1. Introduction to the Join-In project and its goals

 

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Demographic Changes

In Europe in the near future, it is estimated that the EU-25 countries will experience a demographic shift from 2000 when 15.7% of the population was over 64, to an estimated older population of 17.6% in 2010 and 20.7% in 2020 [1]. Also the number of the “very old”, 85+ will rise continuously. Thus it is expected that, in the EU the number of 85+ will triple from 23.7m to 62.4m by 2060 [2]. This will have a major impact on public expenditure. The 2012 Aging Report [2] forecasts a rise of 4.1% of GDP of high-age related costs. Also the European labour market will be affected. It means that more dependants have to rely on fewer active nursing staff and dependants. The demand of nursery homes will be growing. For these reasons but also because elderly people want to remain in their own homes, solutions enabling them to do so, are needed.

Social isolation of elderly people

Many of Europe’s elderly citizens live by themselves. In Germany, for example, social analysts estimate that more than 40 percent of elderly people live alone [3], and even in Ireland a third of the people aged 65 years and over lived by themselves in 2009 [4]. Many of these suffer from loneliness and social isolation [5].

Loneliness and social isolation in the elderly are major problems in elderly care. Activities offered by social services do, however, often not reach those most in need. Reasons for this are: social deprivation, low self-esteem or physical inability.

Studies show that people lacking social contacts are more susceptible to diseases, to infarction, stroke and the onset of Alzheimer’s disease [6, 7]. At the same time it is true that loneliness leads to social isolation and to lack of exercising, which itself delays healing processes and speeds up aging. The Join-In project aimed at counteracting loneliness in the elderly by providing technologies and a methodology for elderly persons to participate in social activities.

Join-In Objectives

diakonie17_1Join-In tackles a problem that clearly affects a large amount of the population. Social networks during the last decade have shown themselves as a powerful tool for connecting people and providing emotional support from/to family and friends. This will help the elderly and motivate them to stay fit; it will also reduce treatment by supporting prevention. Additionally, our solution are low-cost, thus seniors of different economic backgrounds can afford these.

Join-In provides tools and activities for social networking specially targeted at the elderly non-experienced computer user. Activities offered are a memory card game, called “Memofix”, a biking exergame and exercises. To enforce communication the “Memofix” is connected to the Join-In videoconference system which can be activated/ turned off individually. Besides the networking features like setting up interest groups, the platform holds an e-mailing and a videoconferencing system. A moderator modul allows the presence of a person to help connect the seniors or to offer special services like gymnastics. On top of that Join-In developed a senior-friendly controller. The prototype is available. Prototypes are also available for 2 more exergames, one concentrating on coordination (“Maze”) and one on exercising different parts of the body (“AntiqueHunt”).

References

[1] EC 2007a http://ec.europa.eu/employment_social/social_situation/docs/ssr2005_2006_en.pdf
[2] http://ec.europa.eu/economy_finance/articles/structural_reforms/2012-05-15_ageing_report_en.htm
[3] http://www.dw.de/poverty-among-the-german-elderly-on-the-rise/a-15092811
[4] http://www.irishexaminer.com/ireland/101000-elderly-women-live-alone-98536.html
[5] http://www.egga.ee/RecommendationsFinalwCoverTOC.pdf
[6] Sorkin D, Rook KS, Lu JL: Loneliness, lack of emotional support, lack of companionship, and the likelihood of having a heart condition in an elderly sample. Ann Behav Med. 2002 Fall; 24(4):290-8
[7] Tomaka J, Thompson S, Palacios R: The relation of social isolation, loneliness, and social support to disease
outcomes among the elderly. JAging Health.2006 Jun; 18(3):359-84


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3. User requirements of the elderly

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Background and Methodology

The Join-In portal were developed on user-based design. All developments were done in close co-operation with the users. It has to be kept in mind that especially older elderly people are not the main target group of social networks nor of game developers.
Scenarios, persona descriptions and literature reviews helped us to get a first impression on the user group’s interests . By a mixed methods approach (focus groups, round table discussions and questionnaires) the users’ interests and expectations, but also fears and anxieties were further assessed.

User groups in Germany, Hungary Norway and Ireland supported the project. In each user group key persons were identified and regular activities with the users were organised. Altogether 134 users supported the user requirement analysis: 39 senior citizens in Germany, 45 in Hungary, 28 in Ireland and in Norway 22.

