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Designing VUIs for Social Assistance Robots for People with Dementia
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Elderly people and especially people with dementia often experience social isolation and need assistance while performing activities of daily living. We investigate a novel approach to cope with this problem by integrating voice assistants and social assistance robots. Due to the special communication needs of people with mild cog-nitive impairment, the design of interfaces of such systems is to be based on the particular requirements of the target user group. This paper investigates, how a voice user interface should be designed for elderly users with mild cognitive impairment-such as an early stage of dementia-to provide personalised support throughout activities of daily living. A context and user analysis delivered a set of 11 guidelines for voice user interfaces for people with demen-tia. For a pilot study we selected those strategies often applied by caregivers in their communication with people with dementia and evaluated the voice user interface among elderly participants and healthcare workers who reported a high feasibility, usefulness and acceptance of the designed system.
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... The 60+ age group was of interest in eight (n=8) publications [11,23,38,42,58,71,76,82], and twelve studies (n=12) examined the 65+ age group [5,8,18,24,62,77,78,84,104,110,111,114]. A further eight (n=8) studies relate to people aged 70+ [53,56,68,85,89,98,99,115]. Twenty-six authors (n=26) did not specify the age group in their studies [10,12,15,17,19,25,36,39,45,47,49,59,66,70,72,81,83,86,88,92,96,97,101,103,107,113]. ...
... Furthermore, seven authors (n=7) particularly emphasized the devices' 'good' to 'very good' usability [5,17,56,77,84,98,110]. Thus, six authors (n=6) see a potential of the systems for personal health management [18,38], in home care [49], people living alone [38], people with cognitive impairments [76], and incipient dementia [98]. ...
... Furthermore, seven authors (n=7) particularly emphasized the devices' 'good' to 'very good' usability [5,17,56,77,84,98,110]. Thus, six authors (n=6) see a potential of the systems for personal health management [18,38], in home care [49], people living alone [38], people with cognitive impairments [76], and incipient dementia [98]. Four papers (n=4) describe that the use of VCDs increases well-being and quality of life among older adults [12,18,38,98]. ...
For older adults Voice Controlled Devices (VCDs) could offer an easy way to access to digital services. This paper provides a systematic literature review (N = 60) of the state of research on learnability, usability, and use of VCDs and older adults. Furthermore, the paper highlight the predominant study methods used and identify positive and negative characteristics of VCDs. In addition, it presents reservations and barriers that prevent older adults from using VCDs. This work extends related work by conducting a literature review within the databases Goolge Scholar, ACM Digital Library, IEEE Xplore, and ProQuest. The structured literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) proposed scheme. The results show that as of 2018, the number of researches on VCDs and older adults is steadily increasing, and this population group is receiving increasing attention. Most of the studies (40%) used mixed methods for data collection and analysis. The literature review clearly shows that older adults have few problems learning and using VCDs. Older adults face problems caused by faulty speech recognition of commands or a non-existent display that visually shows input and output of commands. Obstacles are largely privacy and data protection concerns.
... Even though voice assistants are able to engage in effective conversations, just as with human communication partners, communication breakdowns occur, such as missed inputs and misinterpretations [3]. Research on communication breakdowns suggests that these misunderstandings and small failures are inevitable therefore, it is more important to consider how to recover when breakdowns happen [3,9,10,19,42]. ...
... Thus, leaving much potential by missing helpful interactions, users will just stay with the basic use cases and not learn new things [102]. Thus, design guidelines mentioned easing the feature-finding process [40], utilizing data mining [102], using previous responses [109], or giving relevant feature recommendations [49] to solve the low discoverability. ...
Advances in voice technology and voice user interfaces (VUIs) -- such as Alexa, Siri, and Google Home -- have opened up the potential for many new types of interaction. However, despite the potential of these devices reflected by the growing market and body of VUI research, there is a lingering sense that the technology is still underused. In this paper, we conducted a systematic literature review of 35 papers to identify and synthesize 127 VUI design guidelines into five themes. Additionally, we conducted semi-structured interviews with 15 smart speaker users to understand their use and non-use of the technology. From the interviews, we distill four design challenges that contribute the most to non-use. Based on their (non-)use, we identify four opportunity spaces for designers to explore such as focusing on information support while multitasking (cooking, driving, childcare, etc), incorporating users' mental models for smart speakers, and integrating calm design principles.
... Shortcomings in robot performance led to frustration (Lin et al., 2022;Pripfl et al, 2016), and some users were annoyed by the conversations that companion robots initiated autonomously (De Graaf et al., 2015). Usability was even more challenging among cognitively impaired individuals, as the robots were often unable to match the interaction abilities and speed of such users (Begum et al., 2013;Striegl et al., 2021). ...
Socially Assistive Robots (SARs) are expected to support autonomy, aging in place, and wellbeing in later life. For successful assimilation, it is necessary to understand factors affecting older adults Quality Evaluations (QEs) of SARs, including the pragmatic and hedonic evaluations and overall attractiveness. Previous studies showed that trust in robots significantly enhances QE, while technophobia considerably decreases it. The current study aimed to examine the relative impact of these two factors on older persons QE of SARs. The study was based on an online survey of 384 individuals aged 65 and above. Respondents were presented with a video of a robotic system for physical and cognitive training and filled out a questionnaire relating to that system. The results indicated a positive association between trust and QE and a negative association between technophobia and QE. A simultaneous exploration demonstrated that the relative impact of technophobia is significantly more substantial than that of trust. In addition, the pragmatic qualities of the robot were found to be more crucial to its QE than the social aspects of use. The findings suggest that implementing robotics technology in later life strongly depends on reducing older adults technophobia regarding the convenience of using SARs and highlight the importance of simultaneous explorations of facilitators and inhibitors.
