Designing a gamified cognitive training for elderly people to support ageing in smart homes

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people to support ageing in smart homes.

Designing a gamified cognitive training for elderly

Academic year 2019-2020

Master of Science in de industriële wetenschappen: industrieel ontwerpen Master's dissertation submitted in order to obtain the academic degree of Supervisors: Johanna Renny Octavia, Prof. dr. Femke Ongenae Student number: 01502707

PREFACE

Bringing this research to a successful conclusion would not have been possible without the help of a number of people. Thank you to the following people:

First of all I would like to thank my promoters Johanna Renny Octavia and Femke Ongenae for all the advice and knowledge they gave me during the feedback moments. But also to put me back on the right track and be positive when I didn’t see it all clearly anymore.

Many thanks to my parents and family for supporting me throughout the year. And for filling in as a test subject when we were stuck at home, after spending countless hours listening to my ideas, thoughts and frustrations. But also to my friends to support me through the problems and to listen to every idea and then discuss it in detail.

Finally, I would like to thank all the people who participated in the user tests and interviews. The supervisors and elderly people of WZC De Pottelberg, who helped me several times during interviews or user tests. All other elderly people who participated in the interviews, diary stu-dies and remote tests. And all the other people I interviewed during the year.

Thank you.  

ABSTRACT IN ENGLISH

The population of Flanders is ageing rapidly. The population is growing older and this is accom-panied by the loss of physical and cognitive functions, resulting in more and more older people resorting to service flats, retirement homes or domestic nursing support. The limited number of places available in these service flats and retirement homes creates a problem, as does the limited number of domestic nursing assistants. As a result, smart homes are seen as a possible solution to the ageing population, given that smart home technologies can help the elderly with everyday tasks, as well as monitoring and maintaining their health status. In this way they can support the elderly to live at home for a longer period of time.

This paper presents the design process of a smart home application that can help the elderly in training their cognitive functions. This was achieved using a user centred design approach, involving the elderly in the different phases of the design process. Training the cognitive func-tions is realised through gamification, the result of the research is a boardgame that is con-nected to the smart home. The result of this research is still at an early stage, further research needs to be done on the long term effects of using the product.

ABSTRACT IN DUTCH

In Vlaanderen vindt er een grote vergrijzing van de bevolking plaats. De bevolking wordt ou-der en dit gaat gepaard met het verlies van fysieke en cognitieve functies, wat er toe leidt dat steeds meer ouderen hun toevlucht nemen tot serviceflats, rusthuizen of thuisverpleging. Het beperkte aantal beschikbare plaatsen in deze serviceflats en rusthuizen vormt een probleem, net als het beperkte aantal thuisverpleegkundigen. Hierdoor worden slimme woningen gezien als een mogelijke oplossing voor de vergrijzing van de bevolking. Slimme huizen kunnen de ouderen namelijk assisteren bij het uitvoeren van alledaagse taken, maar ook bij het monito-ren en onderhouden van hun gezondheidsstatus. Op deze manier kunnen slimme huizen de ouderen bijstaan en ondersteunen om langer thuis te blijven wonen.

Deze thesis presenteert het ontwerpproces van een cognitieve training met spelelementen voor het ondersteunen van ouderen die wonen in slimme huizen. Dit wordt bereikt aan de hand van een gebruikersgerichte ontwerpbenadering, waarbij ouderen en domeinexperts in de verschillende fasen van het ontwerpproces worden betrokken. Het trainen van de cognitie-ve functies wordt waargemaakt op een spelende manier. Het resultaat van het onderzoek is een bordspel dat verbonden is met het slimme huis. De finale testen zijn uitgevoerd met een digitaal prototype dat is geëvalueerd door middel van interviews met experten en beperkte gebruikerstesten met de ouderen. Dit resulteerde in een positieve validatie van het concept. Het resultaat van dit onderzoek bevindt zich nog in babyschoenen, verder onderzoek moet gebeuren om het langdurig effect na te gaan bij gebruik van het product.

Designing a gamified cognitive training for elderly

people to support ageing in smart homes.

Nina Storms Master thesis

Department of Industrial Design Ghent University

Kortrijk, Belgium

Supervisor(s): Johanna Renny Octavia, Femke Ongenae Abstract - The population of Flanders is ageing rapidly. The

population is growing older and this is accompanied by the loss of physical and cognitive functions, resulting in more and more older people resorting to service flats, retirement homes or domestic nursing support. The limited number of places available in these service flats and retirement homes creates a problem, as does the limited number of domestic nursing assistants. As a result, smart homes are seen as a possible solution to the ageing population. Given that smart home technologies can help the elderly with everyday tasks, as well as monitoring and maintaining their health status. In this way they can support the elderly to live at home for a longer period of time.

This dissertation presents the design process of a smart home application that can help the elderly in training their cognitive functions and allow them to live at home for a longer period of time. This was achieved through a user centred design approach, involving the elderly and domain experts in the different phases of the design process. Training the cognitive functions is realised through gamification. The result of the research is a boardgame that is connected to the smart home. The final tests were performed with a digital prototype that was evaluated through expert opinions and limited user tests with elderly people. This resulted in a positive validation of the concept. The result of this research is still at an early stage, further research needs to be done on the long term effects of using the product.

Keywords - Elderly people, Smart home application,

Gamification, Cognitive training, Ageing in place, User-centred design

I. INTRODUCTION

For the first time in history, the life expectancy of most people lies in their 60s and above [1]. 19% of the population in Europe are people over the age of 65, and this percentage will continue to rise in the coming years [2]. Growing older, however, does not imply that all elderly people are in good health; a large part of this population group is in need of help [3]. As people age, they experience a loss of physical and cognitive functions, and these losses are accompanied by a need for help and modifications to improve their quality of life [4]. Keeping the quality of life of these elderly people stable is typically accompanied by moving to service flats, retirement homes or domestic nursing support. Not only the limited number of places available in retirement homes and

service flats is a problem, but also the reduction of the working population will lead to a shortage of caregivers in the near future [5].

Encouraging elderly people to grow old in their own homes has been emerging for a number of years, but this requires significant changes in how the elderly live. The need to let the elderly live at home as long as possible in a safe way, while health costs are controlled, has led to the concept of "smart homes for the elderly" [6]. A Smart Home can be defined as a residence equipped with computing and information technology which anticipates and responds to the needs of the occupants, working to promote their comfort, convenience, security and entertainment through the management of technology within the home and connections to the world beyond [7].

These smart home technologies are a potential solution to support the elderly as they grow old in their own homes, allowing them to live in a residence of their choice without having to move when their needs change based on their health [8].

As people get older, they suffer from physical problems, such as fall incidents, or cognitive problems [9]. The two may appear unrelated at first, but the physical and cognitive problems are often connected [10]. As people get older, the risk of fall incidents also increases; about 30% of people over the age of 65 are faced with at least one falling incident per year [11]. These fall incidents are caused by physiological, sensory and cognitive factors, among other things. By tackling the cognitive factor, it can therefore be ensured that the elderly reduce their risk of falling [10]. Improving or maintaining cognitive functions therefore not only results in fewer (mild) cognitive impairments, but also in fewer physical problems.

Therefore, this research will focus on the design of a product that is connected to the smart home, and that can help the elderly in training their cognitive functions. The aim of this research is to increase the independence of the elderly.

II. RESEARCH QUESTION

The research question that is addressed within this research is: How can smart home technology enable older adults to live at home for a longer period of time?

In order to tackle this problem, a number of objectives have been set.

- To investigate how and to what extent smart home technology can support older adults’ independence. - To design a product/application/system based on

smart home technology to support independent living through co-creation with older adults.

- To investigate the perspectives of older adults on independent living and their views on smart home technology.

- To evaluate the user acceptance of the designed product/application/system in the context of smart homes

- To investigate what conditions a design for the elderly must meet.

- To investigate what conditions a product must meet to reduce cognitive decline among the elderly.

III. LITERATURE REVIEW

A. Designing a cognitive game for the elderly

Ageing is accompanied by the loss of cognitive and physical functions, these losses make the use of everyday products increasingly difficult [12]. A number of basic rules for designing for the elderly must therefore be taken into account. What follows are basic recommendations that have been taken into account in the design within this research.

The elderly experience a loss is vision, hearing and touch & movement. Therefore a great colour contrast and a big text fonts are used [13, 14]. The written text is supported by being read out loud [15 16]. To compensate for the loss in motor skills, large buttons and pawns are used [13, 16].

When designing a cognitive training it is best to use a tangible user interface. A connection is made between the digital and the physical world by giving a physical form to digital information [17]. Reducing the gap between the digital and physical world, resulting in a more natural and intuitive interface for the elderly [18].

When a tangible user interface is used to train the cognitive functions of the elderly, this ensures a greater positive effect. This can be explained by the fact that the attention can be given entirely to the task and not to how they should operate the interface [19, 20].

In order to experience a long-term effect of this training, it is not sufficient to perform these exercises from time to time; only older people who include the exercise for everyday learning will experience the long-term positive effects of memory training [21, 22]. In order to get the best effect from these exercises, a link should be made to the daily life of the person, so that the skills used in the training are also used in everyday life [22].

loss in cerebral blood flow [25]. When physical training is combined with the training of cognitive functions, the positive effect is greater than when one of the two is trained alone [21, 25].

B. Competitive market

The preceding section discusses which conditions a game for training the cognitive functions of the elderly should meet. This section provides an overview of a number of promising studies that are similar to what this research aims to achieve.

The condition that is least met is combining the training of physical and cognitive functions. Only one similar study has been found that applies this condition and that is CityQuest [26]. In this study, spatial navigation, obstacle avoidance, and balance control of the elderly are trained using a WII balance board.

The next condition that only a few studies use is the use of a tangible user interface. In general, the studies only use a digital interface. A study that does use a tangible interface is MIDAS [27]. MIDAS focuses on medical training for prevention, where for example the elderly can fill their pill box in a step-by-step process where they can ask for help.

The third condition that a reasonable number of studies take into account is the evolution of the elderly. Some of these studies are: Long Lasting Memories in which a game is developed that focuses on training memory, attention, perception and reasoning [28]. A second study is Eldergames, A research supported by the European union developed games that focus on improving the cognitive function of older people [29].

The condition that most studies meet is a link with the daily life of the elderly. Almost all studies in which a similar product is designed make use of this. However, commercially available games such as BrainHQ, CogniFit and Brain Age that claim to train memory do not meet this requirement [30, 31, 32].

IV. METHODOLOGY

The process followed in this research is based on the double diamond method (Figure 1). This method differs from the traditional linear style by integrating diverging and converging phases in which some form of integrated evaluation and selection of ideas and concepts takes place [33]. The diverging and converging phases are represented by the two diamonds in Figure 1, representing a process of exploring an issue more widely or deeply (divergent thinking) and then taking focused action (convergent thinking) [34].

A. Phase 1: Discover

In order to really attempt to understand the user, semi-structured interviews were held with three groups of elderly people; elderly in retirement homes (six people), in service flats (six people) and elderly who live in their own home (six people). The goal of these interviews was to discover their opinions about technology and smart home technologies. The interviews took place where the elderly live, so that they would feel more comfortable and do not feel limited to express their opinion. Interviews were also held with six people from the home care sector to find out what their opinion is about smart home applications and how they see this as a possible tool for caring for the elderly in the future.

Out of these interviews it became clear that both the home nurses and the various groups of elderly people are open to smart home applications that enable them to stay at home for a longer period of time. The group of elderly people who still live at home are already trying to incorporate a number of electronic devices in their everyday lives that help with their health, or for their entertainment. The problems expressed by the majority of the elderly are first and foremost user-friendliness; they find the technology they now use far too complicated. A second problem they raise is the price; the high initial cost without the certainty that they will be able to use it for a long period of time. The aspect of a smart home that most elderly people are enthusiastic about is voice control, because it feels familiar and is in their opinion easier to use.

B. Phase 2: Define

After the discovery phase the decision was made to develop a smart home application for the elderly with cognitive problems, however, this remains an extensive topic. Therefore, within the define phase the focus was on further research of these cognitive problems, in order to discover the pain points.

1) Observation

The aim of the observation is to gather more knowledge about a specific problem, the cognitive problems they experience in 'real life'. Data collection is based on observations rather than interviews since observations focus on people's behaviour and their interactions with the environment. Observing the elderly in their daily routine leads to a better understanding of how the elderly live and what their problems are.

The observation was carried out in a familiar environment, their home, for the elderly to behave as naturally as possible. The elderly were asked to carry out their daily routine and related activities in the same way as they normally would. With the small difference that they were asked to apply the 'thinking out loud' protocol. This method is used to get a better understanding of what the elderly are thinking when they are performing a certain action.

The observations took place with a couple, both 85 years old, six months ago they moved to an apartment because their old house had become too big to maintain. During the observation, the elderly were very distracted by the presence of the observer. They wanted to constantly stop carrying out their everyday tasks in order to engage in conversation. The elderly were also very conscious of themselves when carrying out tasks, which made them put in more effort.

2) Diary study’s

The goal of the diary study is the same as that of the observation, to analyse the behaviour and cognitive problems of the elderly in their daily lives. Observations are extremely time-consuming and the observation carried out shows that the elderly are distracted by the presence of the observer. For these reasons a diary study has been chosen, allowing data to be collected over a longer period of time.

