The Roles of Familiarity Design in Active Ageing

The elderly often struggle when interacting with technologies. This is because the software and hardware components of the technologies are not familiar to the elderly’s mental model. This is a lack of empirical studies about how the concept of familiarity can be infused into the design of interactive technology systems to bridge the digital divide preventing today’s elderly people from actively engaging with such technologies. In this paper, a multi pronged approach is utilized. We investigate the Effects of Familiarity in Design on the Adoption of Wellness Games by the Elderly, familiarity in productive ageing, familiarity in efficient collaborative crowdsourcing, productive ageing through familiarity based Intelligent Personalized Crowdsourcing and familiarity based Agent Augmented Inter-generational Crowdsourcing. The results show that familiarity in design improves the perceived satisfaction and adoption likelihood significantly among the elderly users. These results can potentially benefit intelligent interface agent design when such agents need to interact with elderly users. A Crowdsourcing algorithm, CrowdAsm is developed. By using CrowdAsm we are able to dynamically assemble teams of workers considering the budgets, the availability of workers with the required skills and their track records to complete crowdsourcing tasks requiring collaboration among workers with heterogeneous skills. Theoretical analysis has shown that CrowdAsm can achieve close to optimal profit for a collaborative crowdsourcing system if workers follow the recommendations. List of figures Figure 1: Netcarity ........................................................................................................................ 22 Figure 2: User-friendly interface for the elderly ............................................................... 24 Figure 3: Observation of elderly's table tennis play involving camer with depth sensors (virtual reality) .................................................................................................... 50 Figure 4: The PWRS table tennis game screen .................................................................. 51 Figure 5: The King Ping Pong Game Screen ........................................................................ 51 Figure 6: Analysis of the relationship between satisfaction and perceived familiarity for PWRS........................................................................................................... 52 Figure 7: Analysis of the relationship between satisfaction and perceived familiarity for King Ping Pong ........................................................................................ 53 Figure 8: Analysis for PWRS and King Ping Pong satisfaction .................................... 53 Figure 9: Analysis of relationship between adoption likelihood and perceived familiarity for King Ping Pong ........................................................................................ 55 Figure 10: Analysis for adoption likelihood for PWRS and King Ping Pong .......... 55 Figure 11: Crowdsourcing team formation for Crowd Asm ......................................... 59 Figure 12: An overview of the inter generational collaborative crowdsourcing for proofreading of ebooks in traditional Japanese scripts (Kobayashi et al., 2013) ........................................................................................................................................ 59 Figure 13: Screenshots from the app .................................................................................... 70 Figure 14: Recommendations made by Crowd Asm agents from multiple workers' apps as viewed from the server-side ........................................................ 70 Figure 15: The proposed crowdsourcing-based app for investigating factors contributing to inter-generational interaction ........................................................ 72 Chapter 1 – Introduction The terms ‘personalization’ and ‘familiarity’ have widely been used and researched in various fields. For instance, relevant outcomes in the consumer behavioral research and trust development for the e-commerce websites (Gulati and Sytch, 2008) have been the direct impact of familiarity and personalization. The applications of familiarity and personalization could have important impacts for the creation of a smart city while adequately attending to elderly care. 1.1 Research Problem This research problem focuses on two key challenges of an ageing population. First, it focuses on the personal wellbeing – cognitive and physical – of an ageing population. For addressing the two-dimensional research problem, the role of gerontechnology has been investigated in the context of “personalized familiarity”, which shall be elaborated in the later chapters of this thesis. Gerontechnology is seen as a means of bringing positive change in the elderly’s lives. This is primarily because gerontechnology in general and health based games in particular, have been reported to bring improvements in the reflexes and core tone of such population, along with proving to be a great cardiovascular workout (O’Loughlin, 2015). Secondly, the paper focuses on Productive Aging with special attention to work-life balance in relation to intergenerational crowdsourcing. The idea has been taken up for an increased involvement of the elderly population in productive activities (Straub, 2014). 