... Additionally, the system should clearly indicate that the usage of a CA-based system for CBT is not intended as a replacement for face-to-face therapy with mental health specialists [18]. Furthermore, as the system is intended for elderly users, guidelines for the design of VUIs for elderly people have to be taken into account [37,19]. Based on related research, three CBT tools were identified as suitable for a VA-based CBT session: A mood journal [11], a radio play with multiple choice questions as a psycho educational component [40,27], and a short meditation practice to end the session [31,21]. ...
To combat the global shortage of mental health services, new solutions - such as computerized therapy options - have to be found. While research in this field has been ongoing for several decades and approaches such as chatbot-based cognitive behavioral therapy (CBT) have already shown to be effective in reducing symptoms of depression for younger adults, voice assistant-based (VA-based) approaches have thus far not been investigated deeply. However, especially for elderly people with depression VA-based systems could yield benefits - such as the avoidance of physical accessibility issues. Therefore, we propose the design of a VA-based system capable of delivering selected methods from CBT to elderly users with depression in order to investigate its usability. To assess the usability of the conceptualized system in comparison to a chatbot-based approach we conducted a randomized controlled A/B testing experiment with 14 participants. Results indicate a good usability and acceptance of the designed system and a preference for the delivery of CBT-methods via voice assistant rather than via chatbot, especially among elderly participants.
Due to an aging population, stressed caregivers within a stressed care sector as well as the wish of aging at home, there is an urgent need to provide solutions to cope with these challenges today and in the future. Finding technological, i.e., robotic, solutions is an interesting approach and is a highly frequented research topic. However, engineering social assistance robots (SARs) to a satisfying degree of usability and technology acceptance is challenging, because fulfilling user’s expectations – especially with older adults as key user group – means to implement naturally-feeling robotic behaviour which leads to emulate a semi-human-like task execution behaviour. Within our work, we addressed the scheduling of robotic activities based on aspects such as parallelisability for multi-task execution, user- and system-triggered commands, as well as task priorities to allow interruption or stopping of running activities or dismissing incoming commands. We assessed user’s expectations within a survey-based requirements analysis and derived a decision-making concept for scheduling incoming activities. We implemented the concept within a small app to evaluate the schema according to the acceptance of the resulting robotic behaviour. With this concept, we set a starting point to engineering well-accepted SARs from a behavioural perspective next to the finally implemented use cases and specific situations to use a SAR in the environment of older adults. This is crucial to move towards accepted technological solutions to the social challenges mentioned above that arise with an aging population.KeywordsHuman-Robot InteractionSocial Assistance RobotsOlder AdultsRobot BehaviourActivity Scheduling
By 2050, the population share aged over 80 will double. Considering the number of older adults and the wide range of chronic conditions, health systems need to assure that care is adapted to the individuals' different needs and enables the elderly to be active and involved.
This article is about introducing a food reminder system into the domain of dementia care. The aim is to explore and describe whether and how such a system, built with existing technology, can be valuable, and how caregivers adopted it in a real-world environment. The system is built with Android® tablets and is called iRemember.® The research is done as a case study at a care facility in Simrishamn, Sweden. Domain knowledge is gained by reviewing previous research and by conducting interviews with professionals at the facility. The system is developed, deployed, and evaluated at a care facility home for persons with dementia. Data about usage and perception of the value of the system is collected through observations and interviews.
Results indicate that a food reminder system can be valuable to and empower people with dementia. They also indicate that caregivers can readily adopt such a solution, including both management and people working directly with persons with dementia.
Accessible user interfaces are useful for people from a population with the widest range of capabilities. People with severe impairments primarily benefit from assistive technology while built-in software-based accessibility functionality and its customisation is advantageous to many other people who experience temporary or situational disabilities. However, increasing software customisation does not naturally result in better user interfaces or reduces barriers. Quite the reverse! Finding proper adjustments requires high computer literacy. Moreover, users must create mental models for different user interfaces and must be able to translate between them back and forth because several digital devices are used sequentially or simultaneous for multifaceted contexts. This thesis investigates accessible design for multifaceted usage of Information and Communication Technology (ICT) such as desktop, mobile devices, web-based applications or ubiquitous services to address people from a population with the widest range of capabilities. Particular attention is given to user-adaptive systems because they can overcome the limitations of manual forms of personalisation and thus can lead to better user interfaces for all people. The presented work is organised in three parts. The first part elaborates the foundations of accessible design. A distinctive domain of a user-adaptive systems called Adaptive Inclusive Interactive System (AIIS) is introduced to show personalisation embodies a new form of accessible design. AIISs distinguish from other user-adaptive systems because they take disability as a starting point for user modelling. Against the background of existing classifications, the common ground between AIIS and other domains of user-adaptive systems is elaborated and distinctive features of AIIS are discussed. The adaptor type of inference is newly introduced in order to describe use-adaptive systems adapting a single application and those considering the interplay of accessibility aids available on an interactive device. More specifically, the interaction within and across different configuration layers (i.e.\,operating system, application, assistive technology, web) is taken into account by inferring from existing knowledge to customisation for new platforms. Furthermore, functional requirements and design choices for AIISs are demonstrated along with five specific use cases; in particular respecting information appliances in ubiquitous or individual environments, highly customisable general purpose computers, multi-user application contexts and multi-screen behaviour. In addition, a systematic literature review of AIISs was conducted to discuss limitations of current approaches and to analyse the degree of user diversity targeted by existing systems. Results show, although multi-device and context-sensitive approaches are widely addressed, identified challenges are not sufficiently treated. Results of the literature survey show further, the adaptation theory of AIISs is mostly based on stereotypical assumptions about commonly known groups of impairments. A main limitation of stereotypes is that within-group diversity cannot be modelled. Feature-based user models such as needs and preferences are promising but seldom applied by AIISs. The second part of this thesis describes a knowledge-based approach to user interface adaptation from preferences and for special needs. The approach was implemented as the Rule-based Matchmaker (RBMM) component of the Global Public Inclusive Infrastructure (GPII). The GPII is a software architecture to facilitate the auto-configuration of ICT such as desktop computers running MS Windows or Linux, Android-based mobile devices or public terminals such as automated teller machines. Compared to the state of the art, the inference of the proposed knowledge-approach is not encoded into explicit rules deriving adaptations from impairment groups by propositional logic. Instead, a domain ontology and logical assertions were formalised to allow inferences compatible with those applied by accessibility experts who set-up interactive devices for people with disabilities. This knowledge was described in a generic and feature-based manner to ensure scalability of the inference about diverse user demands and heterogeneous accessibility aids. The formalisation of the domain knowledge and the logical rules fulfil several challenges, including deducing configurations in cases where a user need cannot be satisfied by device customisation or can be satisfied by a multitude of accessibility aids that interfere with one another. As the proposed system emulates decision-making of accessibility experts, automatically deduced configurations were validated against manual configurations of ten accessibility experts. Results show, the average matching score of the developed system is high. Thus, the proposed system can be considered being capable of making precise decisions towards personalising user interfaces based on user needs and preferences. Third part of this thesis comprises three empirical studies in order to discover specific domain knowledge with respect to insufficiently investigated AIISs-specific use cases as well as ICT-related requirements of certain user groups. Findings of this part of the thesis can be put to partial use -- for instance -- by extending the domain ontology of the proposed knowledge-based approach to user interface adaptation from preferences and for special needs. The first foundational user study investigates what people with disabilities know about their needs and preferences. The results show, user models must include ICT-related difficulties described at a more abstract level in addition to needs and preferences. Findings also demonstrate a wide range of individual requirements that must be considered by AIIS. Knowledge obtained from this user study was primarily used to derive requirements for the implemented RBMM. The second user study addresses a specific use case of AIIS, one that targets multi-user applications. More specifically, contradicting preferences in multi-user application contexts were analysed. Results comprise conflict resolution approaches that can be applied and further investigated by user-adaptive systems targeting this specific use case. A third user study explores ICT-related requirements of people with dementia because cognitive disabilities are not adequately covered by accessible design. The findings indicate an intersection of requirements with existing accessibility guidelines but they emphasise aspects not covered previously.
Background:
the worldwide number of dementia cases is increasing, and this is a trend that is expected to continue as a growing proportion of the population ages. However, conducting research with persons suffering from dementia can be fraught due to fears surrounding research risks in vulnerable populations. This can make seeking approval for studies difficult. As research directly involving persons with dementia is key for the development of evidence-based best practice, the development of a coherent ethical strategy to perform such research feasibly and effectively is of paramount importance.
Objective:
this paper aims to review and synthesise ethical challenges in performing research with persons who have dementia.
Methods:
in undertaking a systematic review of the current research literature, we will identify the central issues and arguments characterising research that concerns the ethical dimensions of research participation in the dementia population. Data were analysed using both inductive and deductive content analysis. Ethical considerations in research involving persons with dementia primarily concern the representation of the interests of the person with dementia and protection of their vulnerabilities and rights.
Results:
a total of 2,894 results were returned from initial searches, following deduplication. In total, 2,458 were excluded at title review, and following abstract review 158 papers remained; 29 papers were included for analysis after full paper review and data extraction. Papers ranged between 1995 and 2013.
Conclusion:
this review has highlighted a lack of consensus in current research and guidelines addressing these concerns; a clear stance on ethical governance of studies is important for future research and best evidence-based practice in dementia.
Objectives: to describe the views of healthcare workers on the facilitators of communication with people with dementia in a care setting.
Design: thematic analysis of semi-structured interviews.
Setting: all participants were interviewed in their place of work.
Participants: sixteen healthcare workers whose daily work involves interacting with people with dementia.
Results: four overarching categories of themes were identified from the interviews that impact on communication: the attributes of a care worker, communication strategies used, organisational factors and the physical characteristics of the care environment.
Conclusion: many strategies used by healthcare workers to facilitate communication have not yet been studied in the research literature. Participants’ views on training should be incorporated into future dementia training programmes.
Intelligent cognitive assistants support people who need help performing everyday tasks by detecting when problems occur and providing tailored and context-sensitive assistance. Spoken dialogue interfaces allow users to interact with intelligent cognitive assistants while focusing on the task at hand. In order to establish requirements for voice interfaces to intelligent cognitive assistants, we conducted three focus groups with people with dementia, carers, and older people without a diagnosis of dementia. Analysis of the focus group data showed that voice and interaction style should be chosen based on the preferences of the user, not those of the carer. For people with dementia, the intelligent cognitive assistant should act like a patient, encouraging guide, while for older people without dementia, assistance should be to the point and not patronising. The intelligent cognitive assistant should be able to adapt to cognitive decline.
© The Author(s) 2015.
Background:
There are many recommended language-based strategies for effective communication with persons with dementia. What is unknown is whether effective language-based strategies are also person centered. Accordingly, the objective of this study was to examine whether language-based strategies for effective communication with persons with dementia overlapped with the following indicators of person-centered communication: recognition, negotiation, facilitation, and validation.
Methods:
Conversations (N = 46) between staff-resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded twice, using language-based and person-centered categories. There were 21 language-based categories and 4 person-centered categories.
Results:
There were 5,800 utterances transcribed: 2,409 without indicators, 1,699 coded as language or person centered, and 1,692 overlapping utterances. For recognition, 26% of utterances were greetings, 21% were affirmations, 13% were questions (yes/no and open-ended), and 15% involved rephrasing. Questions (yes/no, choice, and open-ended) comprised 74% of utterances that were coded as negotiation. A similar pattern was observed for utterances coded as facilitation where 51% of utterances coded as facilitation were yes/no questions, open-ended questions, and choice questions. However, 21% of facilitative utterances were affirmations and 13% involved rephrasing. Finally, 89% of utterances coded as validation were affirmations.
