Prof. Ron Baecker The Technologies for Aging Gracefully lab (TAGlab) Department of Computer Science, University of Toronto HCII Invited Course Los Angeles, 4 August 2015

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Designing for Seniors
Prof. Ron Baecker
The Technologies for Aging Gracefully lab (TAGlab)
Department of Computer Science, University of Toronto
Thanks to many present and past members of the lab and
to our collaborators from across Canada and the U.S.
HCII Invited Course
Los Angeles, 4 August 2015
Research for the Journey through Life
! The Technologies for Aging Gracefully lab (TAGlab)
designs and develops tech to make seniors & families
“smarter, i.e., more capable, resourceful, independent
" Not … making machines “smarter” to “watch over” seniors
! Method … focus on needs
" Identify where technology could serve human needs
and enable greater inclusion in life and in society
" Envision, design, build, test, improve, & commercialize
solutions for conditions such as AD, MCI, stroke, MS,
vision loss … and for normally aging senior citizens

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Identify real needs, then design and develop
! Diagnostic instruments that detect problems
! Prostheses that assist with or compensate for a loss
! Rehabilitative systems to strengthen or restore a facility
! Preventative interventions, e.g., to delay mental aging
! Ideally, technology interventions are informed by
medicine and the health sciences, and can in turn also
contribute to the development of such science
The Problem and The Opportunity
! The good news: we are living longer (U.N., 2012)
" 1950: 5% of world population is over 60
" 2013: 12%
" 2050: 21%
" 2100: 28%
" Years to enjoy family/friends, convey wisdom, reap rewards
! The bad news
" Alzheimer’s disease (AD), aphasia from stroke, Parkinson’s,
blindness, deafness, poor mobility, etc.
" Sensory, motor, cognitive challenges
" Isolation, loneliness, vulnerability, depression
! Can technology assist seniors? How?? … i.e.,
In response to what needs?

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Advances in Assistive Technology
! Visual challenges # Display substitution, re-creation
" Screen readers, audio description, descriptive video, sonification
" Haptic displays
" Nuances: Acuity /= glaucoma /= macular degeneration
! Hearing challenges # Sound substitution, re-creation
" Captions, sign language
" Haptic displays, e.g., of music (Tactical Audio Displays)
! Mobility and wayfinding
" Location tracking, mobile guidance systems
" Obstacle avoidance, e.g, smart canes
" Transport systems, e.g., smart wheelchairs
! Great stuff! But … the most critical needs for seniors??
Maslow Hierarchy
of Human Needs
! Self-actualization
" Need for a cause, calling,
vocation, fulfillment
! Esteem
" Need to feel satisfied, self confident, valuable; to have
meaningful work and activities; to develop personally
! Love
" Love, affection, sense of belonging, family, friends
! Safety
" Feeling of safety, freedom from danger or perceived danger
! Physiological
" Oxygen, food, water, warmth, health, fitness, seeing, hearing,
mobility

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Physiological Needs
! Seeking health information online
! Seeking health information via social media
! Keeping physically fit
! Maintaining a good diet
! Dealing with low vision
! Dealing with poor hearing
! Dealing with restricted mobility
! Facilitating breathing
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Safety Needs
! Avoiding falls
! Getting up and about every day
! Avoiding environmental obstacles
! Turning off the stove
! Avoiding medication errors
! Dealing with multiple chronic diseases

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Love Needs
! Staying connected with friends
! Staying connected with family
! Reconnecting to distant family and lost friends
! Making new friends
! Continuing to participate in community
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Esteem Needs
! Being able to remember names
! Being able to speak
! Being able to read
! Remaining cognitively proficient
! Not forgetting where you have left an object
! Being able to write
! Being able to create something, e.g., music

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Meaning in Life
! Understanding where you came from
! Telling your story, helping create your family’s history
! Thinking about and preparing for the end of life
! Giving something back
! Finding meaning in life
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Physiological Needs
! Seeking health information online
! Seeking health information via social media
! Keeping physically fit
! Maintaining a good diet
! Dealing with low vision
! Dealing with poor hearing
! Dealing with restricted mobility
! Facilitating breathing

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Sample Health Websites:
PubMed Health, Mayo Clinic, WebMD
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An Example of Social Media for Health
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FitBit to Monitor Physical Activity for Health
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Seniors Keeping WiiFit (or Kinected)
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Questions For Discussion
! Do these technologies empower seniors?
! How do they change the way medicine is practiced?
! What is sufficient evidence for technology adoption?
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Safety Needs
! Avoiding falls
! Getting up and about every day
! Avoiding environmental obstacles
! Turning off the stove
! Avoiding medication errors
! Dealing with multiple chronic diseases

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Fall Detection (commercial products, Alex Mihailidis)
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Electricity/Water Flow Monitor (Shwetak Patel)
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Crowdsourcing for Safety (Jeff Bigham et al.)
! Large-scale information gathering
! Example 1: Improving public transit accessibility for
blind riders by crowdsourcing bus stop landmark
locations with Google Streetview
! Example 2: Answering visual questions with
conversational crowd assistants, e.g.,
" Do you see picnic tables across the parking lot?
" What temperature is my oven set to?
" Can you please tell me what this can is?
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Questions For Discussion
! Are there disciplines other than computer science
relevant to safety?
! Why is medication safety such a complex issue?