Results

Quality-of-Life

Being able to participate in social life and to be in contact to others was found to be most important. The users emphasized that the quality of life is reduced once communication and sharing daily experiences with other people is no more possible. This finding supports the project goal “social networking of elderly who are due to reduced mobility unable to go out and meet people”,

Maintaining mental and physical health also ranges high on the agenda. Mobility, being able to remain in one’s own house and self-sufficiency are important to elderly. Research results showed that high aged elderly adjust well to decreasing health conditions. They accept these and adapt their activities accordingly. Most senior citizens feel that only when the mobility problems stop them from socialising it impacts their quality-of-life.

Content of the social network

Content and motivation for using the network had to be sought. We, therefore, assessed

  • Hobbies and preferred activities
  • Attitude towards exercising
  • Technical /computer/ computer gaming and exergaming experience

Hobbies and preferred activities differed widely between the participating countries. They ranged from gardening (Ireland) to playing board games (Germany) to cooking and surfing on the internet (Norway).

Exercising was felt to be a favourite pastime in all the countries. Our user analysis showed that around 78% of the involved users exercise on a regular basis. The importance of exercising is very clear to all involved users. Walking and cycling turned out to be favourite activities in almost all of the participating countries.

The Consortium had seen gaming as a communicative activity that makes socialising easy. This needed to be assessed and also the requirements of the older generation on a computer game. From the participants around 57% owned a computer. Elderly above the age of 75 rarely owned a computer and even less play or know computer games. Board and computer gaming sessions in the different countries were set up out which type of games the users would like and what their requirements on the game would be. It showed that usefulness, i.e. training the brain, was one of the most important criteria. The following other conclusions could be drawn

  • Communication is more important than the look of the game, though the graphics need to be clear
  • The game should be cooperative as well as competitive
  • The rules of the game should be simple
  • Visual and verbal explanations of the rules would be appreciated
  • The speed of the game should allow to correct false moves

Exergame sessions were organised with the senior users in all partner countries. We assessed the Wii + controllers as well as the Xbox +Kinect. The participants tried different games. The setting and English language instructions of the Wii console proved difficult. On top of that – due to arthritis – many German and Hungarian elderly users found it hard to get a grip on the Nintendo Wii Remote to being able to use the buttons up front and in the back at the same time. Also the Irish users thought the Wii Remote as being too fast to control and that it required too much precision. In Norway the users only played games that did not require any input through movement. In all cases an assistant was required to set up the games.

Contrary to the German and Hungarian users who had difficulties with Kinect’s sensors, as they were not always able to hold their hand still for the time needed to select an option, the Irish user group found the Kinect to be an intuitive controller.

It needs to be noted that the exergaming sessions became -after overcoming the first mental burdens- a big favourite with the users and turned out to be vastly entertaining.

The following motivational factors in playing could be observed in the user sessions

  • understanding – once the participants understand the new game it becomes fun
  • recognition – known elements ease the access to new games
  • communication – this is the medium for fun, exchange, instructions, etc.
  • reassurance, e.g. by showing achievements -elderly people often lack confidence and are afraid of embarrassing themselves.

Requirements on the social network

Social networking was a new concept to many of the users – especially in Germany – and difficult to grasp. The requirements of the users on the social network can be summarized as follows

  • The new technologies must be beneficial
  • The new technologies must be easy to use
  • The user interface has to be clearly arranged since the actual generation of elderly is not used to a “windows menu structure”
  • Age related limitations have to be taken into account
  • The exercises should not be too fast or too difficult
  • Different levels of difficulty make the applications (exercises, game, exergames) suitable for a wider range of people and more interesting for each participant
  • Things that relate to real life ease the access to new technologies
  • Local references should be given.
  • Data protection is very important to the German users
Infographic: Age-Related Health Problems in Design and User Experience
Infographic: Age-Related Health Problems in Design and User Experience

Conclusion

We found that a social network offering meaningful content which would allow exercising and brain training and other content that could also be entered by the elderly themselves (information on cultural and local issues, calendar functions) would find the interest of the target group.

Maintaining mental fitness is a major requirement with the elderly and this reflects in the user groups’ choice of the game. From a selection of games the users picked a memory card game which was named “Memofix”.

Keeping healthy is another major interest of the target group. We felt that offering an exergame which would motivate exercising would be a big asset to the users. Join-In, therefore, decided to test exergames concerning their usefulness and applicability for elderly users. All users thought exergames fun. The exergames which are on the market were found not suitable for the elderly. As cycling and walking had been named as favourite past times we decided on designing and developing a cycling exergame and a walking exergames and exercising videos specially targeted at the user group.