Conclusions:
The findings identify specific language-based strategies that support person-centered communication. However, between 1 and 4, out of a possible 21 language-based strategies, overlapped with at least 10% of utterances coded as each person-centered indicator. This finding suggests that staff need training to use more diverse language strategies that support personhood of residents with dementia.
As computing devices continue to become more heavily integrated into our lives, proper design of human-computer interfaces becomes a more important topic of discussion. Efficient and useful human-computer interfaces need to take into account the abilities of the humans who will be using such interfaces, and adapt to difficulties that different users may face - such as the difficulties that elderly users must deal with. Interfaces that allow for user-specific customization, while taking into account the multiple difficulties that older users might face, can assist the elderly in properly using these newer computing devices, and in doing so possibly achieving a better quality of life through the advanced technological support that these devices offer. In this paper, we explore common problems the elderly face when using computing devices and solutions developed for these problems. Difficulties ultimately fall into several categories: cognition, auditory, haptic, visual, and motor-based troubles. We also present an idea for a new adaptive operating system with advanced customizations that would simplify computing for older users.
Recent product releases such as Apple's Siri and Google's Voice Search have strongly emphasized the use of voice as a modern interaction modality. Seniors, in particular, might appreciate an alternative to small mobile phone keypads, touchpads and computer mice. This paper presents ini-tial explorations of how elderly people would interact with language-technology-driven interfaces, how these interactions measure up against traditional physical interaction channels, and what features they may require to satisfy the needs of this very specific user group.
Maintenance of communication is important for people with dementia living in long-term care. The purpose of this study was to assess the feasibility of using "Giraff", a telepresence robot to enhance engagement between family and a person with dementia living in long-term care.
A mixed-methods approach involving semi-structured interviews, call records and video observational data was used. Five people with dementia and their family member participated in a discussion via the Giraff robot for a minimum of six times over a six-week period. A feasibility framework was used to assess feasibility and included video analysis of emotional response and engagement.
Twenty-six calls with an average duration of 23 mins took place. Residents showed a general state of positive emotions across the calls with a high level of engagement and a minimal level of negative emotions. Participants enjoyed the experience and families reported that the Giraff robot offered the opportunity to reduce social isolation. A number of software and hardware challenges were encountered.
Participants perceived this novel approach to engage families and people with dementia as a feasible option. Participants were observed and also reported to enjoy the experience. The technical challenges identified have been improved in a newer version of the robot. Future research should include a feasibility trial of longer duration, with a larger sample and a cost analysis.
Older adults with cognitive impairment often have difficulties in remembering the proper sequence of activities of daily living (ADLs) or how to use the tools necessary to perform ADLs. They, therefore, require reminders in a timely fashion while performing ADLs. This is a very stressful situation for the caregivers of people with dementia. In this paper we describe a pilot study where a tele-operated assistive robot helps a group of older adults with dementia (OAwD) to perform an ADL, namely making a cup of tea in the kitchen. Five OAwD along with their caregivers participated in this study which took place in a simulated-home setting. The purpose of this study was to investigate the feasibility and usability of a robotic system in assisting the OAwD to perform ADL in a home setting. The findings from this study will contribute to achieve our ultimate goal of designing a full-fledged assistive robot that assists OAwD aging in their own homes. The assistive robots designed for people with dementia mostly focus on companionship. This is, to the best of our knowledge, the first attempt to design an assistive robot which will provide step-by-step guidance to people with dementia in their activities of daily living.
This paper presents a hypothesis-testing pilot study of socially assistive robotics technology [1] aimed at providing affordable personalized cognitive assistance, motivation, and companionship to users suffering from cognitive changes related to aging and/or Alzheimer's disease. This is work-in-progress.
In less than 25 years, 37 million people are expected to have dementia and/or Alzheimer's disease. This significant figure is a result of several factors, including increasing life expectancy and an ageing population in de-veloping countries. Alzheimer's disease, a form of dementia, is a progressive brain disorder that causes memory loss, and behavior and personality changes. People suffering from this disease become increasingly physically and cognitively impaired; they usually need help with all aspects of daily living. While there is currently no cure for dementia, special therapies (e.g., arts and crafts, music therapy) can help people with dementia to live as good a life as possible. We propose to use socially assistive robots as customized/individualized helpers as a complement to humans. This work proposes a new adaptive socially assistive robotic (SAR) system that aims to provide a customized protocol through motivation, encouragement, and companionship for users suffering from cognitive changes related to aging and/or Alzheimer's disease. The robot aims to maintain/improve the user's cognitive attention in a cognitive music game setup.
Human-robot social interaction plays an important role in spreading the use of the robot in human daily life. Through effective social interaction, robots will be able to perform many tasks in the human society. These tasks may include, but not limited to, handling various house duties, providing medical care for elderly people, assisting people with motor or cognitive disabilities, educational entertainment (edutainment), personal assistance, giving directions at information points in public places, etc. These applications need to develop social robots that are able to behave with humans as partners if not peers. This paper presents Maggie, a robotic platform developed at RoboticsLab for research on human-robot social interaction. The different developed interaction modules are also described
Currently the 2 percent growth rate for the world's older population exceeds the 1.2 rate for the world's population as a whole. By 2050, the number of individuals over the age 85 is projected to be three times more than there is today. Most of these individuals will need physical, emotional, and cognitive assistance. In this paper, we present a new adaptive robotic system based on the socially assistive robotics (SAR) technology that tries to provide a customized help protocol through motivation, encouragements, and companionship to users suffering from cognitive changes related to aging and/or Alzheimer's disease. Our results show that this approach can engage the patients and keep them interested in interacting with the robot, which, in turn, increases their positive behavior.
This study examines the acceptance and usability of an animated conversational agent designed to establish long-term relationships with older, mostly minority adult users living in urban neighborhoods. The agent plays the role of an exercise advisor who interacts with subjects daily for two months on a touch-screen computer installed in their homes for the study. Survey results indicate the eight subjects who completed the pilot study (aged 62-82) found the agent very easy to interact with, even though most of them had little or no previous experience using computers. Most subjects also indicated strong liking for and trust in the agent, felt that their relationship with the agent was more similar to a close friend than a stranger, and expressed a strong desire to continue working with the agent at the end of the study. These results were also confirmed through qualitative analysis of post-experiment debrief transcripts.
