify key problems inherent in using the system in a real environment and to implement new improvements in the system so that we could deliver a better experience in actual use.
Phase 5: Final system verification
Based on the implementation of the improvements identified in the actual use validation, we developed a fourth prototype that was validated in Spain and Switzerland by discussion groups involving seniors and different professional profiles (gerontology, occupational therapy, nursing and sports science). In Spain, in addition to the discussion group featuring users and professionals, SIMPLIT methodology was applied, which ensures that products and services are convenient and easy to use for people of all ages
RESULTS
During the needs detection phase, we identified that the most problematic motor tasks involved climbing stairs, getting up and carrying or moving heavy objects. Based on the selected ADL and on 5 of the bodily functions required to carry them out (endurance, mobility, strength, balance, and coordination) we defined and developed the exercises, strategies and/or support products that were implemented in the system in the form of games and/or training materials.
In relation to the initial system requirements, the participants pointed to the need to practice with a partner or in a group and said the exercises were fun and that what they had learned could easily be introduced into their daily routine. The caregivers asked for training so they could improve their own capacities and adopt strategies to reduce the burden of care and stress, as well as forums in which they could communicate with other caregivers.
Based on the identified needs and the initial requirements, a first prototype was designed (Figure 2).
Figure 2: Image of the first prototype.
The results of the first validation called for basic modifications to the general functionality of the system and in the games, strategies, and aspects of communication.
The implementation of these improvements allowed us to develop a second prototype (Figure 3).
Figure 3: Image of the second prototype.
In this second validation, users indicated that the system was interesting, satisfactory and useful, but proposed certain improvements relating to an interface with a higher contrast (clearer colors in the background and bigger icons), larger font sizes, better games (detection of positions, difficulty levels, a feeling of interaction and graphic design quality) and a clearer and simpler navigation and information flow structure.
The result of this second validation was implemented in a third prototype which was used for the validation in an actual usage environment.
Figure 4: Image of the third prototype.
During the third validation, an important effort was made to objectify the potential improvement achieved in the performance of the ADL and in overall physical condition. In addition to an objective improvement in these variables, the perception of the users regarding the improvement in their physical and mental performance was positive. 53.6% of users indicated that using the WTC system had improved their physical condition and 60.7% of users reported an improvement in their mental state.
Figure 5 shows the evaluation of the system from the point of view of usefulness, ease of use, comfort and user satisfaction, following three months use of the system.
Figure 5: Evaluation of the system after 3 months of use.
However, despite the positive evaluation made by the users and the perceived improvements in both their physical and mental condition, possible improvements were identified in the third prototype, which were then implemented in the final prototype.
Figure 6: Image of the fourth prototype Final prototype.
Figure 7 presents a brief description of the system developed, its benefits, functionalities and usage characteristics.
Figure 7: Infographics used in the WTC System.
CONCLUSIONS
The WTC system developed throughout the project:
♦ Allows seniors to obtain valuable information to prevent potential risks and improve the daily routines they follow when carrying out the ADL they find the most difficult to perform as they get older.
♦ Trains them in functions such as strength and endurance through gesture recognition games involving various levels of difficulty that adapt to the capacities of the different users.
♦ Helps caregivers reduce stress and protect their health by implementing new strategies and healthy habits.
♦ Reduces the digital divide in new technologies, thanks to the development of an easy-to-use and intuitive system based on a TV platform that can be operated with a remote control and a tablet.
♦ Makes it possible to know the user's initial state and his or her progress.
♦ Maintains communication with participants in the WTC system or with social networks external to the system.
Therefore, the WTC system makes it possible to enhance the collaboration between the elderly and non-professional caregivers in order to promote the independent life of the older person through the performance of activities of daily living (ADL) while at the same time training the caregiver in care provision, improving the quality of the care they provide and safeguarding their physical and occupational health. This collaboration also strengthens the relationship between the caregiver and the older person, allowing them to enjoy time together while performing activities and exercises with a recreational approach.
As a final conclusion, we should highlight that keeping the focus of the development of the system on the needs of the potential users and on their preferences, and the application of disciplinary knowledge have been essential to the development of a functional technology prototype for the improvement of healthy aging at home.
REFERENCES
♦ The World Health Organization (2017) Aging and Life Cycle. Retrieved from: http://www.who.int/ageing/es/ Retrieved Abril 2017.
♦ Eurostat (2016). Population structure and ageing, 2015 Retrieved from: http://ec.europa.eu/eurostat/statistics-explained/index.php/Population_structure_and_ageing
♦ Wactlar, H, Kanade T (2008). Quality of Life Technology. Quality of Life Technology Center, Carnegie Mellon University. Retrieved from: http://lazowska.cs.washington.edu/initiatives/Quality%20of%20Life%20Technology.pdf, Retrieved April 2017.
ACKNOWLEDGEMENTS
Our thanks to the seniors, to their families, and to the entities that have collaborated in the project.
The project has been made possible thanks to the co-financing of the AAL program (Call AAL-2012-5 ref: AAL-2012-5-036) and of the Ministry of Industry, Energy and Tourism.
