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Regenerative and Technological Section / Mini-Review

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Immersive Technology and the Elderly: A Mini-Review

Shelton B.E.a · Uz C.b

Author affiliations

aDepartment of Educational Technology, Boise State University, Boise, Idaho, USA; bComputer Education and Instructional Technology Department, Yildiz Technical University, Istanbul, Turkey

Corresponding Author

Brett E. Shelton

Department of Educational Technology, Boise State University

1910 University Dr.

Boise, ID 83613 (USA)

E-Mail brettshelton@boisestate.edu

Related Articles for ""

Gerontology 2015;61:175-185

Abstract

Technologies that provide immersive experiences continue to become more ubiquitous across all age groups. This paper presents a review of the literature to provide a snapshot of the current state of research involving the use of immersive technologies and the elderly. A narrative literature review was conducted using the ScienceDirect, EBSCOhost, Springerlink and ERIC databases to summarize primary studies from which conclusions were drawn into a holistic interpretation. The majority of the studies examined the effect of immersive technologies on elder peoples' age-related declines, including sensory and motor changes (vision, hearing, motor skills), cognitive changes and social changes. Various immersive technologies have been described and tested to address these age-related changes, and have been categorized as ‘games and simulations', ‘robotics' and ‘social technologies'. In most cases, promising results were found for immersive technologies to challenge age-related declines, especially through the increase of morale.

© 2014 S. Karger AG, Basel


Introduction

The gap between technology immigrants that make up much of the aging population, and those who have been raised with immersive and often ubiquitous technologies presents an interesting topic for researchers of educational technologies. Yet, there is not a large body of research dedicated specifically to the how and why of immersive technology and the elderly. More focus has been given to those in the K-12 educational settings or to informal learning in general, with some notable exceptions. Several researchers have investigated areas where games, virtual worlds and robotics have lent themselves to the study of physical and cognitive elements for the elderly population [1,2,3,4,5].

Immersive technologies specifically refer to the computer-based devices that allow for physical or cognitive envelopment of one's attention, insomuch as a user primarily attends to an artificial computer-based environment or activity. In addition, immersive technologies leverage forms of virtual realities, which are computer-generated elements that overlap with the real environment. Once the technologies reach the point where they are integrated seamlessly into the perceived natural environment, they become ubiquitous.

As is often the case for the development of immersive technologies, those aimed at elderly populations attempt to improve the quality of life and to extend the duration of life. In particular, Burdick and Kwon [6] defined gerontechnology as technology applications to improve the life conditions of the elderly. Gerontechnology is the design of technology concerning particular abilities and the need for cognition, social interaction and good health of elderly users [7]. For example, technology can offer suggestions for safer physical activity for elderly people, facilitate cognitive training and assist them in their own healthcare [1,2,3,8,9,10,11], aid them in maintaining contact with their families, and support their social life and increase social interaction [12,13,14,15]. Social integration of elderly individuals often plays a beneficial role in the maintenance of psychological well-being and may lead to an improved state of mental health [16].

Ball et al. [11] found in their research on cognitive training [Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)] that if specific cognitive skills are trained separately - such as memory, attention and problem solving - elderly people improve in the particular skill on which they are trained. In addition to cognitive research, recent studies have also focused on how to improve motor skills of elderly people [9,17]. Physical activities and regular exercise have a significant effect on the quality of life of elderly individuals. However, there are various barriers which include program safety monitoring, lack of access to required equipment and facilities, lack of partners, fear of injury and lack of appropriate positive reinforcement for elderly people [3]. It has been suggested that immersive technologies can help overcome some of these barriers [2,3] with respect to physical activity and, indeed, promising results have been found regarding improvement in both engagement and sustainment in physical activity programs for elderly people [2,9,17,18].

There are specific areas of research that focus on addressing the needs of the elderly through the use of immersive technologies. However, the use of any technology in creating solutions may have particular challenges as well. Due to the ever-increasing role that immersive technologies play in daily life, it is important to consider how these technologies may assist in addressing the challenges faced by elderly populations. An exploratory narrative literature review was conducted to synthesize the current state-of-research in this area to better inform healthcare providers and family members. The majority of studies found pertained to the effects of immersive technologies on age-related declines in the elderly population. Van de Watering [19] categorized the changes that occur when a person gets older as sensory and motor changes (vision, hearing, motor skills), cognitive changes and social changes. Various immersive technologies have been described and tested to overcome these changes; these technologies are presented in this mini-review.