Many senior testers found the Wii Remote not suitable for the target group. On request of the users Join-In developed new controllers.

Further reading:

Report on user Requirement Analysis

4. Designing a game for seniors

What is a game?

A game is a structured activity with the emphasis on fun and enjoyment, and may sometimes include a problem solving dimension. A digital video game is comprised of many elements that include story and theme, mechanics, user interface, game balancing and experience, goals, challenges and feedback. Some elements have more importance than others in the design of games for the Join-In project which seek to enhance the social, cognitive and physical skills of the senior players. For example, a scripted story and narrative is not so important, as we wanted the players to socialise and perhaps tell stories through the act of participation in the gaming sessions.

What are the benefits of gaming?

Games can improve general life skills such as problem solving, motivational, cognitive and even physical skills [1]. Different game genres offer different benefits, for example a flight simulation game might train and instruct the player in the art of flying various aircraft, while an exercise game (exergame) might try to measure and improve the players cardiovascular fitness over time. These two examples may be considered to fall under the umbrella of serious games, i.e. games developed more so for training and educational purposes than solely for entertainment. Age Invaders [2] is a serious game that focuses on the elderly to encourage inter-generational interaction through the use of a touch sensitive floor as a means of controlling the game.

The principles of game design

Game mechanics are at the heart of gameplay and form a system by which a game is progressed. Mechanics are often grouped into categories such as space, objects, attributes and states, actions, skill, chance. One of the prototype games developed for Join-In was a multiplayer walking game that takes place inside a 3D maze space.

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The user walks on the spot and their movements are captured by a Microsoft Kinect camera which directs an avatar (a game object around the maze. The avatar has built in animations states which reflect the users actions. The goal of the game is to reach the exit point of the maze, with optional assistance from a walking partner who has their own avatar. The game enforces simple rules, such as the player cannot walk through walls.

The primary actions the player must be able to perform are to walk and make a gesture to turn the avatar left or right. The skills the game addresses are both physical (action of walking) and cognitive (navigating the maze). Chance is used to introduce an element of unpredictability, so the game does not become repetitive and offers a fresh challenge each time. For example, the configuration of the maze in the walking game could be randomised so the path to the exit point is varied.

A user interface is what allows a user to interact with a game. A core element of a UI is the menu system, it is typically the first controllable element of a game. In general, senior computer users can be expected to have reduced visual acuity and/or degradation of fine motor control. Font sizes should be at least 12-points to ensure readability and to make them prominent targets for selection. Moving interface elements such as pull-down menus or hierarchically walking menus should be avoided. Static user interface widgets such as large command buttons are well suited as they do not require pixel-perfect selection.

The home page for the Join-In social network used a series of static coloured balloons for the different activities. When a target is selected with the mouse (red balloon), it is enlarged.

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Game balancing is an important part of game design so that the difficultly threshold is lowered for players who perform poorly and raised to present a challenge for those players who perform well. Games can use adaptive difficulty systems that perform this function transparently without the knowledge of the user. For example, in the walking game the user could place constraints on the number of steps they could take to exit the maze and vary this number depending on their previous performance.

Feedback informs users of the progress they have made. The primary types of feedback are immediate and long term. Immediate feedback is presented to the user continuously and is an important part of making a game accessible. This includes context relevant information such as the number of steps taken so far in the walking game. Long term feedback is used to show user progress over time such as a chart illustrating the number of daily or weekly steps taken.

Blog4_Picture3User requirements inform the game design and are continuously evaluated as development proceeds. A list of prioritised requirements were gathered during the user requirements analysis stage of the project and some examples follow.

The ability to play competitively and cooperatively. The walking prototype supports two players who may compete to exit the maze in the least number of steps or who may cooperate to find the exit together.

Simple to follow rules (that do not cause trouble for elderly users). The concept of a maze puzzle is well known and the simple act of walking on the spot controls the avatar movement.

Fun to play. A fully rigged 3D model of a Lion was chosen as the avatar for the game to add to the ‘fun’ factor for the game (the avatar was chosen after consulting widely with the various user groups).