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Love Needs
! Staying connected with friends, e.g., Facebook
! Staying connected with family
! Reconnecting to distant family and lost friends
! Making new friends
! Continuing to participate in community
The Problem
! A personal story
! Many individuals …
" Live alone, with little family and small social networks
" May have sensory and motor impairments
" May have little control over how they feel at a particular time
and when they are available for social contact
! Examples …
" Seniors living alone, in retirement homes, in long-term care
" People in long-term hospitalization, rehab, quarantine
" Individuals with chronic pain, MS, TBI, ALS
" People in hospice care
" 7/24 home-bound caregivers

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Social Isolation and Loneliness
! 10 to 43% of community-dwelling older adults are
socially isolated (Nicholson, 2012)
! A cohort stury of 1,604 older adults in the U.S. shows
that 43% feel lonely (Perissinotto, Cenzer, &
Covinsky, 2012).
Consequences
! Health effects
" Depression, morbidity, stress, functional decline, death
(Edelbrock et al., 2001; Perissinotto et al., 2012; Steptoe et al., 2013)
" Health risks comparable to the dangers of smoking
cigarettes and obesity (Cornwell & Waite, 2009)
! Loneliness kills !!
" A recent 2010 meta-analysis of 148 studies reported
“50% increased likelihood of survival for participants with
stronger social relationships” (Holt-Lunstad, Smith, & Layton, 2010)
! Socio-economic burden for older adults, families,
social institutions, government, taxpayers

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Connecting Seniors …
Bringing, Keeping Families Together
! Synchronous video chat
" Skype, Google Hangouts, …
! Asynchronous messaging
" Conventional email software
" Modern messaging apps, e.g., WeChat, WhatsApp
! But we (TAGlab) thought we could do better …
the result we call “InTouch”
Field Studies, Prototype Technology
! Interview and diary studies with seniors
" Home dwellers in chronic pain
" Patients in complex continuing care hospitals
" People in retirement residences
" People in long-term care facilities
" Home health care patients
! First deployment: home dwellers in chronic pain

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Design Implications for InTouch
! Design appliances, not software or interfaces
! Leverage pictures of family
! Focus on asynchronous messaging
! Support multimedia messaging, no need to type
! Use iconic communication, not verbal
! …
! Currently, 4th version of the technology
InTouch
! Touch frame, & send ‘wave’ (‘hi there’, request for contact),
voice, photo, video messages; see messages from loved one

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First Mixed Methods Pilot Study
! 1 older adult living in a retirement community
(65+, F)
! 5 frail oldest old living in a long-term care
facility (average age = 87.2, 3 F and 2 M).
Preliminary Results
! High perceived usefulness of InTouch for their
interaction with relatives
! Reduced feelings of being ‘left out’
! Increased perceived levels of interaction with
relatives (e.g., grandchildren)

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Opportunities and Challenges
! Ergonomic and digital literacy challenges
! Need for social support and family buy-in
! Different kinds of adoption and use, varying social
and cultural expectations
! Christie Gardens, Circle of Care, other studies
! Opportunity: Supporting not just social goals, but
also health goals and practical goal, i.e., enabling
seniors to stay at home (famli.net Communications Inc.)
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Questions For Discussion
! How do the needs for love and for health interact?
! How do various stakeholders and actors contribute to
increasing the health and happiness of seniors?
! Please share your experiences with respect to this
area.

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Esteem Needs
! Being able to remember names
! Being able to speak
! Being able to read
! Remaining cognitively proficient
! Not forgetting where you have left an object
! Being able to write
! Being able to create something, e.g., music
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Friend Forecaster
! Predict the names of individuals who you are
comparatively likely to meet in a location.

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MyVoice Inc.
! Aid for word/phrase recall
and articulation
Accessible, Large-print, Listening and Talking
e-Book (ALLT e-book) for Reading

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ALLT
$ Accessible, Large print, Listening and Talking e-reader
$ Combats social isolation —
reading together
in the same place
at different times
Intelligent assistive recording & reading
$ Collaborative and assistive access to
critical information
Support older adults and their caregivers
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Reading together
$ Audio e-book read in a familiar voice, recreating a
pleasant moment
Reading together “in the same place at different times”
$ Machine learning / speech recognition / interface design
Facilitates transparent recording for the caregiver or family
member reading to an older adult
Learning of reading speed
Automatic synchronization
Reduces playback/record
control buttons