1.1.1 Personalised familiarity and Older Adults As people start moving into the later stages of their lives – become elderly i.e. between 50 and 75 years of age – certain physical and cognitive changes occur within their personal spheres. A degree of reluctance to adapting the various aspects of everyday life becomes difficult for such people. This is primarily because they lack the familiarity with that particular environment, be it a general activity or a specific customized environment. Hence, it becomes vital to develop a certain degree of familiarity among these individuals so as to maximize their functional abilities in that very domain (Son, Therrien & Whall, 2002). In particular, older adults with dementia face major difficulties pertaining to familiarity, which limits their functional abilities to a great extent. This implies that there exists a close association between the physical and cognitive abilities of the elderly population and their familiarity with a particular environment. A more common condition underlying familiarity and the elderly is Mild Cognitive Impairment, which is a precursor of dementia (Werner, Heinik, & Kitai, 2013), and thus by instilling personalized familiarity the functional and cognitive abilities of older adults can be fortified. To be specific, technology is somewhat alien to the elderly due to lack of engagement, and thus studies have shown that these technologies can be customized to support their social engagement and wellbeing (Leonardi, et al., 2008). 1.1.2 Cognitive Decline Cognitive decline and ageing have long been associated, and many have investigated the topic. Also commonly referred to as age-associated cognitive decline, this is a condition where individuals start to gradually lose their cognitive abilities as they age; however, this decline varies across individuals and there is no universal marker (Deary, et al., 2009). This decline can be characterized by a variety of components ranging from processing speed, memory, and reasoning to executive functions underpinned as a decline in general cognitive abilities. The severity of this cognitive decline depends on various factors such as lack of engagement and interest, and may lead to acute dementia as a consequence. This decline also has milder conditions like aMCI ‘Amnestic Mild Cognitive Impairment’ and Alzheimer’s disease, which according to studies may contribute to gaps in social cognition and ability to transition from basic to complex situations. Although considered an eventual outcome of healthy ageing, aMCI is considered as a source of decline in episodic memory (Koen & Yonelinas, 2014). This cognitive decline is in turn associated with the lack in familiarity of older adults with the various environments as they age, and thus personalized familiarity is proposed to be the most viable solution to bring knowledge-based familiarity among the elderly population. 1.2 Research Question It has been commonly observed that as people age, they start to lose their cognitive capabilities, which influence their physical abilities as well; a reason why most elderly population representatives are found to be technophobic. The elderly tend to be technophobic. Thus, the research question here is: How to alleviate technophobia and the gap between engagement and familiarity of the older population? The research question also includes how to make the elderly more employable and how to utilize their skills in the form of a meaningful contribution towards solving complex issues that the youth cannot solve by themselves. 1.3 Potential Solution As mentioned earlier, cognitive decline is a common condition associated with healthy ageing, and does not relate to any particular disease; all elderly people experience a decline in their cognitive capabilities – which translates into limiting their physical abilities – however the degree of severity varies across individuals. This variation occurs due to several factors that have already been identified earlier. Therefore, considering the gravity of situation here, many researchers and investigators contend that personalized familiarity is among the best solutions to maintain cognitive and physical wellbeing of the elderly (Leonardi, et al, 2008; Giovanetti et al, 2006). Moreover, since elderly people with AD or dementia have impaired explicit memory but preserved implicit memory, it is proposed that this implicit memory can be utilized by virtue of a developing a sense of familiarity (Son, Therrien, & Whall, 2002). Finally, in order to alleviate the digital divide – the technophobia that exists among the elderly population – it is proposed that gamification be used as a potential intervention (Cugelman, 2013). By inducing protechnology behaviors through gamification, the pertaining technophobia can be reduced to a great extent. Moreover, as the elderly develop more familiarity, and adapt behaviors that encourage the use of products, the digital divide would be eliminated and a higher usability will be attainable (Boger et al, 2013). Finally, increased trends of intergenerational crowdsourcing – such as Grandparent-grandchild GP-GC relationship – is also proposed to bring a fairly positive change in the cognitive and physical wellbeing of the elderly population (Nagai et al, 2013). 