The medium used in the diary study was a paper booklet, paper and pen were chosen because the elderly are most familiar with them. In this booklet the elderly had to answer 10 questions related to their day every day, they had to do so for a period of 7 days.

The diary studies were conducted in five households, the elderly had an average age of 84 years old.

3) Results

The data collected in the observation and diary studies is summarized and visualized by means of an experience map. Which helps to gain insight into all the stages the elderly go through on a day. In the experience map, shown in Figure 2, a typical day in the life of the elderly is shown, what the elderly do, what they think and how they feel about it. The activities they perform are divided into 3 categories:

- Green: these task relate to the health of the elderly. - Red: these tasks are household related.

- Blue: these are the activities that the elderly have for relaxation.

Figure 2 Experience map

Based on the preceding research, the decision was made to develop a smart home application that focuses on preventing the loss of cognitive functions among the elderly. The memory of elderly people declines rapidly and at a certain point in time all elderly people are affected. The elderly are already trying to keep their memory 'fit' by playing brain games such as sudoku.

C. Phase 3: Develop

The development phase starts the second diamond with a clearly formulated problem, being the development of a smart home application to prevent cognitive decline among elderly people. Different answers are formulated for a clear problem, where inspiration is sought in all possible places and from co-designing with the elderly [34].

1) Benchmark

Before ideas are generated, a more accurate understanding of what products are already on the market and what has

available in stores and techniques that have been researched but are not available on the market are being explored. From the literature, some clear guidelines and attention points can be obtained that a memory training application must comply with. These guidelines and related studies have already been discussed in section III.

2) Needs & wishes

Based on the data already collected by means of literature, interviews, diary studies and a benchmark, a list of needs & wishes that the product must meet can be generated.

Table 1 Needs & wishes

Needs Wishes

User-friendly Reduce the financial impact of care

Improve quality of life Reduced the burden on children Maintain independence Being less dependent on others Remaining at home for as long as

possible

Reduce the burden on caregivers Link to their daily life Voice input

Adapt to the elderly's evolution Feeling of a game (fun)

Focus on more than one cognitive function

3) Focus group

Using a morphological chart, ideas were generated in an analytical and systematic manner. From the list of ideas generated, the three best were chosen and discussed in a focus group. The aim of the focus group is to choose a concept that will be developed in the continuation of the research. And to collect additional opinions and recommendations towards the further design of the concept. The aim is to collect the opinions of the elderly about the different ideas and to get an insight in the opinions and needs of the target group. The hope is that the older people will talk and discuss with each other and in this way think more about what they consider to be good and bad about the ideas.

The target group consisted of 8 participants, all residents of the residential care centre de Pottelberg. The youngest participant was 81 years old and the oldest 93 years old, with an average age of 86. A supervisor from the retirement home for the elderly was present to stimulate the elderly to express their opinions or to give each elderly person a chance to talk, if necessary.

The three ideas were presented to the elderly during the focus group. The results show that the elderly prefer a goose board inspired board game, because it feels familiar. This board game will focus on training different cognitive and physical levels. Figure 3 shows sketches of the three ideas presented to the elderly. The further development of this application and evaluation will be discussed in the next section 'Phase 4: Deliver'.

D. Phase 4: Deliver

During the fourth and final phase, a feasible and viable solution is worked out for the specific problem that was identified at the end of the define phase. The fourth phase of this research will focus on the development and testing of the board game that was selected and conceptualized during the development phase. This will be done using a digital prototype that will be tested by experts and in more limited sizes by the elderly themselves.

1) The game

The final concept is a board game in which the elderly move a pawn, in this case a boat, over the board. Each square the pawn lands on is linked to a question. Figure 4 shows what the physical board game would look like.

The questions are divided into five different categories, each of these categories is linked to a cognitive or physical level, as shown in the table 2. The aim of the game is to answer a question from each category correctly as quickly as possible. Table 2 The categories

Category Cognitive / physical level

Handling situations Decision making, judgement & evaluation Friends & family Long term memory: Episodic memory My agenda Long term memory: Episodic memory General Knowledge Long term memory: Semantic memory Stretching exercises Flexibility and balance

Figure 4 Physical representation of the game.

2) Digital game design

In order to test this concept a digital prototype was used. Figure 4 shows a running screenshot of the game. The game is a combination of point-and-click and the use of the arrow keys. Making it easy to use and understand, even for inexperienced gamers. You have to move the mouse to the spinning wheel and click on it to find out how many steps you are allowed to take. With the arrow keys you can then move the boat to the corresponding box. To answer questions the mouse must be moved to an answer and then click on it.

Figure 5 Running screenshot of the game

3) Testing

The prototype was evaluated by 4 experts, focusing on three aspects: game elements, (tangible) user interface and cognitive decline. The experts were first informed about the purpose of the research, followed by an introduction to the user group. Then the experts are introduced to the purpose and intended use of the product. After which they could test the product themselves and finally evaluate the prototype. The evaluation consists of three parts:

The first part of the evaluation consists of open questions. The experts are asked to list three usability strengths and problems. This is followed by some specific questions for each expert. The second part of the evaluation is to complete the System Usablility Scale. And the third part consists of completing the Attrakdiff questionnair.

A limited number of tests have been carried out with elderly people. The aim of these tests is to discover the opinion of the elderly about the use of the prototype and discover the problems of the prototype. A short explanation was given about the purpose of the study and the product. This was followed by testing the digital prototype. Finally, the prototype was evaluated by completing the System Usablity Scale and the Attrakdiff questionnair. After which they were asked to name the biggest problem they experienced and what they experienced as the biggest strength.

From the expert interviews it can be believed that the game has the potential to help the elderly in training their cognitive functions. A number of recommendations were given regarding modifications to the interface, for example making the boxes larger and reducing the number of boxes.

Tests with the elderly showed that the elderly liked playing the game, even though the family and agenda questions were confusing, because they were not about their lives. If the questions were about their family, they would really like this. And the elderly found it difficult to operate the game because it is on the computer. They have difficulty picturing the final product as a board game.

4) The result

The goal of the game is to let the elderly train their cognitive functions in an enjoyable way to reduce cognitive loss. This is achieved by addressing different cognitive levels while playing the game.

The main goals that hopefully can be achieved after integrating the product into the lives of the elderly are:

- Increase independence

From the literature it can be concluded that not all elderly people have the same knowledge and that questions that are too difficult or too easy lead to frustration, therefore the difficulty of the questions is adapted to the behaviour of the elderly. The questions are divided into five levels of difficulty, this level will be determined for each category separately. The level is determined based on one game, if you answer all questions correctly today from the first attempt, the game will become more difficult the next time.