Method

This exploratory narrative literature review summarizes different primary studies from which conclusions were drawn into a holistic interpretation [20]. As narrative reviews are most appropriate for comprehensive topics [21], results are of a qualitative nature rather than attempting statistical analyses. Inclusion criteria for articles specified a discussion of ‘effectiveness of various immersive technologies on elderly populations'. An electronic search of articles from the ScienceDirect, EBSCOhost, Springerlink and ERIC databases was conducted for articles published from 2000 to 2013 using the keywords ‘elderly', ‘immersive', ‘technology' and ‘gerontechnology'. Specifically, the initial inclusion criteria were: (1) empirical research with a focus on immersive technologies, (2) related to elderly, (3) written in English and (4) published from 2000 to 2013. Sixty-two abstracts were reviewed, and articles which met the inclusion criteria were selected. It is worth noting that there were many studies related to technologies for elderly that did not meet the ‘immersive' requirement. Immersive technology refers to technology that makes the individual physically present in a nonphysical environment by creating a sense of immersion. Hence, studies which related to Web 2.0 technologies (i.e. nonimmersive technology), attitudes toward Internet usage and computer literacy were all eliminated. The remaining 28 articles fell into 1 of 3 categories: ‘games and simulations', ‘robotics' and ‘social technologies'. The majority of the 28 articles reported here examined the effect of immersive technologies on age-related declines, including sensory and motor changes (vision, hearing, motor skills), cognitive changes and social changes in the elderly population. Thirteen of the 28 included statistical information (tables 1, 2, 3, 4, 5, 6).

Table 1

Immersive technologies for elderly people: games and simulations, part 1

http://www.karger.com/WebMaterial/ShowPic/131298

Table 2

Immersive technologies for elderly people: games and simulations, part 2

http://www.karger.com/WebMaterial/ShowPic/131297

Table 3

Immersive technologies for elderly people: games and simulations, part 3

http://www.karger.com/WebMaterial/ShowPic/131296

Table 4

Immersive technologies for elderly people: robots, part 1

http://www.karger.com/WebMaterial/ShowPic/131295

Table 5

Immersive technologies for elderly people: robots, part 2

http://www.karger.com/WebMaterial/ShowPic/131294

Table 6

Immersive technologies for elderly people: SNS

http://www.karger.com/WebMaterial/ShowPic/131293

Results

Studies Based on Games and Simulations

Digital games, which range from simple text-based games to complex 3D graphics and virtual worlds, have been widespread over the past decade. Within the large range of game types, there are many variations: first-person shooter games, strategy games, massively multiplayer online games, action games, etc. Recent studies on the elderly showed improvements in cognitive and physical abilities after computer-based action game play [1,17]. This particular category of digital games is generally adaptive and presents an inherent challenge to the player by requiring the use of sensory discrimination and efficient information processing. These types of games could potentially produce transfer to perceptual, attention capabilities and memory abilities in older adults, and promote the gain of cognitive benefits [22]. Zelinski and Reyes [22] stated that such cognitive exercises are effective because digital game activity lies at the intersection of ‘presence', ‘involvement' and ‘flow'. Presence is a term that describes the incorporation of perceptual-attentive and spatial-cognitive processes that place the user in the space of game play. Involvement can be defined as being the representation of the user's acceptance of and adaptation to the play space. Flow describes the response to the ability-challenge tension that motivates the player to keep playing.

Age-related declines in cognitive abilities have been explored on a variety of cognitive tasks, including working memory, processing speed, episodic memory, mental rotation, spatial coping ability and dual-task processing [4,5]. There are various types of games including multiplayer, shooter, exergames and strategy games that have certain features that support and improve cognitive abilities of users. Zelinski and Reyes [22] categorized game types in terms of the impact they may have on the learner: (1) shooter games may improve visual attention and rapid response, (2) strategy games may benefit supervisory skills, working memory and possibly long-term memory retrieval, (3) role playing games may improve retrieval from long-term memory, reasoning, supervisory abilities and working memory, and (4) massively multiplayer online games may improve response speed, reasoning, supervisory abilities and working memory in the context of social interactions.

Previous studies that explored the effects of games on cognitive abilities of the elderly recommend games for enjoyment while improving cognitive abilities [1,17]. Basak et al. [4] conducted a study to examine whether training in a complex real-time strategy game, which provides individualized feedback and requires frequent shifts in component task priority, would show transfer to executive control and memory processes of older adults. Aging is known to affect the frontal lobes, particularly the prefrontal cortex, and it also affects higher level cognitive functions such as dual-tasking, working memory and inhibition [4,23]. The trainees improved significantly in the measures of game performance. They also improved significantly more than the control participants in executive control functions such as task switching, working memory, visual short-term memory and reasoning.