Infographic: Designing Serious Games for Seniors
Infographic: Designing Serious Games for Seniors

Conclusion

Game design is an iterative process where the final product takes shape from prototypes that are refined through play-testing sessions with the user groups. When designing for an elderly audience, particular attention must be taken of the requirements of the players to ensure the usability and acceptance of the end product.

References

[1] Kueider, A.M., Parisi J.M., Gross A.L., Rebok G.W. (2012). Computerized Cognitive Training with Older Adults: A Systematic Review. PLoS ONE 7(7): e40588. doi:10.1371/journal.pone.0040588
[2] Khoo, E.T., Cheok, A.D. (2006). Age Invaders: Inter-generational mixed reality family game. The International Journal of Virtual Reality 5(2), 45–50.

Further reading:

D3.2 Technical Design

5. Technical platform – user requirements

System Platform

In Join-In we designed and implemented a social network and portal, and developed computer games and exercise games that can be accessed through the social network.

System Platform – Requirement Analysis

We identified low-cost technologies for the home, open-source social networking frameworks, easy to use videoconferencing, and various gaming technologies that can be used when creating games for Join-In. It was found that the games and the social platform do not necessarily have to run on the same server but need to exchange data. Thus a common interface is facilitating the integration of various games with social networks.

We initially collected more than 120 requirements related to the Join-In platform, and were left with more than 60 after removing overlapping requirements. These were again sorted into 8 different categories (overall, senior, social tool, game, user environment, operability, documentation, security), and then prioritized based on the MoSCoW methodology; categorising the requirements as Must Have, Should Have, Could Have and Won’t Have. The outcome was 17 important requirements categorised at Must Have or Should Have. These include accessibility as this is a major concern for the user group that is considerably diverse, mostly not familiar with computers, and as many of them suffer from physical limitations. Moreover data security and privacy are essential for the users to have trust in the web-based services.

Infographic: Designing Social Network for Elders
Infographic: Designing Social Network for Elders

An full overview on the available low-cost technologies, open software systems that were analysed for use in Join-In and a user requirement analysis on the platform is presented in ”D 4.1: Report on low-cost solutions for developing home-based platforms adapted to the elderly”.

6. Introduction to Memofix

What is Memofix?

Memofix is a two player turn-based game based on the traditional card game known as ‘concentration’. The game consists of ten pairs of cards arranged in four rows of five cards. Initially, the cards are all placed face down. Each player takes turns to try and match pairs of cards by selecting the two cards they wish to turn over. When two cards are matched, they remain drawn in a face up position and form no further part of the game. A player is rewarded for a successful match by getting another turn. The game ends when all ten pairs have been matched and the winner is the player with the most matches.

Game setup

A game is started from the Join-In portal by one user inviting another to play.

For example, player ‘Pat’ is logged in and can see his friend ‘Bernice’ is currently online.

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Clicking on the ‘Memofix’ button will send an invitation to Bernice. Pat may also choose to video chat with Bernice so that they can see and speak with each other while the game is in progress.

Players may upload their own picture files to their Join-In account and can choose to use these images in the game. The purpose of this feature is to provide opportunities for storytelling and to offer a compelling reason for seniors to engage with the game on a recurring basis.

When one player accepts an invitation, the inviting player can now select a particular card deck to play with:

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Gameplay

Once a deck is selected, the game starts and each player takes turns. The player who must wait their turn (Bernice) sees their profile picture crossed out:

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During play, a simple feedback system displays short-lived notifications to the players. These notifications appear occasionally and praise successful card matches or offer encouragement when no matches are made. Bernice gets a positive feedback message after matching a pair:

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When the game ends, the loser receives a consolation prize in the form of a random scenic image from various natural parks.

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Memofix also supports a single player mode with three adjustable levels of difficulty, which enables players to either practice before playing online.

Do seniors enjoy playing memofix?

Results from the project suggested that participants enjoyed playing Memofix, more so than the physical game of concentration. Although the participants were in separate locations, this did not have a negative effect on the participants’ enjoyment of the game. As this is the context for which the game was designed (users playing at home by themselves playing with other users also at home by themselves), this is an extremely positive result.

7. Designing an exergame for seniors

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The Join-In Project targets a very sensitive audience for computer gaming. Elderly people have very little, if they have any, experience with computers and video-games. Therefore, it was crucial to find our target group’s special needs in order to provide them with motivating games that also helps them to enhance their quality of life.