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Collaborative information access
$ Support for assisting family
members and caregivers with
helping older adults process
critical information
Rich annotations
Interactive sticky notes
Multimedia (text, audio, video)
personal messages and reminders
Brain Training Exercises Are Believed to Aid
Cognitive Health and Delay Decline
! Can we slow down cognitive aging, and delay the onset
of Alzheimer s disease?
! A commercial frenzy ($250M in 2008 ==> up to $5B projected for 2015),
huge promise, but huge controversy

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Can We Slow Mental Aging?
! Evidence for brain plasticity in animal studies and
in rehab contexts suggests yes
! The concept of cognitive reserve (CR) suggests
that innate intelligence or aspects of life
experience like educational or occupational
attainments may supply reserve, in the form of a
set of skills or repertoires that allows some
people to cope with progressing AD pathology
better than others.
(Scarmeas and Stern, J. Clin. & Exp. Neuropsychology 25(5), 2003)
" But … these are impacts of life experience accumulated over the long-
term, over a lifetime
Controversy
! Many studies do not disentangle effects of recent
activities from those of lifelong activities
! Only a few studies evaluate medium-term impacts
" ACTIVE cognitive training for memory, reasoning, or speed of
processing (Ball et al.)
" Baycrest cognitive rehabilitation for memory, goal management, and
psychosocial skills (Winocur, et al.)
! Also, little evidence of transfer of training effects
from the game task to other tasks
! Thus we need more prospective research studies
" But they are very difficult and costly

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Questions For Discussion
! Please share your experiences with respect to this area.
! What about “feeling OK with technology, i.e., not
helpless” as an esteem need for seniors?
! Will computer literacy and “mastery” go away as a
problem in a decade or two?
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Meaning in Life
! Understanding where you came from (ancestry.com)
! Telling your story, helping create your family’s history
! Thinking about and preparing for the end of life
! Giving something back
! Finding meaning in life

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Multimedia Biographies for AD
(Baecker and Marziali)
! Problem: Degenerative brain disease impacts
memory, executive functioning, identity
" Who you were fades from your memory and families memory
" Huge caregiver burden, enormous toll on families
! Possible users
" 400K Canadians with AD in 2010 ==> 750K in 2031
" 36M with dementia worldwide ==> 66M in 2030 (AD Int l.)
! Solution: Digital life histories to aid reminiscing
" For individuals with moderate or mild AD, or MCI
" To help the individual with AD AND the family to remember
and to re-experience, to connect and to feel close
" A practical production method to produce multimedia bios
Ms F (91, mid-stage AD)

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Ms Z (85, mid-stage AD) and daughter
Research Finding and Challenges
! Findings
" Participants enjoy the viewings
" Viewings enhance reminiscing
" Group viewing stimulates family conversation
" Repeated viewings help rekindle sense of identity
" Biographies provide joy & emotional support to family members
" Biography improves AD caregivers ability to understand and
empathize with the biographee
! Challenges
" Gathering media, incl. SenseCam, Glass, social media
" Leveraging family resources to help transform
memories and experiences into stories

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Thanotosensitive Design (Mike Massimi)
! Ferguson et al., Technology in hospice, CSCW2014
! Massimi, Online bereavement support, CSCW2013
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Questions For Discussion
! Does technology distract us from the meaning of life,
e.g., perhaps we should read more books instead.

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Lessons Learned
! It s not just about memory or cognition, but about
identity and efficacy and self-worth
! It s not just for individuals, but for family,
community, caregivers, and clinicians
! The goal is not just prosthetics, but also
rehabilitation of health and preservation of health
! It’s highly multidisciplinary
" Computer science, neuropsychology, neurology, social work,
speech/language pathology, nursing, graphic design, …
! Observing and studying real use by real users in
real environments is the key to inspired design
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Baecker Design Framework: Can Look
Systematically for Design Opportunities
! Goal
! Place in Maslow Hierarchy
! Cognitive/social process
! Users
! Other relevant stakeholders
! Use model, usage style
! Design method
! Technology

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Discussion Example: InTouch
! Goal
! Place in Maslow Hierarchy
! Cognitive/social process
! Users
! Other relevant stakeholders
! Use model, usage style
! Design method
! Technology
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Research Challenge and Design Exercise
! Remembering important objects, finding lost objects

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Research Challenge and Design Exercise
! Detecting signs that warn of possible falls
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Synthesis Lectures on Assistive, Rehabilitative,
& Health-Preserving Technologies (M&C)

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Empowering Seniors for Additional Years
of Contributions
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Thanks for your attention and contributions!!
! Email: ron@taglab.ca
! URL: http://taglab.utoronto.ca/
! Thanks to past students & collaborators
and to financial supporters
" Alzheimer s Association (+ Intel Corp.)
" Connaught Innovation Fund, University of Toronto
" Google Research
" GRAND Network of Centres of Excellence of Canada
" Microsoft Research
" MyVoice Inc.
" NSERC
" OCE+CC
" Revera Inc.