In another study of the elderly and gameplay, Whitlock et al. [1] used online multiplayer gaming to examine the effectiveness of a game-based cognitive training intervention on multiple abilities in a sample of 39 older adults aged 60-77 years. A game that fulfilled the requirements of multitasking and switching between multiple cognitive abilities, the popular World of Warcraft (WoW), was utilized in the research. The study used a pretest-posttest control group design and the authors reported that no relationship was found between age and cognitive change, but the lower-ability adults stood to benefit from cognitive training skills embedded in this game [1].

Besides cognitive abilities, the effect of games on physical abilities of elderly people has also been explored [2,3,18]. Wiemeyer and Kliem [3] demonstrated the advantages of physical activities for elderly people with regard to the cardiovascular and cardiorespiratory system, energy metabolism, strength and flexibility, bone structure, immune system, and sensory-motor coordination. Because the elderly often experience barriers to traditional physical exercises, exergames, which involve whole-body movements set to game-like activity, may help elderly people overcome some of these barriers. These games combine game motivation with physical exercise through the use of physical input devices such as popular home consoles like XBox and Wii [3,18,24]. Exergames, available and accessible with minimal costs, are increasingly being used in senior centers and retirement communities [18].

Lai et al. [17] explored the effects of interactive video game-based training on balance, modified fall efficacy and stepping abilities of persons over 65 years of age. Results showed the interactive video game-based intervention improved balance after 6 weeks of training. Wollersheim et al. [2] investigated the physical and psychosocial effect of exergaming on older women as part of a community health service. Findings from the quantitative data showed that Wii play did not have substantial physical effects; nevertheless, qualitative data revealed that the participants perceived an improved sense of physical, social and psychological well-being.

Pichierri et al. [10] researched the effect of dance video gaming versus traditional strength and balance programs for the elderly. After the intervention, a between-group comparison revealed significant differences for gait velocity and single support time during the fast-walking dual-task condition in favor of the dance group. No significant between-group differences were observed either in the foot placement accuracy test or in efficacy of preventing falls. There was a significant interaction in favor of the dance video game group for improvements in step time. Significantly improved fast-walking performance under dual-task conditions (velocity, double support time, step length) was observed for the dance video game group only. These findings suggest that in older adults, a cognitive-motor intervention may result in more improved gait under dual-task conditions in comparison to a traditional strength and balance exercise program.

Another recommendation for elderly people is combining physical and cognitive training into clinical practice protocols for training older adults to function safely in their physical environments [10]. Exergames seem to be a motivating and effective way for incorporating a cognitive element into a physical exercise program. For instance, interactive dance video games require the player to follow drifting cues and to concurrently execute well-coordinated body movements that have shown promise in training executive functioning processes, practicing of particular divided attention skills and balancing confidence and mental health. They are a safe, low-cost and motivating way to activate and ensure continuation of physical exercise in middle-aged and older adults [10,21,25,26]. Studenski el al. [9] reported similar findings with their video game intervention. Subjects that completed the program reported better health and showed a trend toward improved physical and cognitive performances. Study participants also showed improvement in walk time, self-reported balance confidence with regard to balance and self-reported improvement in perceived quality of mental health. A summary of the empirical results summarized in this mini-review can be explored in tables 1, 2, 3.

Robotics

Broekens et al. [27] demonstrated that robot research for elderly people involves assistive robots, which can be categorized as ‘rehabilitation' robots or ‘social' robots. Rehabilitation robots are physical assistive technologies that are not communicative, e.g. smart wheelchairs. These types of robots can promote an increase in the quality of life for the elderly. Social robots communicate with the user and can be either a service-type robot or a companion-type robot. Socially assistive robotics are considered to be at the intersection of assistive robotics and social robotics with regard to healthcare; the assistance is mainly provided by social interaction [15]. One type of social robotics, ‘service-type robots', is a class of assistive devices that support independent living by supporting basic activities (eating, bathing), mobility, cognitive functions and safety [27]. For example, decreased memory is a common effect of age-related cognitive decline for elderly people and may result in forgetfulness about basic daily activities such as taking medications, attending appointments, eating and drinking. Thus, there is a need for a robot that can offer cognitive reminders [13].

