Assistive robots for socialization in elderly people: results pertaining to the needs of the users

Abstract

Background/aim
Technological solutions can support the elderly, improve their quality of life and reduce isolation and loneliness. The Euro-Japan ACCRA (Agile Co-Creation for Robots and Aging) project has the objective of building a reference co-creation methodology for the development of robotic solutions for ageing. The aim of this study is to provide a pilot qualitative analysis of the real needs of elderly people and their caregivers when exposed to conversational activities with robots and to identify priority needs that should be developed from end-user perspectives.

Methods
A qualitative research design was adopted to define a pre-structured questionnaire that was administered to the elderly taking part in the piloting sessions. Three groups of end-users were included: subjects with an age ≥ 60 years, informal caregivers and formal caregivers.

Results
The interviews were carried out in Italy and Japan. A total of 17 elderly and 36 caregivers were recruited. Common needs in the two sites were categorized into 3 groups: Communication; Emotion Detection and Safety. General robot acceptance level is good and perception is positive among participants in the pilot sites.

Conclusion
A positive perception of the elderly on the application of a robotic solution was found and many are the needs that could be addressed by an appropriate and careful robotic development taking into account the real needs and capabilities of the involved subjects.

Full text

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Aging Clinical and Experimental Research
https://doi.org/10.1007/s40520-018-1073-z
ORIGINAL ARTICLE
Assistive robots forsocialization inelderly people: results pertaining
totheneeds oftheusers
GraziaD’Onofrio1,2 · LauraFiorini2· HiroshiHoshino3· AikoMatsumori3· YasuoOkabe4· MasahikoTsukamoto4·
RaaeleLimosani2· AlessandraVitanza5· FrancescaGreco1· AntonioGreco1· FrancescoGiuliani5· FilippoCavallo2·
DanieleSancarlo1
Received: 27 August 2018 / Accepted: 2 November 2018
© Springer Nature Switzerland AG 2018
Abstract
Background/aim Technological solutions can support the elderly, improve their quality of life and reduce isolation and
loneliness. The Euro-Japan ACCRA (Agile Co-Creation for Robots and Aging) project has the objective of building a refer-
ence co-creation methodology for the development of robotic solutions for ageing. The aim of this study is to provide a pilot
qualitative analysis of the real needs of elderly people and their caregivers when exposed to conversational activities with
robots and to identify priority needs that should be developed from end-user perspectives.
Methods A qualitative research design was adopted to define a pre-structured questionnaire that was administered to the
elderly taking part in the piloting sessions. Three groups of end-users were included: subjects with an age ≥ 60years, infor-
mal caregivers and formal caregivers.
Results The interviews were carried out in Italy and Japan. A total of 17 elderly and 36 caregivers were recruited. Com-
mon needs in the two sites were categorized into 3 groups: Communication; Emotion Detection and Safety. General robot
acceptance level is good and perception is positive among participants in the pilot sites.
Conclusion A positive perception of the elderly on the application of a robotic solution was found and many are the needs
that could be addressed by an appropriate and careful robotic development taking into account the real needs and capabili-
ties of the involved subjects.
Keywords Social robot· Elderly· Qualitative research· Needs
Introduction
Between 2015 and 2050 worldwide population is expected
to increase from 900million to 2billion people over the age
of 60years [1].
Older adults may experience reduced mobility, chronic
pain, frailty, dementia or other health problems, or experi-
ence events such as bereavement, or a drop in socioeconomic
status after retirement [1]. All these factors can result in
isolation, loneliness or psychological distress, determining
long-term care [1] and a rise in social costs.
In this respect, digital technologies could play a key role
in supporting the well-being of older people considering
also that more than 2billion people will potentially need
them by 2050 [2].
One proposed solution to face the care needs of the aging
population and to lower workforce demand in healthcare is
social robotics. However, while considerable progress has
been made in recent years in terms of technological improve-
ments, the ability of conversational agents to interact with
humans in an intuitive and socially viable way is still quite
limited. Indeed, an important challenge for social robotics
will be to design robots that can perceive the needs, the
* Grazia D’Onofrio
g.donofrio@operapadrepio.it
1 Department ofMedical Sciences, Geriatric Unit, Fondazione
Casa Sollievo della Sofferenza, SanGiovanniRotondo, FG,
Italy
2 The BioRobotics Institute, Scuola Superiore Sant’Anna,
Pontedera, Italy
3 Connectdot Ltd, Kyoto, Japan
4 Academic Center forComputing andMedia Studies, Kyoto
Bunkyo University, Kyoto, Japan
5 ICT, Innovation andResearch Unit, Fondazione Casa
Sollievo della Sofferenza, SanGiovanniRotondo, FG, Italy