For this reason the consortium of the project performed a very intensive user-requirement analysis. For a better understanding the special needs of a game design to elderly, user groups have been set up in Germany, Ireland, Hungary and Norway. With existing exergames (Kinect/Wii sport and dancing games) tests have been performed with elderly participants.

A selection of Exergames (Wii, Kinect and an early version of a persuasive game) has been tested with more than 40 elderly aged 55 to 90 years old, the majority of them being retired. Many of them had little or no experience with computers and computer gaming, and some were even reluctant towards new technologies. However, the concept of exergaming was well perceived by the participants, who found it inspiring and enjoyable.

Cultural differences and previous experiences seem to influence the perception of the exergames, such as preferences for particular games (e.g. boxing, slalom, golf etc.). The participants gave valuable input for the design and development of exergames for elderly; such as speed, intensity, who to play with, language, how it was to handle the remote control, brightness of colors and more.

3The user-groups of elderly people were vary depending on age, health situation and social network. What all have in common, is that the access to new technologies is through an obvious benefit. The results of the research are the foundation for a methodology of how elderly people can be attracted to digital media and to the social platform.

Over all it must be said, that the needs of the users are similar in all participating countries. Below is the finding of this research, which contains some obvious and some unique findings about elderly needs in modern game design:

  • The new technologies must be beneficial
  • The new technologies must be easy to use, this requirement is so far not met by the existing technologies
  • The user interface has to be clearly arranged since the actual generation of elderly is not used to a “windows menu structure”
  • Different age related limitations have to be taken into account (e.g. limited fine motor skills)
  • The interests of the groups should be met on a local basis. The local reference is very important for the elderly.
  • The exercises should not be too fast or too difficult
  • Different levels of difficulty make it suitable for a wider range and more interesting for each participant
  • Negative Experiences result in rejection, elderly can therefore not be confronted with inadequate solutions
  • Things that relate to real life ease the access to new technologies
  • Data protection issues have to be explained (e.g. negative propaganda of Facebook)

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Specifically related to games:

  • Rules should not be complicated
  • advanced gaming when the basic rules are clear
  • Cooperative and competitive game play
  • Specific exercises with a clear benefit
  • Correction of one’s mistake – they should not fear that they will damage the solution.
Infographic: Designing Exergames for Elderly Users
Infographic: Designing Exergames for Elderly Users

Recommended further reading:

8. User requirements of the seniors for exergames

Exergames and seniors

blog 8Exergame is a term used for video games that are also a form of exercise. In an exergame movements are usually tracked using a set of sensors, embedded in the device, and this is used to control the game. Exergames can be used as a nice way for senior citicens to exercise in fun way and thus stay physically active.

Some existing commercial exergames can be played by elderly, but they are not ideal since they are made for a younger audience. When we get older we both experience physical and cognitive impairments. For instance we find a decrement in the fine motoric skills, the balance gets worse and might lead to a risk of falling and both sight and hearing get impaired. We also see a decrement in episodic memory and a reduced attention span.

Existing games are often too fast, they have too much information at once – and on several places on the screen, there is often not enough contrast for seniors to see details and many games require movements that can be too challenging for seniors.

Nonetheless our test with some carefully chosen commercial exergames indicated that seniors really enjoyed this type of fun exercise given that they did not have to tackle too much of the technology.

diakonie24_1Requirements for exergames for elderly

The project defined some basic requirements for exergames for seniors. These requirements are defined based on state of the Art about elderly and games and physical and cognitive restrictions common amongst elderly. In addition we used observations of gameplay and interviews and group discussions after gameplay.

A game should be a game, that is, it should be fun to play, but there are some specific requirements that should be met when designing exergames targeting users over 70 years old. The requirements below are some of the requirements identified in Join-In.

1. Game rules should be simple
2. Layout graphics should be adequate for elderly
3. Must offer the possibility to choose difficulty and speed levels for each person
4. Must be beneficial for the physical fitness
5. Must be perceived as useful for the health
6. Must be fun to play
7. Should contain elements for fun and playability over time
8. Must allow the participants to see their progress
9. Must give positive feedback
10. Must follow “design for all” principles, including
11. Must have different levels of difficulty
12. Must allow for pauses
13. Should have only one centre of attention, no distractions
14. Mmust be safe to use
15. Should include some of these types of activities:
a. Warm-up b. Cool-down c. Balance d. Strength e. Endurance f. Flexibility (upper part of body)

The project also defined requirements for the possibility to add social elements in the games.

Recommended further reading: