Hannah R. Marston

ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial

BackgroundFalls are very common, especially in adults aged 65 years and older. Within the current international European Commission’s Seventh Framework Program (FP7) project ‘iStoppFalls’ an Information and Communication Technology (ICT) based system has been developed to regularly assess a person’s risk of falling in their own home and to deliver an individual and tailored home-based exercise and education program for fall prevention. The primary aims of iStoppFalls are to assess the feasibility and acceptability of the intervention program, and its effectiveness to improve balance, muscle strength and quality of life in older people.Methods/DesignThis international, multicenter study is designed as a single-blinded, two-group randomized controlled trial. A total of 160 community-dwelling older people aged 65 years and older will be recruited in Germany (n = 60), Spain (n = 40), and Australia (n = 60) between November 2013 and May 2014. Participants in the intervention group will conduct a 16-week exercise program using the iStoppFalls system through their television set at home. Participants are encouraged to exercise for a total duration of 180 minutes per week. The training program consists of a variety of balance and strength exercises in the form of video games using exergame technology. Educational material about a healthy lifestyle will be provided to each participant. Final reassessments will be conducted after 16 weeks. The assessments include physical and cognitive tests as well as questionnaires assessing health, fear of falling, quality of life and psychosocial determinants. Falls will be followed up for six months by monthly falls calendars.DiscussionWe hypothesize that the regular use of this newly developed ICT-based system for fall prevention at home is feasible for older people. By using the iStoppFalls sensor-based exercise program, older people are expected to improve in balance and strength outcomes. In addition, the exercise training may have a positive impact on quality of life by reducing the risk of falls. Taken together with expected cognitive improvements, the individual approach of the iStoppFalls program may provide an effective model for fall prevention in older people who prefer to exercise at home.Trial registrationAustralian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651.International Standard Randomised Controlled Trial Number: ISRCTN15932647.

Digital Gaming Perspectives of Older Adults: Content vs. Interaction

There were two objectives to this study: (a) to establish flow and (2) to establish whether computer game interaction or content was important to the older adult, using the Nintendo Wii and the Sony PlayStation 2 consoles. An earlier study had identified the sports genre as a preference, and three games (golf, tennis, and boxing) were selected that suited play on the game consoles. Participants completed a survey that incorporated the Flow State Scale (FSS). Observations undertaken used, a seven-point scale adapted from the FSS measuring subjects’ ease of use, control of game, enjoyment, concentration, and skill. Participants reported a more positive experience on the Wii console than on the PS2 in relation to the sports genre. Qualitative data collected illustrated participants’ experienced fun, laughter, and smiling and gave more positive aural feedback than the PS2. Two of the three games (golf and tennis) played on the Wii console identified the experience of flow by participants.

The Importance of Personal Possessions for the Development of a Sense of Home of Nursing Home Residents

ABSTRACT Personal possessions of nursing home residents can contribute to their sense of home. This study investigated which of the personal belongings were considered most important, and if these items indeed contributed to a sense of home. A qualitative research was conducted with 27 nursing home residents. Photographs, paintings, and pieces of furniture are objects with sentimental value. The television set is valued for its practical function. Residents of larger rooms have more flexibility in bringing along personal items, including pieces of furniture. The results of this study can be used for the design of nursing homes or for making informed choices during the process of institutionalization.

Exploring user experience and technology acceptance for a fall prevention system: results from a randomized clinical trial and a living lab

BackgroundFalls are common in older adults and can result in serious injuries. Due to demographic changes, falls and related healthcare costs are likely to increase over the next years. Participation and motivation of older adults in fall prevention measures remain a challenge. The iStoppFalls project developed an information and communication technology (ICT)-based system for older adults to use at home in order to reduce common fall risk factors such as impaired balance and muscle weakness. The system aims at increasing older adults’ motivation to participate in ICT-based fall prevention measures. This article reports on usability, user-experience and user-acceptance aspects affecting the use of the iStoppFalls system by older adults.MethodsIn the course of a 16-week international multicenter study, 153 community-dwelling older adults aged 65+ participated in the iStoppFalls randomized controlled trial, of which half used the system in their home to exercise and assess their risk of falling. During the study, 60 participants completed questionnaires regarding the usability, user experience and user acceptance of the iStoppFalls system. Usability was measured with the System Usability Scale (SUS). For user experience the Physical Activity Enjoyment Scale (PACES) was applied. User acceptance was assessed with the Dynamic Acceptance Model for the Re-evaluation of Technologies (DART). To collect more detailed data on usability, user experience and user acceptance, additional qualitative interviews and observations were conducted with participants.ResultsParticipants evaluated the usability of the system with an overall score of 62 (Standard Deviation, SD 15.58) out of 100, which suggests good usability. Most users enjoyed the iStoppFalls games and assessments, as shown by the overall PACES score of 31 (SD 8.03). With a score of 0.87 (SD 0.26), user acceptance results showed that participants accepted the iStoppFalls system for use in their own home. Interview data suggested that certain factors such as motivation, complexity or graphical design were different for gender and age.ConclusionsThe results suggest that the iStoppFalls system has good usability, user experience and user acceptance. It will be important to take these along with factors such as motivation, gender and age into consideration when designing and further developing ICT-based fall prevention systems.

Understanding the Nintendo Wii and Microsoft Kinect consoles in long-term care facilities

In recent years video game consoles, such as the Nintendo Wii TM and the Microsoft Kinect TM , have been introduced into residential facilities. This paper presents a review of current studies documenting the benefits and detriments the Wii could have on adults aged 60 years and over in residential facilities, concentrating on the common uses of the Wii in care facilities: maintaining physical fitness, promoting mental well-being, encouraging social interaction and both physical and mental rehabil- itation. Furthermore, this paper discusses the potential use of the Microsoft Kinect in care for older persons. The Wii can have a positive impact on the physical and mental health of older adults living in care facilities, but additional work should still be conducted, including assessing the use of games outside of Wii Sports and Wii Fit and possible non-gaming application of the Wii in care for older adults. Results for the Wii display potential for use of the Kinect in care facilities but further exploration is required to assess the potential physical impact and interaction viability.

Design Recommendations for Digital Game Design within an Ageing Society

This paper proposes a series of design guidelines for implementation into digital game concepts for second and third-age adults based upon results collected from an empirical study. A mixed methods approach was undertaken comprised of game design workshops (Group 1) and observations of participants during game play on the Nintendo Wii™ and Sony PlayStation 2 consoles (Group 2). A mapping process encompassing previous literature keywords, and observations was performed, categorizing three main areas (older adults, technology, and interaction/content). This paper highlights several facets aimed towards the incorporation of design recommendations and rationales for digital game design. To produce games that appeal to a wider or ageing audience, consideration to content variety, choice, and flexibility is important—as is the ease of interaction.

The design of a purpose-built exergame for fall prediction and prevention for older people

BackgroundFalls in older people represent a major age-related health challenge facing our society. Novel methods for delivery of falls prevention programs are required to increase effectiveness and adherence to these programs while containing costs. The primary aim of the Information and Communications Technology-based System to Predict and Prevent Falls (iStoppFalls) project was to develop innovative home-based technologies for continuous monitoring and exercise-based prevention of falls in community-dwelling older people. The aim of this paper is to describe the components of the iStoppFalls system.MethodsThe system comprised of 1) a TV, 2) a PC, 3) the Microsoft Kinect, 4) a wearable sensor and 5) an assessment and training software as the main components.ResultsThe iStoppFalls system implements existing technologies to deliver a tailored home-based exercise and education program aimed at reducing fall risk in older people. A risk assessment tool was designed to identify fall risk factors. The content and progression rules of the iStoppFalls exergames were developed from evidence-based fall prevention interventions targeting muscle strength and balance in older people.ConclusionsThe iStoppFalls fall prevention program, used in conjunction with the multifactorial fall risk assessment tool, aims to provide a comprehensive and individualised, yet novel fall risk assessment and prevention program that is feasible for widespread use to prevent falls and fall-related injuries. This work provides a new approach to engage older people in home-based exercise programs to complement or provide a potentially motivational alternative to traditional exercise to reduce the risk of falling.

Older adults as 21st century game designers

This study aimed to explore what type of game genres older adults would want to play, given the opportunity. A series of creative workshops were devised, and the focal point was to facilitate the creation of individual game concepts relating to participants’ hobbies, interests or dreams, and categorising them into a classification system. A series of presentations were given, followed by worksheets, to facilitate completion of the concept in a step-by-step approach. A survey was administered to 24 participants between the ages of 50 and 70+ years. Quantitative results showed the older adults in this study preferred or would consider playing games in the adventure, strategy, puzzle and sport genres. Qualitative results identified game concepts, categorised into current genre classification. Some designs were not easily placed, thus leading to the notion that combining respondent hobbies, interest and dreams with game designs may lead to new types of game(s) for an ageing population.

Ambient Assisted Living and Care in The Netherlands: The Voice of the User

Technology can assist older adults to remain living in the community. Within the realm of information and communication technologies, smart homes are drifting toward the concept of ambient assisted living (AAL). AAL-systems are more responsive to user needs and patterns of living, fostering physical activity for a healthier lifestyle, and capturing behaviours for prevention and future assistance. This study provides an overview of the design-requirements and expectations towards AAL-technologies that are formulated by the end-users, their relatives and health care workers, with a primary focus on health care in The Netherlands. The results concern the motivation for use of technology, requirements to the design, implementation, privacy and ethics. More research is required in terms of the actual needs of older users without dementia and their carers, and on AAL in general as some of the work included concerns less sophisticated smart home technology.

Breaking Down Barriers: Hospice Palliative Care as a Human Right in Canada

The need to attend to terminally ill persons and provide improved quality of living and dying should be a national priority in Canada. Hospice palliative care (HPC), a person-centered approach that addresses the needs of the whole person, improves the quality of living and dying of persons facing a life-threatening illness. To ensure Canadians are able to benefit from HPC, we propose that it should be enshrined as a human right in Canada with access guaranteed to all terminally ill persons under the Canada Health Act (CHA). This paper describes numerous barriers that currently exist including, but not limited to, barriers from geographic location, prognosis, ageism, and constraints from the Canadian medical system that have resulted in unequal access to of a patchwork of services. This paper proposes if HPC is formally recognized as a human right, then financial allocation specifically for HPC will require provincial governments to address the substantial inequalities in access to HPC.