In this paper, we argue for embodied corrversational charactersas the logical extension of the metaphor of human - computerinteraction as a conversation. We argue that the only way to fullymodel the richness of human I&+ to-face communication is torely on conversational analysis that describes sets ofconversational behaviors as fi~lfilling conversational functions,both interactional and propositional. We demonstrate how toimplement this approach in Rea, an embodied conversational agentthat is capable of both multimodal input understanding and outputgeneration in a limited application domain. Rea supports bothsocial and task-oriented dialogue. We discuss issues that need tobe addressed in creating embodied conversational agents, anddescribe the architecture of the Rea interface.
This paper aims to contribute to the voice user interface systems area by establishing directions to be used during the requirements engineering phase of the development of this type of system. The process of requirements engineering proposed here takes into account specific characteristics of voice user interface, and is based on concepts deriving from the software engineering area, namely the elicitation, specification, and evaluation phases. In order to illustrate the process, a case study is discussed and presented, as well as the conclusions obtained during the development of the research.
This paper proposes a model of technology acceptance that is specifically developed to test the acceptance of assistive social
agents by elderly users. The research in this paper develops and tests an adaptation and theoretical extension of the Unified
Theory of Acceptance and Use of Technology (UTAUT) by explaining intent to use not only in terms of variables related to functional
evaluation like perceived usefulness and perceived ease of use, but also variables that relate to social interaction. The
new model was tested using controlled experiment and longitudinal data collected regarding three different social agents at
elderly care facilities and at the homes of older adults. The model was strongly supported accounting for 59–79% of the variance
in usage intentions and 49–59% of the variance in actual use. These findings contribute to our understanding of how elderly
users accept assistive social agents.
Primary objective : The study aim is to explore the perceptions and expectations of seniors in regard to Âsmart home technology installed and operated in their homes with the purpose of improving their quality of life and/or monitoring their health status. Research design and methods : Three focus group sessions were conducted within this pilot study to assess older adults' perceptions of the technology and ways they believe technology can improve their daily lives. Themes discussed in these groups included participants' perceptions of the usefulness of devices and sensors in health-related issues such as preventing or detecting falls, assisting with visual or hearing impairments, improving mobility, reducing isolation, managing medications, and monitoring of physiological parameters. The audiotapes were transcribed and a content analysis was performed. Results : A total of 15 older adults participated in three focus group sessions. Areas where advanced technologies would benefit older adult residents included emergency help, prevention and detection of falls, monitoring of physiological parameters, etc. Concerns were expressed about the user-friendliness of the devices, lack of human response and the need for training tailored to older learners. Conclusions : All participants had an overall positive attitude towards devices and sensors that can be installed in their homes in order to enhance their lives.
Sumario: The thinking-aloud method has been used successfully in user interface research. The present study investigates the application of the method for user interface design. The study is based on interviews with nine systems designers who had used the method in design practice. Their application of the method was in general very successful. This paper focuses on a unique property of this method: its inherent promotion of cognitive ergonomics due to the timely, genuine and applicable feedback to the designers in the design context
To compare brief dementia screening tests as candidates for routine use in primary care practice.
We selected screening tests that met 2 criteria: 1) administration time of 10 minutes or less in studies including individuals with, and without, dementia; and 2) performance characteristics evaluated in at least 1 community or clinical sample of older adults. We compared tests for face validity, sensitivity, and specificity in a clearly defined subject sample; for vulnerability to sociodemographic biases unrelated to dementia; for direct comparison with an accepted standard; for acceptability to patients and doctors; and for brevity and ease of administration, scoring, and interpretation by nonspecialists.
Thirteen instruments met our inclusion criteria. Very short tests (1 minute or less) proved unacceptable by several criteria. Standard instruments requiring more than 5 minutes to complete, including the best-studied Mini-Mental State Examination (MMSE), were found to be too long for routine application. Several failed other performance tests or could not be adequately assessed. Short tests taking between 2 and 5 minutes that can be administered by nonspecialists with little or no training and are relatively unbiased by language and education level appear to be superior to both shorter and longer instruments.
Three tests showed the most promise for broad application in primary care settings: the Mini-Cog, the Memory Impairment Screen, and the General Practitioner Assessment of Cognition (GPCOG). Formal practice intervention trials are now needed to validate the utility of short screens with regard to implementation, effect on rates of diagnosis and treatment of dementia patients, and outcomes for patients, families, and health care systems.
Opportunities for social interaction are lacking within today's nursing homes and staff frequently communicate messages of dependence, incompetence, and control to residents. This study evaluated a brief educational program designed to increase staff awareness of intergenerational speech modifications such as elderspeak and strategies to enhance communication.
A communication-training program was provided to Certified Nursing Assistants (CNAs; n = 20) in five nursing homes. Audio recordings of staff interacting with residents before and after training were transcribed, coded, and compared on features of elderspeak.
After the training, CNAs reduced their use of elderspeak including terms of endearment, inappropriate collective pronouns, and shortened sentence length. In addition, the emotional tone of staff speech with residents was rated as less controlling and more respectful after the training while caring qualities were maintained. Speech rate did not change significantly.
Teaching CNAs to reduce elderspeak holds promise as an approach to improving the social environment in nursing homes.
Voice assistants embodied in smart speakers (e.g., Amazon Echo, Google Home) enable voice-based interaction that does not necessarily rely on expertise with mobile or desktop computing. Hence, these voice assistants offer new opportunities to different populations, including individuals who are not interested or able to use traditional computing devices such as computers and smartphones. To understand how older adults who use technology infrequently perceive and use these voice assistants, we conducted a 3-week field deployment of the Amazon Echo Dot in the homes of seven older adults. While some types of usage dropped over the 3-week period (e.g., playing music), we observed consistent usage for finding online information. Given that much of this information was health-related, this finding emphasizes the need to revisit concerns about credibility of information with this new interaction medium. Although features to support memory (e.g., setting timers, reminders) were initially perceived as useful, the actual usage was unexpectedly low due to reliability concerns. We discuss how these findings apply to other user groups along with design implications and recommendations for future work on voice-user interfaces.
The evolution of designing interactive interfaces has been rather incremental over the past few decades, largely focused on graphical user interfaces (GUIs), even as these extended from the desktop, to mobile or to wearables. Only recently can we engage in ubiquitous, ambient, and seamless interactions, as afforded by voice user interfaces (VUIs) such as smart speakers. We posit here that recent speech engineering advances present an opportunity to revolutionize the design of voice interactions. Yet current design guidelines or heuristics are heavily oriented towards GUI interaction, and thus may not fully facilitate the design of VUIs. We survey current research revealing the challenges of applying GUI design principles to this space, as well as critique efforts to develop VUI-specific heuristics. We use these to argue that the path toward revolutionary new ubiquitous conversational voice interactions must be based on several evolutionary steps that build VUI heuristics off existing GUI design principles.
As research on speech interfaces continues to grow in the field of HCI, there is a need to develop design guidelines that help solve usability and learnability issues that exist in hands-free speech interfaces. While several sets of established guidelines for GUIs exist, an equivalent set of principles for speech interfaces does not exist. This is critical as speech interfaces are so widely used in a mobile context, which in itself evolved with respect to design guidelines as the field matured. We explore design guidelines for GUIs and analyze how these are applicable to speech interfaces. For this we identified 21 papers that reflect on the challenges of designing (predominantly mobile) voice interfaces. We present an investigation of how GUI design principles apply to such hands-free interfaces. We discuss how this can serve as the foundation for a taxonomy of design guidelines for hands-free speech interfaces.
From an accessibility perspective, voice-controlled, home-based intelligent personal assistants (IPAs) have the potential to greatly expand speech interaction beyond dictation and screen reader output. To examine the accessibility of off-the-shelf IPAs (e.g., Amazon Echo) and to understand how users with disabilities are making use of these devices, we conducted two exploratory studies. The first, broader study is a content analysis of 346 Amazon Echo reviews that include users with disabilities, while the second study more specifically focuses on users with visual impairments, through interviews with 16 current users of home-based IPAs. Findings show that, although some accessibility challenges exist, users with a range of disabilities are using the Amazon Echo, including for unexpected cases such as speech therapy and support for caregivers. Richer voice-based applications and solutions to support discoverability would be particularly useful to users with visual impairments. These findings should inform future work on accessible voice-based IPAs.
Voice User Interfaces (VUIs) are becoming ubiquitously available, being embedded both into everyday mobility via smartphones, and into the life of the home via ‘assistant’ devices. Yet, exactly how users of such devices practically thread that use into their everyday social interactions remains underexplored. By collecting and studying audio data from month-long deployments of the Amazon Echo in participants’ homes—informed by ethnomethodology and conversation analysis—our study documents the methodical practices of VUI users, and how that use is accomplished in the complex social life of the home. Data we present shows how the device is made accountable to and embedded into conversational settings like family dinners where various simultaneous activities are being achieved. We discuss how the VUI is finely coordinated with the sequential organisation of talk. Finally, we locate implications for the accountability of VUI interaction, request and response design, and raise conceptual challenges to the notion of designing ‘conversational’ interfaces.
Intelligent Personal Assistants (IPAs) are widely available on devices such as smartphones. However, most people do not use them regularly. Previous research has studied the experiences of frequent IPA users. Using qualitative methods we explore the experience of infrequent users: people who have tried IPAs, but choose not to use them regularly. Unsurprisingly infrequent users share some of the experiences of frequent users, e.g. frustration at limitations on fully hands-free interaction. Significant points of contrast and previously unidentified concerns also emerge. Cultural norms and social embarrassment take on added significance for infrequent users. Humanness of IPAs sparked comparisons with human assistants, juxtaposing their limitations. Most importantly, significant concerns emerged around privacy, monetization, data permanency and transparency. Drawing on these findings we discuss key challenges, including: designing for interruptability; reconsideration of the human metaphor; issues of trust and data ownership. Addressing these challenges may lead to more widespread IPA use.
Background
Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included.
Methods
A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases.
Results
After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of family caregivers and healthcare professionals. These studies either explored experiences without suggestions of communication methods, “open exploration,” or through examining experiences of strategies, “exploration of strategies.” A significant theme was around communication difficulties that affected interpersonal relationships and activities of daily living. Conversely, personhood strategies and a strong underlying relationship were believed to facilitate communication. The one study that examined the perspectives of people with dementia emphasized the importance of retaining valued relationships and feeling respected during communication.
Conclusions
The need to involve people with dementia in research, particularly around their experiences of communication, is evident. Such research would be imperative for facilitating person-centered care, strengthening social relationships, and informing training programs.
Individuals diagnosed with dementia are often most concerned about loss of independence, defined as the ability to continue living in one's own home. Currently, assistive technologies that provide in-home cognitive support for those with degenerative brain diseases have not been widely adopted, and individuals often rely entirely on informal caregivers to aid them in planning and performing the daily activities that allow them to continue living independently. To help these individuals, we designed Robin, a conceptual context-aware assistive application that supports independent living for users with cognitive impairments by providing temporally and physically appropriate audio prompting for the routine tasks that are most important for health outcomes and life satisfaction.