Aging Clinical and Experimental Research
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feelings, and the intentions of the users, to adapt to the user a
broad range of cognitive abilities. Having robots these skills,
humans would mainly accept them as social companions
[3]. In 2009, Broekens etal. argued that robots had posi-
tive effects on health by lowering levels of stress, increasing
immune system response, decreasing the feeling of loneli-
ness, and increasing communication [4].
In this perspective, the Euro-Japan ACCRA (Agile Co-
Creation for Robots and Aging) project [5] has the objec-
tive of building a reference co-creation methodology for the
development of robotic solutions for ageing. An application
of this project is aimed at improving socialization through
the use of robotic platforms. These platforms will support
speech recognition and speech synthesis in the Italian and
Japanese languages. In Japan, the Rospeex speech recogni-
tion and speech synthesis engine will be used. The ACCRA
robotic solution will provide challenging interaction exer-
cises to stimulate intellectual curiosity of the elderly on dif-
ferent topics (i.e., cognitive stimulation, fashion, and golf)
which are adapted to their preferences and psychological
profiles [6]. Additionally, to investigate how the cultural
background could influence the personal attitude toward the
robotic service, each application will be refined and tested
in two different countries (i.e., Italy and Japan). Another
purpose of this project is the identification of the needs
and behaviors of the elderly and the caregivers and, con-
sequently, the continuous re-definition of the applications.
The aim of this paper is to provide a pilot qualitative
analysis about the real needs of elderly people and their
caregivers in the context of a use case centered on the con-
versation between the user and the robot and to identify the
priority needs that should be developed from the perspective
of end-users.
Methods
Participants
A qualitative research design was adopted for the needs study
using pre-structured questions. The study was approved by
a local ethical committee. Three groups of end-users were
involved: the elderly, informal and formal caregivers. The
socialization needs interview took place in Italy and Japan.
All participants were informed about the scope and aim
of the general project and the details of the needs study. All
of the interviews were 1-on-1. The average interview time
was 1h and it took place in pilot site offices.
The inclusion criteria for recruitment were: (1)
Age ≥ 60years, (2) Absence or mild level of cognitive
impairment assessed by Mini Mental State Examination
(MMSE) [7], (3) Ability to sign an informed consent. The
exclusion criteria were based on the: (1) presence of severe
acute or chronic disease, and (2) presence of moderate or
severe cognitive impairment.
The informal caregivers were recruited according to the
relationship with the subjects involved in the study. The for-
mal caregivers were recruited in a medical ward on the basis
of their elderly care experience.
In the Italian pilot site, the elderly, the formal and infor-
mal caregivers were recruited on June–August 2017 from
the outpatient department of the Complex Unit of Geriat-
rics of the IRCCS “Casa Sollievo della Sofferenza”. Before
starting the interview, a psychologist and a geriatrician have
introduced the project to every patients and caregivers, and
invited them to participate in the need interview.
In the Japanese pilot site, the elderly and the formal car-
egivers were contacted and recruited on September 2017
in Fukuzuen (social welfare corporation, located in Aichi
pref. Japan) and in Kyoto lighthouse Suzaku dorm (general
welfare center for the elderly, located Kyoto pref. Japan).
No informal caregivers were interviewed because not hang-
ing out at the above mentioned sites. Before the interview,
an Employee of ConnectDot, through the dormitories of
Fukujuen and Suzaku dorm, has introduced the project to
every patient and caregiver, inviting them to participate in
the needs interview.
In all pilot sites, the following parameters were collected
about the patients: gender, age, social support network, and
educational level (in years). The following parameters were
collected about the caregivers: gender, age, and caregiving
type [formal caregiver (geriatrician or nurse), and informal
caregiver (relative/unpaid or paid caregiver)].
To compare the two different cultures of the pilot sites,
the indicators of socioeconomic development assessing
wealth, population structure, and education levels were
drawn from the 2016 Human Development Report (2016-
HDR) for Italy [8] and Japan [9].
Interview specifications
The interviews were video–audio recorded and stored using
a recording device. For each participant, a code generated
by a randomized algorithm was associated with the related
audio–video data. The association table was stored by the
principal investigators of the study following the standard
security procedures.
Both countries were aiming to interview caregivers to gain
insights from their perspective on what their loved ones’ needs
would be. This allowed analyzing how three close groups
of people thought about the same subject. For instance: the
elderly person might view that they did not have a particular
need, but their caregivers might think otherwise. The inter-
views were meant to understand the context and the way of
life of the person with regards to their socialization issues,
to identify difficulties and needs in terms of daily activities

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and to measure early indications of the robot’s attractiveness
and its main functionalities. The interviews consisted of two
parts: (1) socialization needs and (2) perception of robots.
A semi-structured interview was designed, with questions
designed to explore in depth the context and way of life and
of the recovery in hospital/nursing home. The second part of
the interview included questions about the current experience
with technology in general and how the respondent felt about
robots (Appendix 1).
During the second part of the interview, in the Italian site, a
demo of the BUDDY robot was shown through the computer
of the researcher (with a simultaneous translation from Eng-
lish to Italian). BUDDY is a small-size robot designed to be
used as a companion at home. The video showed BUDDY as
an endearing emotional robot with a range of emotions that it
can express naturally throughout the day thanks to its interac-
tions with family members. The video showed also the various
services and activities performed by BUDDY: to protect the
home, to offer assistance in the kitchen, to entertain the family
with music and videos, to act as a calendar and alarm clock and
to interface with popular smart home solutions. The video is
available at the following link: https ://youtu .be/51yGC 3iytb Y.
In the Japanese site, in addition to a video about Rospeex,
a brief video of BUDDY was shown to the person (through
a simultaneous translation from English to Japanese by a
researcher) receiving the interview.
Procedure anddata analysis
Both in the Italian and Japanese pilot sites, the interviews were
fully transcribed verbatim. After transcription, each interview
was analyzed using the method of Thematic Content Analysis
(TCA) [10]. The first level of coding was meant to identify
themes and units of meaning. In this, we stayed close to the
wording used by the respondent. In the second level of cod-
ing, we used more theoretical words. Finally, the third level of
coding was the actual analysis: looking for recurring themes,
coherence and unique cases. In particular, the TCA is divided
into two fundamental analyses: (1) analysis of vertical content
[coding and categorizing by an intra-interview reading (pro-
gress of an interview on all codified themes)], and (2) analysis
of horizontal content [second coding and categorizing on read-
ing inter-interviews (illustration of a theme by all the inter-
views)]. In particular, the analysis was meant to highlight the
similarities and differences between the two pilot sites.
Results
Profiles oftheelderly participants
The characteristics of the elderly participants are shown
in Table1.
In the Italian pilot site, a total of 10 elderly patients
(M = 7, F = 3) with an average age of 73.9 ± 5.6years
(range 65–81years) were recruited from two types of
housing; 8 patients lived at home (2 of these patients lived
with their spouse, and 6 patients were widowed and lived
alone), and 2 patients (1 patient was widowed and 1 patient
was unmarried) lived in a nursing home. The average years
of education were: 7.6 ± 2.9years (range 5–13years).
From the interviewed patients, 2 patients had a mild hear-
ing impairment (with no difficulties to hear a telephone
call, a movie on TV or a conversation with their relatives/
friends), 1 patient had a mild vision impairment (with no
difficulties in watching TV or the Smartphone screen).
In the Japanese pilot site, a total of 7 elderly patients
(M = 1, F = 6) with an average age of 77.4 ± 8.8years
(range 63–92years) were recruited from two types of
housing; 1 patient lived at home with a spouse, and 6 wid-
owed patients lived in a nursing home. The elderly people
average years of education was: 11.7 ± 2.2years (range
9–16years). Among the interviewed patients, 1 patient
had a hearing impairment (specifically, she had difficulties
to hear a telephone call, a movie on TV or a conversa-
tion with their relatives/friends), and 6 patients had visual
impairment (thus, they had many difficulties to watch TV
or their Smartphone screens).
Profiles ofcaregivers
The characteristics of the recruited caregivers are shown in
Table2.
In Italy, a total of 30 caregivers (M = 13, F = 17) with an
average age of 50.5 ± 12.7years (range 33–68years) were
recruited. Among the caregivers, 15 of them were profes-
sional caregivers (12 geriatricians and 3 nurses), and 15 were
informal caregivers (13 relatives and 2 paid caregivers).
Table 1 Characteristics of the elderly
Italy Japan Total
Gender
Male 7 1 8
Female 3 6 9
Age
Average 73.9 ± 5.6 77.4 ± 8.8 –
Housing situation
Nursing home 2 6 8
Senior residence/home 8 1 9
Living situation
Living alone 6 0 6
Living with partner or children 2 1 3
Educational level
Average 7.6 ± 2.9 11.7 ± 2.2 –

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In Japan, a total of 6 caregivers (M = 4, F = 2) were
recruited for the needs interviews with an average caring
experience of 9.5 ± 4.1years (range 4–17years). All were
formal caregivers (nurses).
Needs
The needs from the elderly and caregivers perspectives are
shown in Table3.
The common needs both in the Italian and the Japanese
pilot sites were categorized into 3 groups:
1. Communication needs Call/video-call to keep in touch
with their family and friends. The need for help with
socializing and loneliness has been widely reported.
Table 2 Characteristics of the caregivers
Italy Japan Total
Gender
Male 13 4 17
Female 17 2 19
Age
Average 50.5 ± 12.7 Unknown
Role
Formal
Nurse 3 6 9
Geriatrician 12 0 12
Informal
Relative 13 0 13
Volunteer 2 0 2
Table 3 Daily life needs from elderly and caregiver perspective
Country
I = Italy
J = Japan
Users
E = elderly
F = formal
caregiver
I = infor-
mal
caregiver
Need category Service
I, J E, F, I Communication needs 1. Call/video-call
to keep in touch with their family and friends
IF, I Cognitive stimulation needs 1. Calendar
to remember appointments and things to do during the day, acting as a calendar
I E, F 2. Music
to propose the listening of music tracks, previously chosen according to the specific
individual tastes, to relax the patient
I E, F, I 3. News
to announce news headlines
IF, I 4. Memory items
to show pictures of the patient and ask him/her if he/she remembers when and where
one particular shot has been taken, and who are the people with him in the pictures
J E, F Travel&fashion/golf support needs 1. Travel
The users can speak about weather, city to go to travel, gourmet preferences, local/
cultural fashion
J E, F 2. Golf
The users can speak about weather, type of competition, driving distance
J E, F 3. Shopping
The users can speak about weather, Shopping center flyer, event calendar
I, J E, F, I Emotion detection needs Emotional changes
to detect the emotional status
I, J E, F, I Safety needs Emergency
video-call the medical center or relatives in case of emergencies
I F Clinical assessment Monitoring
To assess daily the clinical parameters of the patients
I I Reminder Daily structure
The robot should provide structure to the elderly’s life by offering reminders to take
their medicine and eat/drink at specific times of the day

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Indeed, typical psychological difficulties that the elderly
deal with are correlated to loneliness, dependence on
caregivers due to lack of autonomy and fear of falling.
In this respect, the BUDDY robot can be perceived as a
companion robot, allowing the patients to keep in touch
with their family and friends.
2. Emotion detection needs Generally, emotions can be
simply classified according to a positive or negative
valence (such as angry, happy, fear, disgust, sadness,
contempt, and amusement), and a neutral state, as well.
They represent a key interaction feature that can help in
interpreting the emotional engagement of users during
the interaction. Other behaviors to take into account in
conversational expressiveness assessment that indicate
the maintenance of engagement, or conversely, loss of
interest are facial and body gestures. Facial expressions,
like smiling, laughing, eyebrow movement, or body ges-
tures like lifting shoulders, nodding, or shaking the head
represent information coming from back channels that
represent the added value to information provided to
verbal communication. The emotion changes in elderly
people are common, in particular in people with cogni-
tive impairment. They would need a robot capable to
measure movement and physiological parameters for
gesture and emotional status recognition.
3. Safety needs The main need regarding safety arisen by
the interviews was to recognize a health emergency and
call the appropriate services or relatives. A robot may
offer a lot of potential benefit in this area and it could
make a significant difference in the lives of older people
and their informal caregivers.
In addition, the Italian elderly participants have raised
another need: cognitive stimulation, that is an individual-
ized approach to help cognitively impaired elderly and their
families to identify personally relevant goals and devising
strategies for addressing them, with an emphasis not on cog-
nitive performance enhancing in itself, but on improving
functioning in an everyday context. The robotic platform
could be used for cognitive stimulation, e.g., to remember
appointments and things to do during the day, to propose
the listening of music tracks, to adjourn on daily news, and
to show the pictures to support the patients with cognitive
impairment during the hospitalization. Furthermore, it could
improve the users’ comfort degree when using the device,
automatically adapting to users behaviors and their personal
histories. Conversely, the Japanese elderly participants have
reported more conversation needs on hobbies such as Travel/
Fashion/Golf, which could be useful to improve function-
ing in the everyday context thus encouraging autonomy of
the patients and reducing the risk of isolation. The robotic
platform and Rospeex can be used for these needs, providing
appropriate suggestions which take in consideration different
preferences of the elderly (i.e., the weather forecast, best
places to travel, gourmet preferences, local/cultural fashion).
Moreover, the robotic platform and Rospeex can be used
for playing golf, providing appropriate answers in line with
different aspects (i.e., the weather, the type of competition,
driving distance).
In addition to the previously mentioned needs, the Ital-
ian caregivers had expressed further needs. From the formal
caregivers’ perspective, the robot should monitor the health
status of the patients. The robotic platform should routinely
visit the elderly in their hospital room and assess the health
status combining multimodal clinical parameters using also
wearable sensors for cardiac frequency, arterial pressure,
etc. In this way, it could support the formal caregivers to
optimize their work.
From the informal caregivers’ perspective, instead,
offering reminders to take the medicine or to eat/drink at
specific times of the day were been more relevant needs.
Furthermore, BUDDY should support the patients in sim-
ple meal preparation. Also in this case, the robotic platform
could optimize and improve the care time of the informal
caregivers.
Perception oftherobot
The general level of acceptance of the robot was good with a
positive perception among the participants of both the Italian
and the Japanese pilot site (Table4).
In Italy, at least seven of the interviewed elderly were
positive, two patients were neutral, and only one had a nega-
tive impression about the robot.
In Japan, five of the seven interviewed elderly were posi-
tive, one of them was neutral, and another one had a negative
idea about the robot.
Generally, in both pilot sites, the elderly think that the
robot can be useful. Even the elderly who are not techno-
logically advanced, with little experience with computers,
tablets, and Smartphones, have shown interest in the robotic
platform and think they could control the robot properly.
The caregivers at both pilot sites are quite positive on
the robot, but they still have some doubts. Among all the
caregivers, 27 of them are positive about the usefulness of
the robot, 4 are neutral and 5 caregivers are negative. A
large group of them believe that the robot could be useful
in supporting the elderly in socialization or help them with
their cognitive exercises or travel, fashion and golf activities.
However, there are several factors that negatively influ-
ence perceptions, such as the fear that robots could replace
human beings, the incapacity to manage technological
devices, the approach to something unknown, as expressed
by the elderly and the caregivers (Table5).

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Characteristics oftheItalian andJapanese
socio‑cultural states
According to the 2016 Human Development Report
(Table6), significant socio-cultural differences were pre-
sent between Italian and Japanese people. In particular, the
total Japanese population is higher than the total Italian
population (126.6 vs. 59.8million, respectively, p < 0.0001).
Japanese people are older (33.3 vs. 13.4million, respec-
tively, p < 0.0001), with a higher public health expenditure
(8.6% vs. 7.0%, respectively, p < 0.0001), but are also more
urbanized (93.5% vs. 69.0%, respectively, p < 0.0001), with
a higher schooling level (12.5 vs. 10.9years, respectively,
p < 0.0001), and a higher internet user percentage (93.3% vs.
65.6%, respectively, p < 0.0001).
Cross‑country analysis
In Table7, the feasibility analysis of cross-country ser-
vices is shown. Regarding the communication need, the
robot could promote the conversation with family, relatives,
friends, and clinicians. It could help users to video-chat with
their families or it can suggest calling a friend if the users
did not talk to him/her for a long time. Technical require-
ments have resulted totally feasible (e.g., to conduct a simple
conversation of a specific topic, to have a more natural voice
intonation, and to navigate with obstacle avoidance), feasible
Table 4 Perception on Buddy robot
a Participants who are positive and willing to use Buddy. They believe the robot is beneficial to themselves or elderly
b Participants who are positive about the usage of robots and believe it can be beneficial. However, they think that they do not need one at the
moment
c Participants who are negative about robots and do not want one now or later
Perception Users
E = Elderly
F = Formal
caregiver
I = Informal
caregiver
Country
I = Italy
J = Japan
NExamples of reasoning
PositiveaE I 7 “The robot is useful to help us in cognitive exercises in hospital” (Interviewee 7, Italy)
“This robot could be an assistant in travels, fashion and golf activities” (Interviewee 2, Japan)
J 5
I I 11 “This robot could reduce the isolation risk of the elderly and improve the socialization and conversation” (Interviewee 14,
Italy)
F I 12 “I believe that this robot is useful to help the elderly in cognitive exercises in hospital” (Interviewee 11, Italy)
“I think that the robot could be very useful to help the elderly in travels, fashion and golf activities” (Interviewee 1, Japan)
“The robot can increase the conversation, and therefore, the socialization” (Interviewee 2, Japan)
J 4
NeutralbE I 2 “If I need more help, this thing would be ideal” (Interviewee 2, Italy)
“Yes, it is useful. But I don’t need one now” (Interviewee 4, Japan)
J 1
I I 2 “In this moment I succeed to manage my mother. I don’t need a robot, even if it seems useful” (Interviewee 9, Italy)
F I 1 “I would like to test the robot first before rejecting or accepting it.” (Interviewee 5, Japan)
J 1
NegativecE I 1 “I do not believe that a robot can help us” (Interviewee 5, Italy)
J 1 “A robot cannot support us in socialization” (Interviewee 6, Japan)
I I 2 “I do not see much potential in a robot. It is not human, everything is done by a machine” (Interviewee 21, Italy)
FI 2 “The robot is not as a human being, it cannot have any feelings” (Interviewee 3, Japan)
J 1
Table 5 Factors for disapproving robots and negative perceptions
Limits acceptance and perception Explanation
Decrease in human contact Elderly are afraid that the little social contact that they have with the caregivers will be diminished
even further. A caregiver would guide or support them, but now a robot would do those tasks
The robot feels “cold”, it is not human Elderly find the robot too machine like and miss the human warmth. They for example believe that
the robot cannot hold a simple conversation with the elderly
Complicated communication with the robot Elderly and caregivers think that it is difficult for a robot recognizing the dialect of patients
Robots are something unknown The caregivers mention that they have difficulties imagining what robots exactly are, because it is
something new and they do not have any experience with robotics

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with exception (e.g., to “hear” the user instruction even if the
robot is far from the user, to remember the contents of the
conversation, and explain them to the caregiver later), and
not feasible (e.g., to offer a choice between various voices).
About the emotion detection need, two types of emotion/
mood information, i.e., the immediate emotion/mood at that
time and the log of past emotions and moods, are classified
into two types of robot dialogue services and remote car-
egiver services. Technical requirements have resulted totally
feasible (e.g., to adopt a sensor that can read the feelings and
moods of elderly people, to provide environments where the
user can always view recorded information so that experts
can make judgments and actions at that time, and to have
a variety of expressions and movements of the neck and
torso to express emotions accordingly), and feasible with
exception (e.g., to continue the conversation casually while
confirming approval or disapproval).
For the safety need, the main specific need was detection
and support of emergency situation. Technical requirements
have resulted totally feasible (e.g., medical devices must be
easy to interface via an open protocol), feasible with excep-
tion (e.g., to send regular feedbacks to the caregiver), and
not feasible (e.g., to detect specific medical problems, and to
support the elderly with arms and to carry things).
Discussion
Nowadays, older people have a positive perception and a
good acceptance of robots and are motivated to use technol-
ogy, especially when it helps them in their daily routine.
In this study, we present the needs of a small sample of
older people, formal and informal caregivers when involved
in a robotic interaction based on conversation. We found that
the common needs in both the Italian and Japanese pilot site
can be categorized into 3 groups: communication, emotion,
and safety needs.
Considering the general population of the two coun-
tries, Japanese people are older, with a higher public health
expenditure, but are also more urbanized, with a higher
schooling level, and a higher internet user percentage. The
data confirm that it is possible to age in an active way in a
condition of urbanization, good schooling and technology
use.
Nevertheless, most of the technological products devel-
oped for the elderly are not specifically designed for them,
i.e., taking into account their specific needs. Therefore,
although considered useful, technology is perceived as too
demanding for the majority of elders, often too intrusive,
complex and rarely disruptive. Recent qualitative studies
highlighted the importance to acquire relevant knowledge
on user needs to develop robots that can handle real life
situations of the older people [11–13]. A literature review
on social robots and older people concluded that “There is
a need for a participatory design that includes users at the
early stages of social robot development and continues to
include them iteratively throughout the design process” [14].
Hence, in designing smart robots for socialization in
elderly people some open issues shall be considered: What
are elderly needs? What kind of problems do the elderly
experience in their daily life? For which needs, would they
like to receive support? Would the people be interested in
robots? How do they view and feel about the deployment
of robots in healthcare? In this respect, the design of tech-
nological products should address a deep inclusion of the
elderly during the development process. The ACCRA pro-
ject deals with this aspect. Indeed, the mission of the pro-
ject is to develop advanced robotic solutions for ageing by
defining, developing and demonstrating an agile co-creation
development process, so as to design specific guidelines for
the implementation of the outlined robotic services.
It is already well-known that digital inclusion improves
not only the cognitive abilities but also the physical and
mental health of the older people, providing the opportu-
nity to enhance their independence. It is fundamental that
robots involve the elderly in pleasant experiences, providing
positive emotional feedbacks [15].
In that sense, some studies have shown how mind percep-
tion induces a positive effect in the human–robot interac-
tion [16]. Basically, in human interactions, specific brain
areas are responsible for social-cognitive processing, making
inferences based on observing others’ behaviors.
However, to make inferences, especially about intentions or
emotions, humans need to perceive others as intentional beings
(i.e., mind perception) [17]. Attributing internal states in social
interactions might not automatically happen during interac-
tions with artificial agents like robots, and this could have a
negative impact on human–robot interactions. Conversely, it
Table 6 Characteristics of Italian and Japanese socio-cultural state
HDI Human Development Index, GDP gross domestic product
*Data source by 2016 Human Development Report
Italy Japan p value
Population, total (millions) 59.8* 126.6* 0.0001
Population, ages 65 and older (millions) 13.4* 33.3* 0.0001
Population, urban (%) 69.0* 93.5* 0.0001
HDI, female 0.865* 0.887* 0.889
HDI, male 0.899* 0.914* 0.924
Mean years of schooling (years) 10.9* 12.5* 0.0001
Life expectancy at birth (years) 83.3* 83.7* 0.012
Public health expenditure (% of GDP) 7.0* 8.6* 0.0001
Internet users (% of population) 65.6* 93.3* 0.0001

Aging Clinical and Experimental Research
1 3
Table 7 Feasibility analysis of cross-country services
Need category Specific need Service Technical requirement Feasibility
Communicatio
nAvoid social isolationTo can call BUDDY/Rospeex and ask to video
To can use BUDDY/Rospeex to video-chat
BUDDY/Rospeexcan suggest to call a friend if the
user don’t talk with him/her fo r a long time
If the user can’t move, BUDDY/Rospeexcan reach
him/her to when an incoming video-call occur
BUDDY/Rospeexcan act as a mediator with the
technology
To be able to conduct a conversation simple of a
specific topic
To offer a choice between various voices (feminine
and masculine)
To have a more natural voice intonation
To be able to “hear” the user instruction even if the
robot is far from the user
To remember the contents of the conversation, and
explainthem to the caregiver later.
To navigate with obstacle avoidance.
Emotion
detectio
n
To measure/inspect the state of
health that can be read from
feelings and moods
To provide emotional/mood
based services/dialogue
Utilization of logs of past emotions and moods in robot
dialogue services
Utilization of logs of past emotions and moods in
remote carer service
Real-time use of feelings and mood at that time (as an
immediate, responsive) in robot dialogue service
Real-time use of emotions and mood at that time (as an
immediate, responsive) in remote caregiver service
To adopt a sensor that can read the feelings and
moods of elderly people.
To provide environments where the user can always
view recorded information so that experts can make
judgments and actions at that time.
To proceed conversation casually while confirming
approval or disapproval.
The robot should have a variety of expressions and
movements of the neck and torso accordingly to
express emotions.
Safety
Support in dangerous situationBUDDY/Rospeexautonomously detect abnormal
situation (i.e. fall) and alerts the clinicians
If the user needs help he/she can use BUDDY/Rospeex
to call clinicians or relatives
Clinicians and familiars can remotely move
BUDDY/Rospeexto visit the beloved one
To send regular feed backs to the caregiver.
To detect specific medical problems.
To support the elderly with arms and carry things.
Medical devices must be easy to interface via an open
protocol.
100% feasible
fe
asible with excepon. The needs will be adapted according to the technical resour
ces.
notfeasible

Aging Clinical and Experimental Research
1 3
has be shown that perceiving mind is not exclusive to agents
that actually have a mind, but can also be triggered by agents
who are not believed to have a mind (i.e., robots, avatars,
self-driving cars) or agents with ambiguous mind status [9].
Mind is in the eye of the beholder, which means that it can
be assigned or denied, based on the perception of cognitive,
physical and behavioral features of the agent [9, 18, 19].
Eventually, in these paper, we highlight that the design of
social robots should be the result of a co-creation process in
which end-users (specifically, the elderly and caregivers) are
actively involved. It is clear that further researches in social
and assistive robotics are needed in the next future.
We are firmly convinced that the evaluation of users’ needs
is a crucial aspect to improve the acceptability and the effec-
tiveness of social robots. Therefore, it is essential to identify a
systematic and iterative approach to evaluate which abilities of
the robot’s behavior and appearance mainly fit with the users’
needs.
Funding This work was supported by the ACCRA Project, founded by
the European Community’s Horizon 2020 Programme (H2020-SCI-
PM14-2016)—Grant agreement no. 738251.
Compliance with ethical standards
Conflict of interest All authors declare that there are no conflicts of
interest.
Statement of human and animal rights All procedures performed in
the study fulfilled the Declaration of Helsinki, and the guidelines for
Good Clinical Practice. The approval of the study for experiments
using human subjects was obtained from the local Ethics Committees
on human experimentation.
Informed consent All participants were required to sign three consent
forms before participation: consent for participation to the research
study, consent for sharing the audio–video recorded material and data
with other consortium members, and a consent form for using the
audio–video recorded material and data for public purposes (publica-
tions, dissemination goals).
Appendix1: Conversation interview guide
Interview objectives
• Understanding the context and the way of life of the per-
son (in order to know what his/her conversation activities
are and to situate the context of intervention of the robot).
• Identifying problems related to loneliness and isolation
(slightly or advanced).
• Identifying needs in terms of conversation.
• Getting early indications of the potential attractiveness
of the robot and its main functionalities.
Interview guide forelderly
Archival #: Ex/ CIZ10Se
First leer of applicaon (W/H/C), First leer of country name (F/I/N/J), Type
of respondent (X, Y, Z), Number of respondent (1 to 10), Housing (Ho/Nu/Se)
Applicaon: Walking Housework Conversaon
Country: France Italy Japan Netherlands
Respondent #:
1 2 3 4 5 6 7 8 9 10
Respondents are idenfied through a number from 1 to 10 (as there are 10
respondentsper country/appli)
Site:
Interviewer:
Date:
Start:
End:
Am/pm
Am/pm
EMS Score
Interviewee
Age
Gender
Living
condion
Male Female
Home Senior residence Nursing home

Aging Clinical and Experimental Research
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Introduction
Dear Mr./Mrs:…………………………………. Thank you
for accepting to participate in this “needs” interview for
the ACCRA project. Your collaboration is appreciated! I
will shortly explain the interview procedures.
Interview protocol:
• This interview aims to determine potential issues and
needs that you might have come across concerning your
conversation activity.
• This interview aims to determine your perceptions
about the usage of technology and robotics for health
care and for reducing the loneliness and isolation of the
elderly people.
• The data will be used for the ACCRA project to prepare
the robots that fits the elderly needs.
• This data may be used for future publications includ-
ing, but not limited to: academic journals, websites and
policy papers.
• This interview will be recorded.
• The interviewer/researcher conducting this interview
will make sure that the data is treated confidentially
and that the data will not be traceable to a specific indi-
vidual to safeguard privacy.
• If you do not feel comfortable to give answers to a ques-
tion, you can state this without providing any reason and
the interviewer/researcher will skip the question.
• If you do not feel comfortable to continue the interview
any further, you may at any moment discontinue the
interview without providing any reasons.
Do you have any questions? Do you understand and accept
the above mentioned procedures?
If so, we will start the interview.
First part
1. Context and way of life
(1) Are you a person with sensorial and/or cognitive
disabilities?
Probes:
i. Have you hearing impairments? Have you dif-
ficulties to hear a telephone call, a film on TV
or a conversation with your relative/friend?
ii. Have you vision impairments? Have you
difficulties to watch TV, computer or your
smartphone?
iii. Have you cognitive impairments? Have you
often memory loss? Do you often lose the
thread of one’s discourse?
2) Do you succeed to have conversations with people?
Probes:
i. When talking to people, do you pay attention to
their body language (ex. facial expression, hand
movement, etc.)?
ii. Do people get what you are saying?
(a) Do people tend to misinterpret what you
say?
(b) Do you find it hard to express your feelings
to others?
(c) Do you have difficulty putting your
thoughts into words?
(d) Do you find it difficult to express your
opinions when others do not share them?
(e) Do you try to divert or end conversations
that do not interest you?
3) What are your feelings about your social status?
Probes:
i. How often do you feel that you lack companion-
ship?
a) How often do you feel that there is no one
you can turn to?
b) How often do you feel alone?
ii. How often do you feel that your interests and
ideas are not shared by those around you?
iii. How often do you feel that you are “in tune”
with the people around you?
a) How often do you feel left out?
b) How often do you feel that your relation-
ships with others are not meaningful?
c) How often do you feel isolated from others?
4) Could you indicate the people that you often meet?
What have you social interaction with them?
Probes:
i. Is there a special person who is around when
you are in need?
a) Is there a special person with whom you
can share your joys and sorrows?
b) Have you a special person who is a real
source of comfort to you?
c) Is there a special person in your life who
cares about your feelings?
ii. Does your family try to help you?

Aging Clinical and Experimental Research
1 3
a) Do you get the emotional help and support
you need from your family?
b) Can you talk about your problems with
your family?
c) Is your family willing to help you make
decisions?
iii. Do your friends try to help you?
a) Can you count on your friends when things
go wrong?
b) Have you friends with whom you can share
your joys and sorrows?
c) Can I talk about your problems with your
friends?
2. Hospital/Nursing home
5) How does this hospital ward/nursing home make
you feel?
Probes:
i. What is the atmosphere like?
ii. What interactions are there between staff/pa-
tients/visitors?
a) How are visiting times managed?
b) Does the healthcare team take the problems
seriously, explain information clearly, and
try to understand your experience, and pro-
vide viable options?
iii. What do you notice about safety issues?
a) What does information tell you about the
quality of care here?
b) Is hospital ward/nursing home accessible to
those with disabilities?
Second part
1. First investigation of the interests for a robot
1) Do you have any experiences with technology?
Probes:
i. Do you use computers/smartphones/tablets?
Why (not)?
a. If you are using:
• What do you use it for?
– Calling friends/family
– For online shopping
– For watching television shows
• Did you buy it on your own or did
somebody else buy it for you?
– Why did you get it on your own/
somebody else buy it for you?
– Who did buy it for you?
b. If you are not using
• Why do you not use them?
– Do you have issues using these
equipment?
– What kind of issues do you experi-
ence using them?
• Are you interested in using computers/
smartphones/tablets?
– What would you like to be able to
do?
ii. What kind of technology are you most comfort-
able with?
a. Could you mention 3?
b. Why are you the most comfortable with
these 3?
• Are you experienced with them?
• Did somebody explain it to you
on how to use them?
• Were they intuitive for you to
use?
2) Are your family/friends experienced with comput-
ers/smartphones/tablets?
Probes
i. What do they use?
ii. What do you think about the fact that they use
it?
iii. Have you ever used a computer/smartphone/
tablet together with your close ones?
At this point; show video/pictures about BUDDY with a
short explanation on what it can do at the moment.
3) After looking at these video/pictures about BUDDY,
what do you think about BUDDY? Could a robot
help you with your conversational issues?
Probes:
i. What are your first impressions about the robot?
a. Interesting? Strange? Scary? Why do you
think that?
b. What do you think about the idea of robots
in health care?