Table 3 gives an overview of the connection between the questions and the smart home.

Table 3 Questions and the connection to the smart home

Category Connection to smart home

Handling situations Currently there is no connection between the data of the smart home and these questions.

Friends & family These questions can be passed on from afar by the family via an application. My agenda The data on which these questions are

based is measured by the smart home. General Knowledge These questions are not connected to the

smart home, providing an extra element of fun.

Stretching exercises Fall detection of the smart home is used for safety. The exercises can be entered by a physiotherapist, doctor,...

V. DISCUSSION

A digital prototype was used for the final user tests. The design of this prototype lacked some functionalities that should have been included in it initially. This is due to the lack of knowledge about the encoding language and the program. In the end, most of the functionalities were integrated in the prototype and it worked, allowing some tests to be carried out with it. The tests that were performed with the digital prototype and the elderly were limited and therefore so were the results. The results showed that the elderly had difficulties imagining that the end result would be a physical game. This can be explained by the fact that the elderly never saw what the product was supposed to look like, only the digital version on the screen. The fact that the tests took place via skype and with an intermediate person made communication difficult as well.

Because a physical game was never tested with the users, the elderly, it is difficult to predict how they would accept the product. Results earlier in the research show that the elderly are enthusiastic about board games and like to work on improving their health. If these results are combined with the results of the limited user tests with the digital prototype. It can be believed that the elderly would accept the product and incorporate it into their lives.

VI. CONCLUSION

From research, literature study and interviews, it can be learned that the elderly would like to remain independent. This causes them to be open to the integration of smart home technologies into their lives.

Further analysis of the lives of the elderly by means of observation and diary studies has shown that the elderly try to perform exercises almost daily to maintain their cognitive and

physical health. This led to the design of a board game that focuses on training the cognitive functions of the elderly.

Research shows that the best method to train the memory of the elderly is by using a tangible user interface. As a result, the final concept combines virtual and physical components. This ensures that the action to be performed feels natural to the user. Which in turn ensures that full focus can be on the activity and not on how a certain action should be performed.

The final result of the research is a digital prototype. From the final tests with this prototype it can be concluded that the game is well constructed and that the different categories appeal to the elderly. From the expert interviews it can be believed that the game has the potential to help the elderly in training their cognitive functions. Although it has not been possible to test this during the research.

The next steps to be taken is the extensive testing of the product using a physical prototype. The last prototype that has been developed is a digital prototype and has been evaluated by a number of experts and some tests with the elderly. A next step would be to make a physical prototype of it and perform tests with the elderly based on user-friendliness. Initially this could be done with a simple prototype to evolve to tests with a more final prototype. After the user-friendliness has been fine-tuned, the long-term use of the product needs to be tested, to see if it has a long-term impact on the cognitive functions of the elderly.

Currently, the involvement of the (grand)children is only determined conceptually. Further research should be carried out into how best to involve them in the game. Thereafter, this should also be tested. In the end, this should be done together with the long-term testing of the game for the elderly.

REFERENCES

[1] Who.int. 2020. Ageing And Health. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/ageing-and-health> [Accessed 9 November 2019].

[2] Population.un.org. 2020. World Population Prospects - Population Division - United Nations. [online] Available at: <https://population.un.org/wpp/> [Accessed 23 November 2019]. [3] van Hoof, J., Demiris, G. and Wouters, E., 2017. Handbook Of Smart

Homes, Health Care And Well-Being.

[4] L. Sauvé, L. Renaud, D. Kaufman, and E. Duplàa, “Can digital games help seniors improve their quality of life?,” Commun. Comput. Inf. Sci., vol. 739, no. 1993, pp. 179–192, 2017.

[5] Frenier, I. and Beirnaert, A. (2017). Aangepast thuis wonen voor ouderen, voor iedereen mogelijk?.

[6] G. Demiris, B. K. Hensel, M. Skubic, and M. Rantz, “Senior residents’ perceived need of and preferences for ‘smart home’ sensor technologies,” Int. J. Technol. Assess. Health Care, vol. 24, no. 1, pp. 120–124, 2008.

[7] FK. Aldrich, “Smart Homes: past, present, and future.” In: Harper R (ed.) Inside the Smart Home. London, UK: Springer, pp. 17–39, 2003. [8] K. Marek and M. Rantz, "Aging in Place: A New Model for

Long-Term Care", Nursing Administration Quarterly, vol. 24, no. 3, pp. 1-11, 2000. Available: 10.1097/00006216-200004000-00003.

[9] K. N. Williams and S. Kemper, “Interventions to reduce cognitive decline in aging,” J. Psychosoc. Nurs. Ment. Health Serv., vol. 48, no. 5, pp. 42–51, 2010.

[10] N. A. Merriman, E. Roudaia, M. Romagnoli, I. Orvieto, and F. N. Newell, “Acceptability of a custom-designed game , CityQuest , aimed

Conf. Inf. Technol. Multimed. UNITEN Cultiv. Creat. Enabling Technol. Through Internet Things, ICIMU 2014, pp. 318–323, 2015. [14] M. Butlewski, “Practical approaches in the design of everyday objects

for the elderly,” Appl. Mech. Mater., vol. 657, no. October 2014, pp. 1061–1065, 2014.

[15] M. C. Brugnoli, F. Morabito, G. Bo, and E. Murelli, Cognition, technology and games for the elderly: An introduction to ELDERGAMES Project in, “‘Augmented itineraries’: Mobile services differentiating what museum has to offer,” PsychNology J., vol. 4, no. 3, pp. 311–335, 2006.

[16] W. IJsselsteijn, H. H. Nap, Y. De Kort, and K. Poels, “Digital game design for elderly users,” Proc. 2007 Conf. Futur. Play. Futur. Play ’07, pp. 17–22, 2007.

[17] R. Pastel, C. Wallace, and J. Heines, “RFID cards: A new deal for elderly accessibility,” Lect. Notes Comput. Sci. (including Subser. Lect. Notes Artif. Intell. Lect. Notes Bioinformatics), vol. 4554 LNCS, no. PART 1, pp. 990–999, 2007.

[18] W. K. Bong, W. Chen, and A. Bergland, “Tangible User Interface for Social Interactions for the Elderly: A Review of Literature,” Adv. Human-Computer Interact., vol. 2018, 2018.

[19] S. Bakker, D. Vorstenbosch, E. Van Den Hoven, G. Hollemans, and T. Bergman, “Tangible interaction in tabletop games: Studying iconic and symbolic play pieces,” ACM Int. Conf. Proceeding Ser., vol. 203, pp. 163–170, 2007.

[20] V. Meza-Kubo, A. L. Morán, and M. D. Rodríguez, “Bridging the gap between illiterate older adults and cognitive stimulation technologies through pervasive computing,” Univers. Access Inf. Soc., vol. 13, no. 1, pp. 33–44, 2014.

[21] S. L. Willis et al., “Long-term effects of cognitive training on everyday functional outcomes in older adults,” J. Am. Med. Assoc., vol. 296, no. 23, pp. 2805–2814, 2006.

[22] S. Bottiroli, E. Cavallini, and T. Vecchi, “Long-term effects of memory training in the elderly: A longitudinal study,” Arch. Gerontol. Geriatr., vol. 47, no. 2, pp. 277–289, 2008.

[23] U. Diaz-Orueta, D. Facal, H. H. Nap, and M.-M. Ranga, “What Is the Key for Older People to Show Interest in Playing Digital Learning Games? Initial Qualitative Findings from the LEAGE Project on a Multicultural European Sample,” Games Health J., vol. 1, no. 2, pp. 115–123, 2012.

[24] F. Imbeault, B. Bouchard, and A. Bouzouane, “Serious games in cognitive training for Alzheimer’s patients,” 2011 IEEE 1st Int. Conf. Serious Games Appl. Heal. SeGAH 2011, pp. 1–8, 2011.

[25] C. Fabre, K. Chamari, P. Mucci, J. Massé-Biron, and C. Préfaut, “Improvement of cognitive function by mental and/or individualized aerobic training in healthy elderly subjects,” Int. J. Sports Med., vol. 23, no. 6, pp. 415–421, 2002.

[26] N. A. Merriman, E. Roudaia, M. Romagnoli, I. Orvieto, and F. N. Newell, “Acceptability of a custom-designed game , CityQuest , aimed at improving balance confidence and spatial cognition in fall-prone and healthy older adults,” vol. 37, no. 6, pp. 538–557, 2018.

[27] MIDAS Innovation Report. [online] Itea3.org. Available at:

<https://itea3.org/project/innovation-report/6168-MIDAS_innovation_report.pdf.html> [Accessed 15 February 2020]. [28] C. A. Frantzidis and P. D. Bamidis, “Description and future trends of

ICT solutions offered towards independent living: The Case of LLM project,” ACM Int. Conf. Proceeding Ser., 2009.

[29] Gamberini L, Alcaniz M, Barresi G, Fabregat M, Ibanez F, Prontu L, Cognition, technology and games for the el- derly: An introduction to ELDERGAMES Project, 2006, In Psychology Journal, Volume 4, Number 3, pp 285-308

[30] BrainHQ from Posit Science. 2020. Brainhq From Posit Science. [online] Available at: <https://www.brainhq.com/?v4=true&fr=y> [Accessed 15 February 2020].

[31] Verstand Spellen - Train Uw Brein Met denkvermogenspellen. 2020. Cognifit. [online] Available at: <https://www.cognifit.com/nl/public/games> [Accessed 28 February 2020].

[32] Nintendo of Europe GmbH. 2020. Dr. Kawashima’S Brain Training Voor De Nintendo Switch. [online] Available at:

<https://www.nintendo.be/nl/Games/Nintendo-Switch/Dr-Kawashima-TABLE OF CONTENT

1

. Introduction ... 1

1.1 The need ... 1

1.1.1 Ageing population ... 1

1.1.2 What is a smart home and how can it help? ... 2

1.1.3 Partners ... 2

1.2 Research questions and the specific objectives ... 4

1.3 Methodology of the research ... 5

1.4 Impact of Covid-19 ... 8

2. Literature review ... 10

2.1 Design for elderly people ... 10

2.2 Smart home technologies ... 11

2.3 Smart home technologies and the elderly ... 13

2.3.1 The elderly peoples opinion on technology and smart

homes ... 15

2.4 Cognitive training ... 16

2.5 Tangible User Interface ... 17

3. Phase 1: Discover ... 19

3.1 Literature ... 19

3.2 Stakeholders ... 20

3.3 Interviews ... 22

3.3.1 Goal ... 22

3.3.2 Method ... 22

3.3.3 Participants ... 24

3.3.4 Location ... 25

3.3.5

Results ... 26

3.3.6 Insights obtained in the inteviews ... 29

3.4 Combining the findings of the literature and interviews ... 30

4. Phase 2: Define ... 33

4.1 Observation ... 33

4.1.1 Goal ... 33

4.1.2 Method ... 33

4.1.3 Participants ... 34

4.1.4 Results ... 34

4.2 Diary study ... 36

4.2.1 Goal ... 36

4.2.2 Method ... 36

4.2.3 Participants ... 39

4.2.4 Results ... 39

4.3 Comparing insights on observations and diary study ... 42

4.4 Trade-off table ... 43

4.5 Conclusion ... 45

5. Phase 3: Develop ... 46

5.1 Benchmark ... 46

5.2 Needs and wishes ... 51

5.3 Milestone 3 ... 52

5.4 Ideate ... 52

5.5 Focus group ... 58

5.5.1

Goal ... 58

5.5.2 Method ... 58

5.5.3 Participants ... 58

5.5.4 Location ... 58

5.5.5 Results ... 59

5.6 Conclusion ... 60

6. Phase 4: Deliver ... 61

6.1 Exploration idea ... 61

6.4.1 Goal ... 67

6.4.2 Method ... 67

6.4.3 Location & participants ... 68

6.4.4 Results ... 68

6.5 Digital game design ... 69

6.5.1 Developing the game ... 69

6.5.2 Look & feel of the game... 70

6.5.3 Gameplay ... 71

6.6 Testing ... 73

6.6.1 Expert interviews ... 73

6.6.2 Testing with elderly ... 75

6.6.3 Conclusion ... 76

6.7 The result ... 77

6.7.1 Goal ... 77

6.7.2 Final product ... 77

6.7.3 Game flow ... 79

7. Discussion ... 80

8. Conclusion ... 82

References ... 84

Appendix ... 89

1. Introduction

During this research a smart home application will be developed that can help the elderly in training their cognitive functions. In this section, an introduction is given to the target group, the elderly, and their needs. Followed by a short explanation of why smart homes can offer a possible solution, who Imec HomeLab is and why they are a partner in this research. Finally, this section explains how this problem is being approached within this research.

1.1 The need

1.1.1 Ageing population

The phenomenon of an ageing population can be explained by a combination of a reduction in the number of children being born and the post-war baby-boom generation getting older, which means that in most countries we are faced with an accelerated ageing of the population [1]. For the first time in history, the life expectancy of most people lies in their 60s and above [2]. Europe is one of the regions with the highest ageing populations, with a ratio of 1 elderly person to 11 (9%) in 2019, but by 2050, 1 in 6 (16%) people will be over the age of 65. Similar-ly, the population aged over 80 will triple, from 143 million in 2019 to 426 million in 2050 [3]. An improvement in hygiene, nutrition and medical care will allow people to age more and more [4]. Growing older, however, does not imply that these elderly people are all in good health; a large part of this population group is in need of help [5]. As people age, they experi-ence a loss of physical and cognitive functions, and these losses are accompanied by a need for help and modifications to improve their quality of life [6]. Keeping the quality of life of these elderly people stable is typically accompanied by moving to service flats, retirement homes or domestic nursing support. Not only the limited number of places available in retirement homes and service flats is a problem, but also the reduction of the working population will lead to a shortage of caregivers in the near future [7]. Informal caregivers, family or friends, can offer a solution to this problem, as can enabling independent living for the elderly [8]. The ageing of the population will affect almost all aspects of society, including labour and financial markets, the demand for goods and services, such as housing, transportation and social protection, as well as family structures [9]. Within this master thesis a solution will be sought for the housing and care aspect.

1.1.2 What is a smart home and how can it help?

Encouraging elderly people to grow old in their own homes has been emerging for a number of years, but this requires significant changes in how older people live. As the elderly grow older there are a number of problems that often recur such as falls, sensory impairment, immobility and isolation. The need to let the elderly live at home as long as possible in a safe way, while health costs are controlled, has led to the concept of “smart homes for the elderly” [10]. A smart home can be defined as “a residence equipped with a high-tech network, linking sen-sors and domestic devices, appliances, and features that can be remotely monitored, accessed or controlled, and provide services that respond to the needs of its inhabitants” [11]. These smart home technologies are a potential solution to support the elderly as they grow old in their own homes, allowing them to live in a residence of their choice without having to move when their needs change based on their health [12]. For example, smart homes technologies are aimed at supporting aging in place by facilitating tasks such as preparing food and cleaning. Furthermore, smart home technology can assist in monitoring and maintaining health status, can help older adults in communicating and maintaining social interaction with others, and many more [13].

The purpose of these smart homes for the elderly is to reduce the burden on caregivers and the financial impact of care, while improving the quality of care and the quality of life [5].

1.1.3 Partners

Imec HomeLab

Imec is an independent European research centre on micro-electronics, nanotechnology, ar-tificial intelligence, design methods and technologies for ICT systems that aims to be wor-ld-leading in R&D and innovation hub. They are a partner for companies, start-ups and aca-demia and bring together brilliant minds from all over the world in a creative and stimulating environment [14].

HomeLab is an initiative of imec and Ghent University, it is the first independent testing ground for smart home applications and servi-ces in Europe. It focuses on testing and co-de-veloping smart home innovations in a variety of application domains – from home automa-tion and (health)care to entertainment, energy and security. HomeLab is a two-story house (600m²) in which researchers and users can live temporarily to test and co-create Internet of Things (IoT) prototypes or products. With technical corridors in every room and an open

flexibility to install smart products and test their interoperability with other systems [15]. The HomeLab team supports innovation at different stages from concept and co-creation with potential users, to early proof-of-concept testing in a real living environment. Application do-mains can be care, comfort, energy, mobility, media, safety, etc. Personalisation and contex-tualisation of future services for the realisation of the ‘intuitive home environment’ is a key research focus. As such the HomeLab offers a unique co-innovation space for industry, rese-arch groups, non-for-profits and other stakeholders involved in the realisation of future living concepts [16].

The HomeLab is a unique testing facility that fits perfectly in an academic research setting. Where you can experiment with new technologies for residential applications, in a hyper-rea-listic setting, making it seem like you are at home. HomeLab is an environment that takes on the good aspects of both traditional laboratory testing and user testing at home. The ability to quickly and easily add new technologies to a space that can feel like a home makes it ideal for academic research.

1.2 Research questions and the specific

objectives

The population is ageing and not all those elderly people are in good health, causing them to seek help from home caregivers or moving to retirement homes and service flats. The popu-lation of elderly people is too large in comparison to the working popupopu-lation, so a solution is being sought to enable elderly people to age in place without a decline in their quality of live. Research question: How can smart home technology enable older adults to live at home for a longer period of time?

Objectives:

• To investigate how and to what extent smart home technology can support older adults’ independence.

• To design a product/application/system based on smart home technology to support independent living through co-creation with older adults.

• To investigate the perspectives of older adults on independent living and their views on smart home technology.

• To evaluate the user acceptance of the designed product/application/system in the context of smart homes

• To investigate what conditions a design for the elderly must meet.

• To investigate what conditions a product must meet to reduce cognitive decline among the elderly.

Hypothesis:

The design of a product/application/system, based on smart home technology to support the independent living of elderly people.

1.3 Methodology of the research

The process followed in this research is based on the double diamond method (Figure 4). This method differs from the traditional linear style by integrating diverging and converging phases in which some form of integrated evaluation and selection of ideas and concepts takes place [17]. The diverging and converging phases are represented by the two diamonds in Figure 4, representing a process of exploring an issue more widely or deeply (divergent thinking) and then taking focused action (convergent thinking) [18]. Each of the phases consists of a series of iterative loops where exploration and testing of ideas can happen [19].

Problem Definition Solution Discover Define Develop Deliver Reseach, analyze, synthesize Prototype, test, refine

Figure 4 Double diamond

The research starts with the discovery phase, the first half of the diamond, the goal is to under-stand the subject, smart homes for the elderly and its users to underunder-stand rather than simply assume, what the problem is [18]. Once there is a better understanding of the user, how they feel and what they want, it is possible to convert to a specific problem, this is done in the defi-ne phase [19]. After a clearly formulated problem has been identified as a result of the defidefi-ne

Following is a diagram (Figure 5) for the reader that shows which trajectory has been followed within this research and how the double diamond method has been applied to it.

• Research: Within the research blocks (literature) information was collected

about the phase the research was in, this information was used to support other steps in the process.

• User involvement: The research within this thesis is user-centred, so it is im portant to know the user’s opinion. Within the user involvement blocks, interviews, user tests, etc. were conducted in order to collect specific information about the experiences, preferences, etc. of the user.

• Ideation: Within the ideation blocks, ideas are generated and worked out in a detailed way.

• Prototyping: Certain ideas are developed using a physical or digital prototype. These prototypes are used to get a better picture of the product and to get feedback from the user.

• Milestones: Throughout the research important decisions were made that were of great importance for the further course of the research and which direction the research would take. These decisions were made based on the information gathered in the preceding phases of the research.

Research on smart homes

Smart homes for the elderly Interviewing the elderly and caregivers

Focus on older people with cognitive impairments

Observations of the elderly

Diary study

Prevention of cognitive problems

Benchmark

analyse existing solutions

Focus group

Selection of a specific solution

Generating solutions using a morphological map Smart homes for the elderly

Digital game design

User interface

Quick & dirty prototype Tangible user interface

User test

Disc

over

Define

Develo

p

Deliver

1.4 Impact of Covid-19

COVID-19, complete coronavirus disease 2019, is a contagious disease caused by the virus SARS-CoV-2. At the end of 2019 the coronavirus appeared in the Chinese city of Wuhan, and spread to the rest of the world within the next three months. From 11 March 2020, there was an official pandemic; a few days later, Belgium went into quarantine.

The virus is particularly dangerous for people with impaired immune systems, such as the elderly and the chronically ill, in whom it can lead to a serious pulmonary disease with a high mortality rate. It goes without saying that this has a major impact on the course of this rese-arch, in which the users, the elderly, are frequently involved.

When quarantine started in Belgium, the third phase, develop, was just completed. Much of the research went according to plan, only the approach of the deliver phase has changed. Fi-gure 6 shows how the deliver phase would have gone under normal circumstances. The user tests would have been divided into two parts:

1. Testing in early stages with Wizard-of-Oz prototypes. This involves designing simple prototypes with limited functionality, in which the researcher performs tasks during the tests that simulate the behaviour of the final product.

2. Testing in later stages with advanced prototypes. Prototypes are used that approach the functionality of the final product and do not require the intervention of the researcher.

The returning dotted arrow in Figure 6 at the deliver phase indicates re-run tests with prototy-pes in which the errors from the previous test have been solved. These tests would of course have been performed with the elderly themselves in their homes and in the HomeLab.

Figure 5 of the previous section already showed how the deliver phase was actually perfor-med. Physical prototypes have been replaced by a digital prototype. User tests with the elderly have been replaced by expert interviews via skype, tests with the parents of the researchers and limited tests with a some elderly people from a distance.

Research on smart homes

Smart homes for the elderly Interviewing the elderly and caregivers

Focus on older people with cognitive impairments

Observations of the elderly

Diary study

Prevention of cognitive problems

Benchmark analyse existing solutions

Focus group

Selection of a specific solution

Generating solutions using a morphological map

Smart homes for the elderly

D

isc

ov

er

Def

in

e

D

ev

elo

p

Deliver

2. Literature review

The previous section gave an overview of the problem, a possible solution, the partners and the methodology applied to this research. The current section covers designing for the elderly, smart home applications in general, smart homes for the elderly and their opinions on this topic. Within this research a serious game is made that can help the elderly to train their cogni-tive functions. In this section more explanation is given about training the cognicogni-tive functions and how the interface affects the product.

2.1 Design for elderly people

As the population is ageing, more attention than ever needs to be devoted to designing for the elderly. Ageing is accompanied by the loss of cognitive and physical functions, these losses make the use of everyday products increasingly difficult [75]. Design measures for designing for the elderly can be divided into two aspects, perception and attention [73].

Under perception three domains can be discussed; vision, hearing and touch & movement. With aging, the eyes become less sensitive to contrast sensitivity, motion perception and co-lour perception [74]. As a result of these changes, merely increasing the font size, greater colour contrast and increasing the illumination have a significant positive effect on visibility for the elderly [76, 77]. Anatomical changes in the ear cause losses in auditory acuity, high frequency tones and in particular sensitivity for pure tones [73, 74]. To minimize the effect of these losses, avoiding or controlling background noise and supporting spoken text with reada-ble text is a good starting point [73, 74]. There are many possireada-ble causes that lead to negative changes in motor skills in the elderly, leading to slower response times, declines in ability to maintain continuous movements, disruptions in coordination and balance, loss of flexibility and greater variability in movement [74]. This makes it difficult to keep objects stable or to push small buttons [76].

Design measures related to attention, are mainly related to the speed at which information is processed [73]. With age, it becomes more difficult to divide attention, which is why de-signing for the elderly should focus on simplicity and intuitiveness [74]. This means reducing the number of different options and the number of interface elements, but also reducing the speed at which items appear and disappear. When designing for the elderly, the number of steps or actions needed to perform a task should be as low as possible. The likelihood that an error occurs in one of the steps of a long sequence of operations is greater with older people than with young users [73]. Additionally, when the elderly receive immediate feedback from a system, this ensures that the elderly experience the product in a more positive manner [70]. It can be concluded from the above that text or symbols that are large enough and contrast sufficiently with the background should be used in the design for the elderly. Not only the text and symbols should not be too small, but also objects should be large enough for the elderly

2.2 Smart home technologies

American Association of House Builders announced the first official version of a smart home in 1984, after that, there was a rapid growth in this field [20]. But what exactly is a smart house? A house is not smart because it is well built, it makes efficient use of the available space; or because it is environmentally friendly by using solar energy, for example. A smart home often meets the above characteristics, but what makes the house smart are the interactive techno-logies inside [20]. Or as Aldrich’s definition says [21]: “A Smart Home can be defined as a resi-dence equipped with computing and information technology which anticipates and responds to the needs of the occupants, working to promote their comfort, convenience, security and entertainment through the management of technology within the home and connections to the world beyond.” And this concept of a smart home is applied within the various industries. Within the health-care sector, a smart home is a residence that helps the inhabitant to moni-tor and maintain health status, but also helps the inhabitant with health-related problems and thus raises the quality of healthcare [22, 23]. In the eyes of the energy sector, a smart home is a way to efficiently regulate energy consumption as well as alleviating supply constraints during periods of peak load [24]. In addition, within Europe, smart homes are one of the top 10 action possibilities within the Strategic Energy Technology Plan: “Create technologies and services for smart homes that provide smart solutions to energy consumers” [25]. The ICT sector focuses on the internet of things, using innovative solutions they aim for connectedness between people and things, with a focus on entertainment [22]. These different industries all interpret the definition of a smart home in a different way, while pursuing the same goals : a better quality of living [26].

The majority of users understand the benefits of a smart home in the various areas and sees how it can have a positive impact on their lives, but there are also drawbacks to these systems that may lead to failure or the inability to reach its full potential [27].

• Cost: From market research it can be concluded that the biggest reason why people do not accept smart homes are high initial investment costs from the consumer [28]. The cost of smart home technologies is high, while the potential user has yet to be convinced of the benefits. That is why it is advisable to develop a more modular systems that allows users to acquire these technology’s in stages [21].

to be able to hold them easily. When using verbal text it is a positive feature to support it with written text. In addition, a simple interface should be used, the amount of possible options should be limited. Finally, it is an added value to provide the product with immediate feedback.

• Privacy concerns: A serious concern regarding smart homes is what happens to the data that is collected, how it is protected and who can access it [27]. The data collected from, for example, smart electricity meters not only provides information about a household’s energy consumption, this

information can be combined with other data to form a clear picture of the user’s life, including their daily activities and life cycles [29]. To overcome this problem, an information security system and consumer privacy protocols and standards need to be designed to protect the data of the users [30].

• Ease-of-use: There lies a great opportunity in smart homes for the elderly, however, the majority of these elderly people have difficulties using

technology. They should therefore put a lot of time and effort into learning how to work with these technologies [31].

• Loss of social interaction: Within the health-care sector there is an additional disadvantage, while technology replaces social interaction with health care providers, informal caregivers are afraid that this will increase the burden for them [31].

• Lack of a legal framework: Although the development of smart homes within the health care system has already reached an advanced stage, the legal framework for telemedicine is still lacking [30, 31].

2.3 Smart home technologies and the elderly

The world’s population is ageing, and by 2050 16% of the population in Europe will be over the age of 65 [3]. The fact that people are able to become older does not mean that everyone is in good health, a large part of this population is in need of help [5]. The best way to support the elderly is to provide a physical environment where active ageing is stimulated by the use of innovative technologies such as smart homes [32]. Continuous observation and measurement of the physical and mental health of the elderly can ensure that loss of health functions is de-tected early and appropriate measures can be taken to reduce the problem before it becomes catastrophic [33]. This chapter will discuss the smart home technologies that have already been developed in order to get a review on the state of the art.

Most smart homes developed for the elderly consist of a collection of passive sensors that collect different data about the elderly, without the older person being expected to interact with the house [5, 34]. Research using focus groups, interviews and the knowledge of geronto-logy experts have led to the replacement of portable sensors by sensors located in the home, so that the older person is not disturbed or distracted by their presence [33]. In a study by B. Reeder et al. [34] a collection of studies on smart home technologies to support independent living of the elderly has been made, this collection of studies has been categorized based on the state of the technology, testing with older adults in the context of their homes or normal living activities, etc. When looking at the final results of this study, it can be seen that the effective and promising studies all measure the same parameters, being: fall detection, bed occupancy, motion detection, seizure detection and medication reminders. There is a strong reason for why these parameters are included in the effective and promising studies, changes in these measured values are an indication for different events. Increased bed restlessness prior to a fall [35]; decreased activity levels and increased bed restlessness prior to a cognitive decline [35]; decreased bed restlessness and increased bradycardia (slow pulse rate < 30 bpm) before a cardiac event [36]; decreased activity levels, increased bed restlessness and increased time spent in bed prior to hospitalization for gastrointestinal bleeding [37]; and many more. J. van Hoof et al. have bundled 13 researches in one book to get an overview of the practi-cal examples and lessons learned [5]. A smart home as test environment and exhibition is common and aims to test and improve the technology, but also to show what is possible in a smart home for the elderly [38, 39, 42]. The house of the present [38] collects more than 100 different smart home technologies that focus on aging in place of the elderly, every year the latest applications are added and out-dated technologies removed. At the elderly resource centre [42] the focus is on attracting the elderly, to make them aware of what is possible, so that they themselves can choose to use smart home technologies. The technologies used can be divided into four categories [38].

• Convenience services: systems that make everyday tasks easier by automating the house.

• Welfare services: applications that stimulate the resident to connect with other individuals, friends, family, ... to prevent loneliness.

• Security and surveillance: solutions that secure the house against people from the outside in order to comfort the resident.

• Treatment and care: applications that facilitate contact with caregivers, as well as monitoring and observing the elderly in order to detect behavioural abnormalities and physical changes.

The Rosetta project [41] is a research project to support elderly people with mild cognitive impairments and dementia in performing everyday tasks using smart home technologies, for instance, by reminding them about activities and supporting them in social contacts via a pic-ture dialling function; the house monitors early signs of changes in behaviour patterns and functioning and provides alerts for important deviations from a persons’ normal behaviour; and provides autonomous surveillance with sensors and smart cameras. From the research it can be concluded that it was a successful experiment, the elderly experienced the test period positively and also the caregivers saw a positive effect on the lives of the elderly.

TigerPlace [43] is a state-of-the-art housing facility and testing environment where true aging in place is applied. The elderly move to an apartment equipped with smart home technolo-gies, where they stay until the end of their day. The apartment is equipped with motion sen-sors, bed sensen-sors, stove temperature sensen-sors, and fall detection sensen-sors, which are designed to be as undetectable as possible for the elderly. The research in TigerPlace has shown that changes in health can be detected by the house before the residents themselves report chan-ges or complaints.

From these studies it can be concluded that mainly passive technologies are used to monitor the elderly and detect anomalies, such as: sensory floor, motion and bed sensors, and security and surveillance applications.

2.3.1 The elderly peoples opinion on technology and smart

homes

The benefits and added value of smart home technologies to support aging in place of the el-derly is well understood, but a successful integration of this technology in the life of the elel-derly person depends on their acceptance of these systems [44]. Initially, the elderly are reluctant and not very enthusiastic about the idea of a house full of technology, but research shows that 88% of the elderly change their vision positively towards a smart home after having carried out some tests in the house [45]. There are still aspects of the technology in their homes that scare the elderly, such as the fact that they will have no control over the technology and that it will have too great an impact on their lives [46, 47]. For example, they are afraid of the stigma, that they will be considered “old” or “frail” when it is known that they are using technology developed especially for the elderly, such as, for example, very present and prominent medi-cation reminders [46, 48].

One aspect of smart homes to which the older people are more open than the younger po-pulation is the sharing of measured data and who has access to this data in general [25, 49]. The elderly agree that the data measured in the home may be passed on to professional and informal caregivers, but clearly demand for their own participation in decision making [44]. This can be explained by the fact that older people want to remain independent for as long as possible, as soon as their health deteriorates, they want to give up part of that freedom in order to remain as independent as possible [46]. They are very enthusiastic about the idea of a solution to be able to stay at home for longer, not yet for themselves but for other older peo-ple who have poorer health [46]. The fear of not being in control of the technology is because they think they will not be able to operate it, for this purpose research has been done into the interface that best suits the elderly [45, 50]. Research has shown that the elderly prefer voice input over other operating modes, since it feels natural and makes them feel less lonely, although they do prefer the voice input in combination with a standard interface [45]. The possibilities of smart home technologies results in the elderly finding it too expensive, even before they have even been informed of a price [45, 50].

It can be concluded that the elderly are open to a solution for growing old in their own homes, but that the technology aspect discourages them. The current problems they have with tech-nology cause them to assume that they will also have it with a smart home, however, having tested the technology, it turns out that they can nevertheless work with it and that it was not as difficult as expected. The elderly continue to find the high installation costs a problem, be-cause they are not certain that they will be able to use it for a long period of time.