Telepresence robots have been suggested as a solution to alleviate the loneliness of the elderly. In earlier studies, user requirements regarding data quality, connectivity, navigation, and privacy issues have been listed, but feasible calling practices have not been established. We studied the usage of a telepresence robot Double in a nursing home by an elderly resident and her daughters. To enable her to contact her daughters, she could use "Please call me" buttons to send text messages to the daughters' mobile phones. This paper addresses the calling practices with telepresence robots that enable fluent communication but preserves the privacy of the residents, the care staff and visitors. Examples of practical suggestions found in the study were the establishment of mutually agreed calling rules and a "30-minute privacy" button.
The past four years have seen the rise of conversational agents (CAs) in everyday life. Apple, Microsoft, Amazon, Google and Facebook have all embedded proprietary CAs within their software and, increasingly, conversation is becoming a key mode of human-computer interaction. Whilst we have long been familiar with the notion of computers that speak, the investigative concern within HCI has been upon multimodality rather than dialogue alone, and there is no sense of how such interfaces are used in everyday life. This paper reports the findings of interviews with 14 users of CAs in an effort to understand the current interactional factors affecting everyday use. We find user expectations dramatically out of step with the operation of the systems, particularly in terms of known machine intelligence, system capability and goals. Using Norman's 'gulfs of execution and evaluation' [30] we consider the implications of these findings for the design of future systems.
We demonstrate interaction with a relational agent, embodied as a robot, to provide social support for isolated older adults. Our robot supports multiple activities, including discussing the weather, playing cards and checkers socially, maintaining a calendar, talking about family and friends, discussing nutrition, recording life stories, exercise coaching and making video calls.
Aims and Objectives
The study aims to evaluate the effects of a communication skills training programme on community aged care staff's knowledge of communication support in dementia and on staff's care experience. Background
Dementia can lead to impairments in communication. Therefore, quality community-based dementia care requires that staff be skilled communicators, equipped to facilitate interactions with people with dementia. The current investigation evaluated the effectiveness of the MESSAGE Communication Strategies in Dementia for Care Staff training programme with respect to knowledge of communication support and the staff/caregiver experience. DesignA multi-centre controlled pretest/post-test design with randomised cohort allocation was used. Outcome measures were completed at baseline, immediately after training (training group only), and at three-month follow-up. Methods
Thirty-eight care staff working in community aged care participated and completed all outcome measures (training=22; control=16).Training and control groups completed the following outcome measures: knowledge of communication support strategies, self-efficacy, preparedness to provide care, strain in nursing care and attitude to dementia care. Staff in the training group provided written feedback on the training. ResultsA significant improvement in knowledge scores from baseline was found for the training group both immediately after training and at three-month follow-up. There was also a significant training effect for self-efficacy and preparedness to provide care. No significant difference was found for the control group for any measure. No significant training effects were found for measures of strain or attitudes to dementia care. Feedback from staff suggests that the training was well received. Conclusions
The MESSAGE training was positively received by staff and had a significant effect on care staff knowledge, and confidence to provide care for people with dementia. Relevance to clinical practiceThe easily accessible multimedia training programme is well received by staff and has the potential to improve quality of care.
This paper presents an explorative study investigating the applicability of speech-only interaction in the everyday life of elderly people. For the purpose of this study we connected an iPhone 4s including the Siri application with a Bluetooth enabled headset. By pressing the Siri activation button on the iPhone the participants were able to directly access the iPhone services via voice without using a graphical user-interface (GUI).
The aim of this study was to investigate the usability, user experience and acceptance of speech-only interaction by elderly users. The results indicate a high potential of speech-only interaction for elderly users not only in indoor but also in outdoor environments. The participants showed an overall positive attitude and high acceptance of speech interaction. They particularly appreciated the simplicity of this form of interaction and indicated to use speech-only interaction in their everyday life.
People can access computer by the help of Human-Computer Interaction (HCI) assistance. In Human-Computer Interaction (HCI) field, usability is the important substance. If we assume usability substance delayed or at last for system development which will become so expensive to get usable system. So that we need to think usability fact from the beginning of the system development cycle. This research is about the way how to design and develop usable user interface system. Design rules and principles are the effective means to design usable system. These rules provide the designers assistance to improve the usability of a system while designing. Usability rules and principles need to apply during design time of the system to produce best usable system.
Several published sets of usability heuristics were compared with a database of existing usability problems drawn from a variety of projects in order to determine what heuristics best explain actual usability problems. Based on a factor analysis of the explanations as well as an analysis of the heuristics providing the broadest explanatory coverage of the problems, a new set of nine heuristics were derived: visibility of system status, match between system and the real world, user control and freedom, consistency and standards, error prevention, recognition rather than recall, flexibility and efficiency of use, aesthetic and minimalist design, and helping users recognize, diagnose, and recover from errors.
Communication problems stemming from Alzheimer's disease (AD) often result in misunderstandings that can be linked with problem behaviours and increased caregiver stress. Moreover, these communication breakdowns also can result either from caregivers' use of ineffective communication strategies, which paradoxically are perceived as helpful, or can occur as a result of not using effective communication strategies that are perceived as unhelpful.
The two primary aims were to determine the effectiveness of strategies used to resolve communication breakdowns and to examine whether caregivers' ratings of strategy effectiveness were consistent with evidence from video-recorded conversations and with effective communication strategies documented in the literature.
Twenty-eight mealtime conversations were recorded using a sample of 15 dyads consisting of individuals with early, middle and late clinical-stage AD and their family caregivers. Conversations were analysed using the trouble-source repair paradigm to identify the communication strategies used by caregivers to resolve breakdowns. Family caregivers also rated the helpfulness of communication strategies used to resolve breakdowns. Analyses were conducted to assess the overlap or match between the use and appraisals of the helpfulness of communication strategies.
Matched and mismatched appraisals of communication strategies varied across stages of AD. Matched appraisals by caregivers of persons with early-stage AD were observed for 68% of 22 communication strategies, whereas caregivers of persons with middle- and late-stage AD had matched appraisals for 45% and 55% of the strategies, respectively. Moreover, caregivers of persons with early-stage AD had matched appraisals over and above making matched appraisals by chance alone, compared with caregivers of persons in middle- and late-stage AD.
Mismatches illustrate the need for communication education and training, particularly to establish empirically derived evidence-based communication strategies over the clinical course of AD.
Globally, the population of elderly people is rising with an increasing number of people living with dementias. This trend is coupled with a prevailing need for compassionate caretakers. A key challenge in dementia care is to assist the person to sustain communication and connection to family, caregivers and the environment. The use of social commitment robots in the care of people with dementia has intriguing possibilities to address some of these care needs. This paper discusses the literature on the use of social commitment robots in the care of elderly people with dementia; the contributions to care that social commitment robots potentially can make and the cautions around their use. Future directions for programs of research are identified to further the development of the evidence-based knowledge in this area.
Objective:
Remote telepresence provided by tele-operated robotics represents a new means for obtaining important health information, improving older adults' social and daily functioning and providing peace of mind to family members and caregivers who live remotely. In this study we tested the feasibility of use and acceptance of a remotely controlled robot with video-communication capability in independently living, cognitively intact older adults.
Materials and methods:
A mobile remotely controlled robot with video-communication ability was placed in the homes of eight seniors. The attitudes and preferences of these volunteers and those of family or friends who communicated with them remotely via the device were assessed through survey instruments.
Results:
Overall experiences were consistently positive, with the exception of one user who subsequently progressed to a diagnosis of mild cognitive impairment. Responses from our participants indicated that in general they appreciated the potential of this technology to enhance their physical health and well-being, social connectedness, and ability to live independently at home. Remote users, who were friends or adult children of the participants, were more likely to test the mobility features and had several suggestions for additional useful applications.
Conclusions:
Results from the present study showed that a small sample of independently living, cognitively intact older adults and their remote collaterals responded positively to a remote controlled robot with video-communication capabilities. Research is needed to further explore the feasibility and acceptance of this type of technology with a variety of patients and their care contacts.
Relational agents—computational artifacts designed to build and maintain long-term social–emotional relationships with users—may provide an effective interface modality for older adults. This is especially true when the agents use simulated face-to-face conversation as the primary communication medium, and for applications in which repeated interactions over long time periods are required, such as in health behavior change. In this article, we discuss the design of a relational agent for older adults that plays the role of an exercise advisor, and report on the results of a longitudinal study involving 21 adults aged 62–84, half of whom interacted with the agent daily for 2 months in their homes and half who served as a standard-of-care control. Results indicate the agent was accepted and liked, and was significantly more efficacious at increasing physical activity (daily steps walked) than the control.
Difficulties with memory and communication are prominent and distressing features of dementia which impact on the person with dementia and contribute to caregiver stress and burden. There is a need to provide caregivers with strategies to support and maximize memory and communication abilities in people with dementia. In this project, a team of clinicians, researchers and educators in neuropsychology, psychogeriatrics, nursing and speech pathology translated research-based knowledge from these fields into a program of practical strategies for everyday use by family and professional caregivers.
From the available research evidence, the project team identified compensatory or facilitative strategies to assist with common areas of difficulty, and structured these under the mnemonics RECAPS (for memory) and MESSAGE (for communication). This information was adapted for presentation in a DVD-based education program in accordance with known characteristics of effective caregiver education.
The resultant DVD comprises (1) information on the nature and importance of memory and communication in everyday life; (2) explanations of common patterns of difficulty and preserved ability in memory and communication across the stages of dementia; (3) acted vignettes demonstrating the strategies, based on authentic samples of speech in dementia; and (4) scenarios to prompt the viewer to consider the benefits of using the strategies.
Using a knowledge-translation framework, information and strategies can be provided to family and professional caregivers to help them optimize residual memory and communication in people with dementia. Future development of the materials, incorporating consumer feedback, will focus on methods for enabling wider dissemination.
The existence of vascular dementia (VaD) was first identified by Marie, who described the etat lacunaire, and by Binswanger, who identified white matter lesions. The role of cortical lesions, while clear to clinicians, was highlighted only later by the pathological studies of Tomlinson and the clinical demonstrations of Hachinski et al., who have defined multi-infarct dementia. Lately, the emphasis shifted to pathogenic mechanisms with the identification of a multitude of processes, including lipohyalinosis, cardiac dysfunction, and genetic causes, to name only a few. Epidemiologic studies have demonstrated the high frequency of VaD, as well as the fact that vascular factors can contribute to Alzheimer's disease (AD). All these considerations converge to the realization that VaD is an extremely important clinical entity and that its prevention and treatment are within reach. In fact, there are more data on how to prevent strokes (and presumably VaD) than AD. Moreover, many factors that were identified as contributing to cerebrovascular disease in general and VaD in particular are frequently suspected as predisposing to AD as well. This surprising finding highlights the importance of mixed vascular-degenerative dementia as a disorder that has to be properly defined and has important implications on prevention and treatment.
Resistiveness to care is common in older adults with dementia. Resistiveness to care disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger resistiveness to care in individuals with dementia. Videotaped care episodes (n = 80) of nursing home residents with dementia (n = 20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or resistive to care). Bayesian statistical analysis tested relationships between staff communication and subsequent resident resistiveness to care. The probability of resistiveness to care varied significantly with communication (Bayes P = .0082). An increased probability of resistiveness to care occurred with elderspeak (.55, 95% CrI, .44-.66), compared with normal talk (.26, 95% CrI, .12-.44). Communication training has been shown to reduce elderspeak and may reduce resistiveness to care in future research.
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Behavioral and psychological symptoms of dementia
- Yuta Manabe
- Kenji Kosaka
Yuta Manabe and Kenji Kosaka. 2016. Behavioral and psychological symptoms
of dementia. In Dementia with Lewy Bodies: Clinical and Biological Aspects. Vol. 3.
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Voice User Interface Design Patterns
- Dirk Schnelle
- Fernando Lyardet
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