Aging Clinical and Experimental Research
1 3
ii. Do you believe that the robot will be able to
provide you the necessary help to solve your
conversational issues? Why (not)?
a. If it would help you:
• With which issues would it help you?
How would it help you?
b. If it would not help you, why not?
• What would should be changed to
make it useful for you?
• Would it be useful for other elderly?
Why do you think that?
iii. If BUDDY would be here right now, do you
think that you will be able to use BUDDY prop-
erly? Why (not)?
a. Will you be able to give it the proper com-
mands? Why (not)?
b. Will you be able to give any input com-
mands (smart phone/touchscreen)? Why
(not)?
c. What kind of input commands should be
used to make it easier for you to communi-
cate with the robot?
iv. Would you be interested in training sessions to
be able to use BUDDY (alone?)? Why (not)?
a. What kind of training sessions would you
like to attend? Face-to-face, manual, video
training?
4) How would you feel being helped by a robot instead
of a human worker?
Probes:
i. Would you feel sad, scared or something else?
Why would you feel that way?
ii. What positive or negative ideas do you have
about having a robot help you with your con-
versation problems?
iii. What advantages or disadvantages could you
think of about using robots?
I will now provide some functions that BUDDY
could potentially perform.
5) BUDDY could improve your conversation ability
and reduce the isolation risk using cameras and sen-
sors. It could even “see” that you fell down. Based
on the situation it could suggest you some exercises
or warn a health care worker.
Probes:
i. What do you think of such functions? It could
keep track of your conversation ability, living
situations and health. Useful or not? Why?
ii. How would you feel being monitored by a ro-
bot?
a. Is it an invasion of privacy? Or do you not
mind?
b. It weakens the relationships between elderly
and health care workers?
c. Who should have access to your health
data?
6) BUDDY could provide some simple cognitive exer-
cises and keep in touch with your relatives/friends to
help you maintain/improve your conversation abil-
ity. Would you be willing to do cognitive exercises
with a robot? Why (not)?
Probes:
i. Which (lack of) functions would convince you
to (not) do exercises with the robot?
ii. Would you feel safe doing exercises with a ro-
bot?
7) BUDDY could facilitate communication between
you and healthcare workers using digital commu-
nication (e.g. Skype). What do you think of such
function?
Probes:
i. Is it useful? Why (not)?
ii. Would communication with family/friends be
more interesting? Why (not)?
8) Should BUDDY be able to help you solve your con-
versation issues? Why (not)?
9) During the entire interview, were you able to think
and express your opinions about your conversation
issues in daily life and robots in health care? Right
now based on your current knowledge, would you
be interested in using BUDDY?
Probes:
i. Why would you (not) be interested?
ii. Based on the video and your own daily issues,
are there other tasks that you would like BUD-
DY to be able to do, to make it possible for you
to live independently longer?
a. Should BUDDY be able to carry things?
b. Should BUDDY be able to do certain tasks
automatically for you?
iii. What would be required to make BUDDY (even
more) interesting and useful to you?

Aging Clinical and Experimental Research
1 3
iv. Which (lack of) functions would convince you
to (not) use the robot?
Additional elements
1) We are almost at the end of the interview. Are there any
comments that you would like to make or want to add
that you think might be important?
To finish the interview, I would like to ask the final few
questions.
Socio‑demographic information
1) What was your previous occupation?
2) What is your highest enjoyed education level?
3) What is your current family situation? Do you have a
spouse, children or grand-children?
This is the end of the interview, I would like to thank you
for your collaboration!
Interview guide forcaregivers
When you are interviewing an informal caregiver, adjust
the wording of ‘elderly’ to a more appropriate term: spouse,
father (in law)/mother (in law) or loved one.
Archival #:
Ex/ CIY10Se
First leer of applicaon (W/H/C), First leer of country name (F/I/N/J),
Type of respondent (X, Y, Z), Number of respondent (1 to 10), Housing
(Ho/Nu/Se)
Applicaon:Walking Housework Conversaon
Country: France Italy Japan Netherlands
Type of
Respondent:X Professional caregiver Y Informal Caregiver Z Elderly
Respondent #:
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 20 23 24 25 26 27 28 29
30
Respondents are idenfied through a number from 1 to 30 (as there are 10
elderlies, 10 professional caregivers and up to 10 informal caregivers per
country/appli)
Site:
Interviewer:
Date:
Start:
End:
Am/pm
Am/pm
Informal
Caregiver
Yes No
More details:
Observaons

Aging Clinical and Experimental Research
1 3
Introduction
Dear Mr./Mrs:…………………………………. Thank you
for accepting to participate in this “needs” interview for
the ACCRA project. Your collaboration is appreciated!
Interview protocol:
• This interview aims to determine potential issues and
needs that you might have perceived among the elderly
concerning their conversation activity.
• This interview aims to determine your perceptions
about the usage of technology and robotics for health
care.
• The data will be used for the ACCRA project to prepare
the robots that fits the elderly needs and could support
you in your work.
• This data may be used for future publications includ-
ing, but not limited to: academic journals, websites and
policy papers.
• This interview will be recorded.
• The interviewer/researcher conducting this interview will
make sure that the data is treated confidentially and that
the data will not be traceable to a specific individual to
safeguard privacy.
• If you do not feel comfortable to give answers to a ques-
tion, you can state this without providing any reason and
the interviewer/researcher will skip the question.
• If you do not feel comfortable to continue the interview
any further, you may at any moment discontinue the
interview without providing any reasons.
Do you have any questions? Do you understand and accept
the above mentioned procedures?
If so, we will start the interview.
First part
1. Context and way of life
1) Could you describe what you think the current con-
versation issues are among the elderly?
Probe:
i. Do they for example have problems: hearing
problems, vision problems, writing problems,
and problems using the telephone
ii. Memory loss, losing the thread of one’s dis-
course?
2) Could you describe the problems that you have seen
among the elderly in regards with their conversation
activity?
Probe:
a. Reducing of social interaction. What difficulties
do you see? for example Do they have difficul-
ties to call or go out home? What are the prob-
lems?
b. Do the elderly experience any problems with
their social life in their daily life due to their
reduced conversation activity?
i. For example, how often are they visit-
ing family/friends? Do you notice any
variations respect to last year (i.e. reduced
times, same times)?
ii. How is their participation in events/
activities? Do they regularly join and
participate in events?
2. Hospital/Nursing home
3) How does this hospital ward/nursing home make
you feel?
Probes:
ii. What is the atmosphere like?
iii. What interactions are there between staff/pa-
tients/visitors?
c) How visiting times are managed?
d) Does the healthcare team take the problems
seriously and explain information clearly,
about your loved one?
iv. What do you notice about safety issues?
c) What does information tell you about the
quality of care here?
d) Is hospital ward/nursing home accessible to
those with disabilities?
Second part
1. First investigation of the interests for a robot
(1) Do you have any experience with technology?
Probe:
a. Do you use computers/smartphones/tablets?
Why (not)?
i. If you are using:
1. What do you use it for?
2. Did you buy it on your own or did
somebody else buy it for you?
a. Why did you get it on your own/
somebody else buy it for you?