1.4 Overview of Thesis The purpose of this thesis is to investigate the association between familiarity and wellbeing of the elderly population; with particular focus on personalized familiarity and crowdsourcing. Ageing and cognitive decline are two interlinked concepts, that have been the center of academic research for many years. As people age, their wellbeing, characterized by cognitive and physical capabilities, starts to decline and if corrective interventions are not adopted promptly, the situation may lead to drastic outcomes. In order to improve and maintain elderly population’s wellbeing, several interventions are proposed that relate primarily to an increased familiarity to various environments. In particular, personalized / technological familiarity and gamification are proposed as key solutions to this problem and to make use of the preserved implicit memory in older adults. Also because a lack of engagement has also been associated with reduced capabilities, increased intergenerational crowdsourcing is also recommended to keep the elderly engaged and increase the usability of various products and environments by the elderly population. Chapter 2: Personalised familiarity 2.1 Familiarity Theories The terms ‘personalization’ and ‘familiarity’ has widely been used and researched in various fields. For instance, relevant outcomes in the consumer behavioral research and trust development for the e-commerce websites (Gulati and Sytch, 2008) have been the direct impact of familiarity and personalization. Similarly, ‘personalization’ and ‘familiarity’ has various applications in the field of gerontology. Along with the recollection process, familiarity tends to improve the recognizing ability by accessing the information present in brain, already (Bressler and Ding, 2006). Many previous studies have shown that the aging process damages recollection feature, but has significantly little or no effect on the familiarity. Thus, familiarity can be implemented in the recognition memory betterment of the elderly people. In 2000, Pinto et al. emphasized that gerontechnology along with ergonomic approach can result into improvement of life quality and activities. The study put forward some suggestions in the designing of home entrance and kitchen, which could result into increased level of independence and safety for the old people. The main finding was that the homes, where old people have spent most of their lifetime, are easily adaptable for them. This not only conserves their lifestyle but also increases their confidence level. Again in the same year, 2000, Pinto et al. demonstrated the impact of the same approach on the elderly patients suffering from cardiovascular disease. The level of satisfaction was remarkably increased in them by boosting the sense of responsibility and motivation. Thus, gerontechnology sets as a means of upbringing dynamic health related changes in the old-declining patients. In 2002, Son et al. proposed that familiar environment can serve to increase the functional capacities in the elderly people suffering from dementia. A proposed model was constructed by using literature from different sources, through clinical observations and previous experiences. It was found that the people suffering from dementia have preserved implicit memory. This can be utilized along with the familiarity, to bring about positive changes in the patients. In 2004, Demirbilek and Demirkan studied the impact of the environment on the ageing factor of an elder person. Mostly, the people prefer to live in their familiar environments in the ‘getting older’ phase of their life. This sets as a prime important aspect to design homes for the old people, and increases its safety, usability and attractiveness. The study suggests methods such as brainstorming, scenario building, unstructured interviews, sketching, and videotaping techniques to be used in order to increase the participation from the patient. Moreover, quality deployment matrices should be used to analyze relationship between the patients’ requirements and design specifications. The studies emphasized on the participation of the elders in designing the house for them, as this enhances the design solutions, as well as increase the satisfaction level in the subject. In 2005, Sung and Chang conducted a review to study the impact of music on the old people, and showed that such interventions can have positive effects in the patients’ life. Significant results were found in the people suffering from dementia problem. The patients exhibited reduction of agitated behaviors, as an outcome of their favorite music. In 2006, Giovannetti et al. implemented the advantages of using familiar objects for various dementia patients. Various tests such as Naming, Gesture, Semantic/Script Generation, and Personal Object Decision were used to analyze the familiarity phenomena in the patients. The results showed drastic statistical significance in the personal and analog objects. The familiar objects exhibited better gestures and information details. The study encouraged these results to be implemented on the dementia patients. The dementia patients should be provided with the familiar objects for their better use. Furthermore, the dementia patients can take benefit of new objects, with increased pre-exposure and familiarity development to them. In 2005, Mitchell et al. showed that the familiarity can improve interaction ability. With the help of an interactive software application, the improvement in responding of the students was affirmed. In 2005, Musha et al. formulated a therapy that involved the use of a robotic pet. This study proved that implementation of such personalization therapy can cause neuron activation of the brain cortical for the patients getting older. This therapy was given for 20 minutes along with 2-hour art therapy, and it brought about significant improving results in the patients under observation. In 2006, Turner and van de Walle described familiarity in HCI approach. They suggested that the familiarity is applied by simply “coping with situations, tools, and objects, or more specifically by understanding the referential whole.”. The younger generation has intimacy with the technology and interactive products, but the ageing adults do not get engaged with the technology. It is supposed that rather they seek that how the technology “meet the demands, hopes and aspirations of their everyday life”. Turner and his colleagues have focused on familiarizing the elderly people with the prevailing information technology. For this, they interviewed them about their computer learning and its effect on their lives. In 2008, Leonardi et al. proposed a design to convert the technology language to a familiar one, which could easily be understood and adopted by the elderly people. The interface was supposed to be interactive by physical and cultural means. This approach ruled out the traditional windows. In 2008, Turner conducted an empirical study on the familiarity, which involved groups striving to learn about the computer and its services. The study suggested the incorporation of technology in the everyday life, to help in its understanding. Moreover, the daily practices need to be changed in accordance to the requirement, in order to get better comprehension of the technologies, apart from designing for easy use and experience. The technology is meant not only to make practices efficient but it is responsible to change them entirely. Therefore, research is required to explore the technological horizons in terms of the evolving practices. In 2008, Barry encouraged the incorporation of familiarity into the home design plans, by the designers in order to bring positive changes in the old people. The houses of elderly people should be sensitive towards their habits and routines. Due to undesirable time changes, the older people might not be able to continue living in the same house, to which they usually adopts familiarity. They might have some sort of feelings, sense of identity and attachment associated with their house. However, they still seek for comfort level in the new locality through previous habits. Therefore, the design of a home, where an old person has to live, should tend to preserve all her character attributes, which defines him. The study also formulated an ideal home, with the incorporation of the habits and routines of an old man. In 2010, Algarabel et al. studied familiarity in the patients of Parkinson’s disease and Lewy bodies’ disease. The extent of familiarity in the patients was estimated by using recognition for word targets and distractors. The results showed that the patients of Parkinson’s disease and dementia can use familiarity process, despite of the diseases’ impact on their memories. Though, in the late stages of these diseases, the familiarity phenomenon is highly affected. In 2010, Weiermann et al. studied the relation of Parkinson’s disease to the memory process. Both the recollection and familiarity were analyzed, which may be effected because of this disease. The comparison between the Parkinson disease patients and healthy old people showed that the recollection remains intact, but the familiarity process is selectively affected. In 2011, Jurjanz et al. studied the impact of amnestic mild cognitive impairment on the familiarity. They show memory dysfunction and deficits in contextual knowledge. This leads to problems in the identification of objects and person around them. The relation of the neural networks was investigated within such people with regard to the familiarity. The results depicted decreased activity in the right prefrontal brain regions, with regard to familiarity. This can result in reduced social cognition, and task management in the patients. In 2011, Chrysikou et al. envisaged a relation between the semantic dementia (SD) and the familiarity loss. The study focused on the effect of SD on the loss of conceptual knowledge in the patient and investigated the autobiographical experiences to devise methods of maintaining the object concepts in the patients. By using tasks such as naming, gesture generation, and autobiographical knowledge for familiar or similar objects, the study was conducted. The results showed that significant dissociation relation between performance and assessments exists. In 2013, Silveira et al. proposed an increase in the activity of the old aged patients through an IT-based system. This proactive training application was especially made for the people who cannot exercise due to their growing age. Moreover, it was meant to assist the patients to follow training plans along with increase