Service-type robots assist the elderly by supporting these routine tasks. Examples of these robots are Nursebot Pearl [13], iCat [28] and Nabaztag [15]. Nursebot Pearl interacts with the world through speech, visual displays, facial expressions and physical motion. Pineau et al. [13] focused on the integrated features in the robot, including a reminder system that incorporates knowledge of a person's typical schedule with observations of recent activities and a high-level robot controller that uses probabilistic reasoning techniques. The robot's ability was tested with 12 test scenarios, and the response from the elderly participants was uniformly positive. iCat (interactive cat), developed by Philips, is a 38-cm tall immobile robot with movable lips, eyes, eyelids and eyebrows to display different facial expressions to simulate emotional behavior. There is a camera installed in the iCat's nose which can be used for different computer vision capabilities, such as recognizing objects and faces [28]. Heerink et al. [28] completed a study with 40 elderly people where half of the participants were exposed to a more sociable version and the other half to a less sociable one. It was found that the participants were more comfortable with the more sociable robot, and behavior analyses showed that participants were encouraged to be more expressive by a more sociable robot. Wu et al. [15] developed a specific robot to provide verbal and nonverbal help, support, and coaching during various tasks such as cognitive stimulation exercises. To develop the assistive robot, researchers explored the difficulties of older adults in daily life as well as their strategies to overcome these difficulties. Next, focus group sessions were conducted to determine how the older adults perceived expressions of an assistive robot. Nabaztag, a nonanthropomorphic rabbit robot which is capable of exhibiting only nonfacial expressions was developed. Results showed that although older participants reported difficulties in managing some daily activities, they expressed that they did not need or want a robot. However, younger participants considered this device to be potentially useful for other older adults suffering from frailty, loneliness or disability.

Some studies focus on pet-like companionship robots. These robots enhance the health and psychological well-being of elderly users by providing companionship [27]. Loneliness can be a common problem among elder people. One suggested method of decreasing loneliness in long-term care facilities is the use of animal-assisted therapy (AAT) [12]. In recent studies, researchers focused on using robotic animals to overcome loneliness in an elderly population [12,14]. Banks et al. [12] claimed that pet-like robots have become popular in Japan in addition to other Western countries because lifestyles make it difficult to attend to the biological needs of living dogs. Examples of these types of robots are the Japanese seal-shaped robot Paro [14] and Aibo of Sony [12]. Paro was developed by the Intelligent Systems Research Institute (ISRI) of the National Institute of Advanced Industrial Science and Technology (AIST) in Japan to study the effects of AAT with companion robots [14]. Paro was equipped with four primary senses consisting of visual, audio, balance and tactile capabilities. Wada and Shibata [14] conducted an experiment with 12 subjects, aged 67-89 years, regarding their relationship with Paro. Interview results showed that Paro encouraged them to communicate with each other and brought about psychological improvements. Banks et al. [12] found similar findings with Aibo of Sony. Aibo had programmable behavior, a hard plastic exterior and a wide variety of sensors and actuators including a camera, touch sensors, infrared sensors and stereo sound. Half of the participants (38 elderly people) received no AAT and half of them received AAT with Aibo or a living dog. Participants who received scheduled AAT with either a living or robotic dog reported being significantly less lonely than those who did not receive AAT. A summary of the data-based studies reviewed for this mini-review are in tables 4 and 5.

Social Nature of Technology

The social environment of elderly people is underrepresented in technology research, with most attention being given to cognitive, physical and sensory aspects of the elderly and technology [29]. However, recent studies have shown promising results concerning the effect of socialization on healthcare of the elderly [14,30]. As mentioned earlier, social robotics studies focus on the improvement of communication skills of elderly people. In addition, one of the most significant impacts of technology on the social life of elderly people is that of computer-based communication with the outside community. As mentioned by Karavidas et al. [29], computer technologies can provide opportunities for elderly individuals to socialize and establish social networks. Technology can be used effectively to promote the socialization of the elderly that have mobility problems or who are far away from their families. However, there are various barriers that inhibit elderly people from actively using these technologies. Identified barriers include technological complexity and change, age-related capability changes, and a lack of learning and support mechanisms [31].

Blazun et al. [32] explored information and communication technology (ICT) usage of the elderly and analyzed how an ICT learning intervention supported the development of their ICT skills and how it affected their social interaction. Results of their study showed a significant decrease in loneliness of older people after the computer training course. ICT could offer opportunities to increase social contacts and hence reduce levels of loneliness.