Aging Clinical and Experimental Research
1 3
b. Who did buy it for you?
ii. If you are not using
1. Why do you not use them?
a. Do you have issues using these equip-
ment?
b. What kind of issues do you experi-
ence using them?
2. Are you interested in using these equip-
ments?
a. What would you like to be able to do?
b. Do you have experience with assistive robots?
i. If so, what kind of robots?
(2) Could you describe your work with the elderly
Probe:
a. It was addressed a little bit before, but could
you explain further what kind of work you do
with/for the elderly?
i. What are your most important tasks?
ii. How does an average daily routine look
like for you?
b. How much direct contact do you have with
the elderly? Do you visit the elderly often?
Do you attend multiple elderly? Do you work
individually or in teams?
At this point; show video/pictures about BUDDY with
a short explanation on what it can do at the moment.
(3) After looking at these video/pictures about
BUDDY, what do you think about BUDDY? A
robot that could help you with your work in help-
ing elderly with mobility issues?
Probe:
a. What are your first impressions about the
robot?
i. Is BUDDY look interesting, cool, strange
or something else?
ii. What do you think about the idea of
robots in health care?
b. Do you believe that the robot will be able to
provide you the necessary support to solve
elderly’s conversation issues? Why (not)?
i. If it would help you, with issues would it
help you? How would it help you?
ii. In particular, why it would not help you?
1. What should be changed to make it
useful for you?
2. Might BUDDY be useful for other
healthcare workers or another depart-
ment? Why do you think that?
c. If BUDDY was right here, do you think that
you will be able to use BUDDY properly?
Why (not)?
i. Will you be able to give the proper com-
mands? Why (not)?
ii. Will you be able to give or input com-
mands (smart phone/touchscreen)? Why
(not)?
iii. What kind of input commands should
be used to make it easier for you to
communicate with the robot?
d. Would you be interested in receiving training
to be able to use BUDDY? Why (not)?
i. What kind of training would you prefer?
Face-to-face, manual, video training?
(4) How would you feel to use robots to take care of
elderly?
Probe:
a. Would you feel happy, sad or anything else?
Why would you feel that way?
b. What kind of positive or negative ideas do
you have about having a robot helping you
with your work in elderly care?
c. What advantages or disadvantages could you
think of about using robots?
d. How do you think that the elderly will view
robots as a nursing tool?
I will now provide some functions that BUDDY could
potentially perform
(5) BUDDY could improve your conversation ability
and reduce the isolation risk (using cameras and
sensors).
Probe:
a. What do you think of such functions? It could
keep track of their conversation activity, liv-
ing situation and health. Is it useful or not?
Why (not)?
b. What do you think about the remote monitor-
ing of the elderly?

Aging Clinical and Experimental Research
1 3
c. How would you feel using robots to monitor
the elderly?
i. Is it an invasion of privacy?
ii. Does it weaken the relationships between
elderly and healthcare workers, or
between you and elderly?
iii. Who should have access to the data?
(6) BUDDY could provide some simple cognitive
exercises to help elderly maintain/improve their
conversation activity. Would you be willing to
use or allow robots to do such exercises with the
elderly? Why (not)?
Probe:
a. Is it because of safety reasons? Or something
else?
b. Which (lack of) functions would convince you
to (not) do exercises with the robot?
(7) BUDDY could facilitate communication between
you and the elderly from a distance using digital
communication. What do you think of such func-
tion?
Probe:
a. Do you think that it is useful? Why (not)?
b. Would communication with family or friends
be more interesting? Why (not)?
(8) Should BUDDY be able to help you solve these
issues? Why (not)?
(9) During the entire interview, were you able to think
and express your opinions about elderly’s con-
versation issues in daily life and robots in health
care? Right now based on your current ideas,
would you be interested in using BUDDY to
support you in your daily activities?
Probe:
a. Why (not)?
b. Based on the video and your own work expe-
rience, are there other tasks that you would
like BUDDY to be able to do to make it more
attractive for you to use BUDDY, whether it’s
to make it possible for elderly to live indepen-
dently longer or help you in your work?
i. Should BUDDY be able to carry things?
ii. Should BUDDY be able to do certain
tasks automatically?
c. What would be required to make BUDDY (even
more) interesting and useful to you?
d. Which (lack of) functions would convince you
to (not) to use the robot?
Additional elements
(1) We are almost at the end of the interview. Are there any
comments that you would like to make or want to add
that you think might be important?
To end the interview, I would like to ask you some final
questions
Socio‑demographic information
(1) What is your highest enjoyed education level?
(2) What is your current job position?
(3) How many years of work experience do you have in
elderly care?
This is the end of the interview, I would like to thank you
for your collaboration.
References
1. World Health Organization (2017) Mental health of older adults.
Posted. http://www.who.int/media centr e/facts heets /fs381 /en/.
Accessed 16 Feb 2018
2. World Health Organization (2017) Global priority research
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tive technology. Geneva: World Health Organization. http://
apps.who.int/iris/bitst ream/10665 /25466 0/1/WHO-EMP-IAU-
2017.02-eng.pdf. Accessed 21 Apr 2017
3. Wiese E, Metta G, Wykowska A (2017) Robots as intentional
agents: using neuroscientific methods to make robots appear
more social. Front Psychol 8:1663
4. Broekens J, Heerink M, Rosendal H (2009) Assistive social
robots in elderly care: a review. Gerontechnology 8:94–103
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-co-funde d-call-sc1-pm-14-2016-nict (2016–2019)
6. Gamberini L, AlcaizRaya M, Barresi G etal. (2006) Cognition,
technology and games for the elderly: an introduction to elder
games project. PsychNol J 4:285–308
7. Folstein M, Folstein S, McHugh PR (1975) Mini-mental state:
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