in their social activity. This application proved to be highly motivational for the patients by helping them in monitoring their performance, and hence is a source of encouragement for similar mobile-based incentives. In 2013, Boger et al. suggested utilizing the products of higher familiarity to bring betterment in the condition of the dementia patient. This approach can enable the patient to move independently, without the need of a caretaker. The study assessed the impact of familiarity on the use of different faucet designs by dementia patients. The findings suggested that familiarity could turn into lower assistance level, lesser operational problems, and higher satisfaction levels. Such a prospective can be implemented to various other products and tasks, in future, to increase their usability. In 2013, Werner et al. conducted a study regarding the familiarity, knowledge, and treatment options for the dementia disease. The findings emphasized the knowledge of physicians and their preferences. The research serves to provide guidance about the dementia and its symptoms among the physicians. In 2013, Jaffer et al. suggested the use of Internet in the medical monitoring by the trainees. The Internet serves to shorten the distances and increase the interactivity across the distances. This can be used in the medical perspectives, to bring about positive changes. Such a technology is Web 2.0 and 3.0. A workshop was arranged to bring about the task along with the questionnaire section. The study encouraged the virtual mentoring system and opinion setting in the medical staff, according to the overall questionnaire results. In 2013, Cugelman provided a view on the gamification and its effects on the health behavior change. He described the principles, mechanisms, and evidences governing these changes and their efficacy in the patients’ health betterment. Moreover, the principles for both the gamification and the resulting behavioral change were interrelated. A criteria of assessing the gamification strategy was also provided to be implemented in the digital health interventions. The study encouraged the engaging use of gamification in the digital interventions by finding more innovative ways in future and highly socializing the approach. In 2014, Koen and Yonelinas conducted a review to formulate the relation between the diseases like amnestic Mild Cognitive Impairment (aMCI), and Alzheimer’s disease (AD) and the memory decline. The effect of these diseases was checked on the two important aspects of memory; recollection and familiarity. The results showed that the aging has direct effect on the recollection phenomena, whereas, the familiarity aspect mostly remains intact. The diseases aMCI was also found related to the decline of recollection. On the other hand , the AD was associated with both the recollection and the familiarity. The familiarity decline was also found to act as a behavioral marker for the patients that might develop dementia in the near future. The study further suggested that the recollection is critically linked to hippocampus, whereas, the familiarity is associated with the perihinal cortex region. 2.1.1 Familiarity and personalized familiarity In order to understand personalized familiarity, it is important to break the term down and consider their individual definitions. ‘Personalized’ means adjusting or aligning components / features of a particular environment, situation, area, or product / service according to the requirements of a person. Familiarity on the other hand is defined as having the knowledge or mastery of something (Dictionary.com, 2015). Thus, personalized familiarity can be defined as aligning or customizing the attributes and features of a particular place or thing in order to enable an individual develop relevant knowledge or mastery. Familiarity has many different types that can generally be characterized as familiarity with a person, place or thing. To be more specific familiarity may range from familiarity with technology, familiarity with a particular area or environment such as the kitchen or the living room, familiarity with the neighborhood, and familiarity with processes to familiarity with food and health characteristics etc. Although the aspects of familiarity vary to a great extent, this thesis is only going to focus on a few most relevant aspects. These aspects include personalized familiarity with interactive and personalized games and familiarity with intergenerational crowdsourcing. This is done with the help of the portrayal of some highly interactive games and other activities. 2.1.2 Personalised familiarity and Recognition Memory Recognition and familiarity are closely associated with each other. Recognition memory and its deficit are often considered to be associated with Parkinson’s disease. It has been contended that the patients that have acquired this disease have deficit in recognition because of the low retrieval requirements of the task and not the encoding deficits (Algarabel, et al, 2010). However, there exist several contradictions pertaining the association of Parkinson’s disease with impaired recognition memory (Weiermann, et al, 2010). Nevertheless, regardless of these contradictions, recognition memory and familiarity have been reported to have some degree of association, especially in elderly population. Those representatives of the elderly population who are less familiar with a particular phenomena may be expected to experience a greater lack of recognition memory. This implies that unless an individual is familiar with a particular concept or product or thing, he or she cannot be expected to recognize it for future references. As Yonelinas (2002) elaborates, familiarity means that the individual feels that a similar event has happened before, without recalling the particular encoding text, it becomes easier to bridge the association between personalized familiarity and recognition memory. By inducing a higher degree of personalized familiarity among elderly populations, recognition memory can be be improved to a greater extent. 2.1.3 Personalised familiarity and Gerontechnology Similarly, the ‘personalization’ and ‘familiarity’ has various applications in the field of gerontology. Along with the recollection process, familiarity tends to improve the recognizing ability by accessing the information present in brain, already (Bressler and Ding, 2006). Many previous studies have shown that the aging process damages recollection feature, but has significantly little or no effect on the familiarity. Thus, familiarity can be implemented in the recognition memory betterment of the elderly people. 2.1.4 Encouraged use of IT in the medical field The medical and healthcare paradigm has spearheaded over the years – the past 2 decades especially – by virtue of an increased utilization of Information Technology. From treatment to prevention, and from efficiency to effectiveness, use of Information Technology has revolutionized the realm of medical sciences. IT has especially played an integral role in supporting the wellbeing and lifestyles of those who experience some type of impairment or inability. For example, the development and utilization of accessibility devices, prosthetics, and devices equipped with artificial intelligence in a variety of ways has nurtured medical sciences significantly. Key areas where IT has played a profound role include biotechnology, pharmaceuticals, medical device and equipment development, and other innovations. A recognized example of the use IT in medical field is EMR or Electronic Record Management, which has enabled healthcare providers and associated professionals improve the quality and correctness of services being provided to patients. More pertinent examples – relevant to the current thesis of personalized familiarity and wellbeing – include the utilization of smartphones, tablets, tele-health services, and other key mobile technologies. These technologies are making it easier to overcome the digital divide that exists among the elderly people who either suffer from dementia or cognitive decline of some sort. 2.1.4 Definition of Personalised familiarity As elaborated earlier, in order to gain an understanding of the term ‘Personalized Familiarity’, it is important to break the term down and consider their individual definitions. ‘Personalized’ means adjusting or aligning components / features of a particular environment, situation, area, or product / service according to the requirements of a person. Familiarity on the other hand is defined as having the knowledge or mastery of something. Thus, personalized familiarity can be defined as aligning or customizing the attributes and features of a particular place or thing in order to enable an individual develop relevant knowledge or mastery 2.1.5 Comparisons of existing frameworks and choice of a Framework for Personalised Familiarity The effect of familiarity on the interaction between a user and a technological product can be summarized in three stages. The first stage relates to the works of Fitts and Posner (Fitts and Posner, 2010), Taatgen et al (Taatgen et al., 2008), and Ericsson (Ericsson and Towne, 2010), and can be referred to as the “Cognitive stage”. It revolves around the basic knowledge required for task execution. The second stage is referred to as the “Associative stage” in which the persons move from their declared understanding of the action to a process based performance of the action. The stronger the association with something the person is already familiar with, the higher the speed of execution and the lower the amount of effort needed to carry out the action (Taatgen et al., 2008). The third stage is called the “Autonomous stage” in which the actions follow a smooth procedure and actions are quick and involve negligible effort. While innovation on a fundamental level could repay an age's portion related changes in their physical, social and intellectual assets, in this manner improving their personal satisfaction, the elderly much of the time get impartial and baffled by excessively complex innovation. Other than procedures to persuade and prepare more seasoned clients to utilize innovation, there is additionally a requirement for gadgets that are better customized to the abilities of a maturing client. The ordinary maturing procedure is ordinarily accompanied by visual and sound-related hindrances, and a decrease in working memory, particular consideration, and engine control is examined. Based on this three-stage model of the effect of familiarity, we need to propose a framework of familiarity design for human computer interactions. The following are the proposed frameworks for the elderly.