The use of social network sites (SNSs), Web-based services that allow individuals to share connection and create a community, are gaining in popularity. Although elderly people are increasingly participating on SNSs, the percentage of older adults with an SNS profile is still remarkably low [16]. Previous studies of social network activity of elderly individuals showed that these activities enhance the quality of life and improve health [14,30,33]. The use of digital picture frames to share information electronically with care networks of the elderly has been a topic of research since the 1990s [8]. To incorporate SNSs, Cornejo et al. [16] developed a digital picture frame (Tlatoque) that provides a means of reciprocating digital daily information into Facebook (table 6). Tlatoque serves as an interface for controlling the social information shown in the environment and enables older adults and their relatives to share knowledge of their everyday lives, personal interests and photographs in an automated fashion. Adapting social media to the domestic environment enables elderly people to interact with family members, and like with many studies involving immersive technologies, elderly participants were positive and enthusiastic about the system.

Conclusion

The studies in this literature review examined the effectiveness of a variety of immersive technologies used with elderly people. The majority of these studies examined the effects of immersive technologies on age-related declines in elderly people, separated into sensory and motor changes (vision, hearing, motor skills), cognitive changes and social changes [1,5,12,17,22,29]. The review presented a discussion categorized into games and simulations, robotics, and the social nature of technology. The limitations of this literature review include the reliance on the reliability and validity of the included studies, and the availability of the studies using the search methods reported. For future reviews, systematic reviews could be performed by reviewing and evaluating the scientific literature ranging from highly formal, quantitative information syntheses to summaries of observational data with explicit and rigorous methods. In addition, the search criteria could be relaxed to allow studies that focus on computer-based skills of elderly, their attitudes to these technologies and barriers that inhibit elderly people from actively using technologies.

Previous studies have shown that there are various types of games and simulations that have certain features that support and improve the cognitive abilities of the elderly [4,22,23]. Promising results were found for real-time strategy games that provide individualized feedback and require frequent shifts in component task priority. Real-time strategy games show support for the transfer to executive control and memory processes of older adults [4]. Moreover, online multiplayer games have reported cognitive improvements in the abilities of the elderly [1]. Besides cognitive abilities, positive effects of games on physical abilities of elderly people have also been found [2,3,18]. Exergames, which combine game motivation with physical exercise through the use of physical input devices, have reduced some barriers to exercising.

Promising results were reported for service-type social robotics [13,15,27]. Previous studies have shown that service-type robots such as Nursebot Pearl [13], iCat [28] and Nabaztag [15] support the independent living of elderly people by supporting basic activities such as eating and bathing, mobility, cognitive functions, and safety. On the other hand, pet-like companionship robots enhanced health and psychological well-being of elderly users by providing companionship [27]. In recent studies, researchers have focused on using robotic animals to overcome loneliness challenges of elderly people [12,14,27]. Studies that explore the effects of pet-like companionship robots found that they encourage the elderly to communicate with each other and brought about psychological improvements.

One of the most significant impacts of technology on the social life of elderly people is that of computer-based communication with the outside community. Recent studies have focused on computer technologies which provide opportunities for elderly people who have mobility problems and who are far away from their families, limiting their opportunities to socialize and establish social networks. Previous studies of SNSs that allow individuals to share connections and create communities have shown that they hold potential to enhance the quality of life and improve health [14,29,33].


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Author Contacts

Brett E. Shelton

Department of Educational Technology, Boise State University

1910 University Dr.

Boise, ID 83613 (USA)

E-Mail brettshelton@boisestate.edu


Article / Publication Details

First-Page Preview
Abstract of Regenerative and Technological Section / Mini-Review

Received: January 08, 2014
Accepted: July 07, 2014
Published online: December 10, 2014
Issue release date: February 2015

Number of Print Pages: 11
Number of Figures: 0
Number of Tables: 6

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: https://www.karger.com/GER


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References

  1. Whitlock LA, McLaughlin AC, Allaire JC: Individual differences in response to cognitive training: using a multi-modal attentionally demanding game-based intervention for older adults. Comput Hum Behav 2012;28:1091-1096.
    External Resources
  2. Wollersheim D, Merkes M, Shields N, Liamputtong P, Wallis L, Reynolds F, Koh L: Physical and psychosocial effects of Wii video game use among older women. Int J Emerg Technol Soc 2010;8:85-98.
  3. Wiemeyer J, Kliem A: Serious games in prevention and rehabilitation - a new panacea for elderly people? Eur Rev Aging Phys Act 2012;9:41-50.
    External Resources
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