using impairment simulation tools to demonstrate age ...

USING IMPAIRMENT SIMULATION TOOLS TO DEMONSTRATE AGE-RELATED CHALLENGES IN EVERYDAY TASKS AND PROMOTE UNIVERSAL DESIGN 1

Marita A. O’Brien1, Cara B. Fausset2, Elizabeth L. Mann2, & Christina N. Harrington3 Franciscan University of Steubenville, Steubenville, OH; 2Georgia Tech Research Institute, Atlanta, GA; 3 Georgia Institute of Technology, Atlanta, GA The increasing proportion of the population that is over age 65 stimulates the need for more technologies that can be safely and easily used by older adults to allow them to continue living in their homes. Yet, even designers who know typical age-related declines may not understand specifically how the declines affect interaction with everyday technologies to complete activities of daily living. Thus, technologies may not be effectively designed to accommodate these declines. Through demonstration, participants will develop this experience by completing activities typical of older adults while wearing tools that simulate typical sensory and motor declines. Facilitators will encourage discussion of the specific difficulties experienced by participants with other observers, highlighting features that may facilitate or hinder use given the simulated disability. Highlighting limitations and task difficulties that may be experienced through use of simulation tools will encourage a better understanding of universal design criteria that will be more inclusive of the overall population. INTRODUCTION

Background Demographic changes across the globe are increasing focus on developing technologies that help older adults (aged 65 and older) complete activities of daily living safely and easily. The proportion of older adults in the population is expected to change not only in developed countries such as the US and Japan where estimates range from 20-30% of the population, but also in developing countries such as India and South Africa where older people are expected to be nearly 10% of the population by 2030 (Rogers, O’Brien, & Fisk, 2013). Although there is a recent emergence of user-centered and empathetic design as a practice, designers of age-focused technologies are typically younger and may experience few of these limitations themselves (Holzinger, Searle, & Nischelwitzer, 2007). Some may have taken classes to learn typical age-related declines, but even these designers may not understand the actual impacts on technology use. Thus, they may create technologies and products that are not accessible for target users. Because understanding the capabilities and limitations of older adults is also important for allied health disciplines (e.g., social work, nursing), an increasing number of heathcare worker training programs and assisted living centers are using aging simulations to help caregivers understand the impacts of these limitations (e.g., Pecala, Boult, & Hepburn, 2006; Wood, 2002). These simulations typically utilize household supplies such as cotton balls, ear plugs, and safety goggles to temporarily impair trainees. Trainees then complete activities of daily living (ADLs) such as buttoning a shirt and instrumental activities of daily living (IADLs) such as organizing medications for a weekly regimen that are typical of older adults (Lawton, 1990). Evaluations of these simulations suggest that trainees develop increased knowledge and comprehension of the limitations as well as the psychological toll that these limitations inflict on older adults.

We propose to demonstrate how aging simulation tools can help HFES attendees better understand the impact of aging on technology use to improve design for this growing population. Age-related physical changes. Many older adults report physical activities that restrict their ability to perform ADLs and IADLs. More than 25% of adults aged 65 and older reported difficulty performing one or more ADLs (“Profile of Older Americans,” 2011). The most common disability that influences motor capabilities is arthritis, with approximately half of adults aged 65 and older reporting that they had been diagnosed with arthritis (Arthritis Foundation, 2011). Age-related visual impairments. In a 2010 survey of residents of 19 U.S. states, between 5.4 and 16% of adults aged 65 and older reported moderate or extreme vision loss (Centers for Disease Control and Prevention, 2011). The reasons for this vision loss include cataracts (25.3-33.7%), glaucoma (6.8-12.3%), macular degeneration (6.8-11.0%) and diabetic retinopathy (1.6-5.0%). In addition, approximately 70% of adults aged 65 and older wear glasses, but vision correction to an acuity of 20/40 is only possible for 80% of older adults (Fisk, Rogers, Charness, Czaja, & Sharit, 2009). Value of simulation tools and kits. Simulation tools and kits provide value by fully considering the physical capabilities and limitations of intended users, such as older adults, in the design process. By doing so, designers both in academia and industry can better address key aspects of the universal design process and move towards truly inclusive design solutions. Simulation suits to demonstrate aging and obseity have been developed by the MIT AgeLab (Age Gain Now Empathy System; AGNES), the University of Applied Sciences in Austria (JOANNEUM), and the Nissan Motor Company in Japan to assist students, design teams, and industry professionals in better understanding limitations faced by this population and anticipating special requirements necessary (Kim & Joines, 2013). Simulation kits have aided investigations of the interaction between older adults and individuals with disabilities and various machines such as

vehicles, and environments such as retail stores, the home and the workplace (Holzinger et al., 2007). Universal design principles. Even beyond permanent impairments experienced by individuals as they age, many people could benefit from designs that improve product accessibility and simplify product usage. As one researcher noted, “Often the aging process simply exacerbates suboptimal design features that, to a lesser extent, affect everyone’s performance.” (Howell, 1997, p.4). For example, kitchen tools that can be used by individuals with arthritis can also facilitate use by anyone holding a child while cooking. A working group of designers and researchers established seven principles for universal design to improve usability of products and environments for all people to the greatest extent possible without the need for adaptation or specialized design (http://www.ncsu.edu/ncsu/design/cud/). In particular, the universal design principles of “low physical effort” and “perceptible information” highlight the need to consider product use by individuals with motor and visual impairments. Expected value of demonstration. Simulations are limited in fully replicating the impact on older adults who often experience gradual declines in capabilities to which they can adjust their behaviors to accommodate their changing abilities. No simulation could offer such a replication of gradual decline, but it can provide insight into the challenges that older adults and those with limited capabilities may face. In fact, the medical students in Pacala, Boult, and Hepburn’s (2006) study reported that they now have a memorable impression of the impact of specific impairments and have changed their attitude about aged individuals after the workshop. Undergraduate students in an applied experimental psychology class also used their simulation experience to create proposed redesigns of relevant technology for older adults (Beer, McBride, Adams & Rogers, 2011). Thus, we expect that attendees will gain both specific and general knowledge that will help them improve usability of technologies for older adults. In addition, this demonstration may also be helpful for designers targeting other user groups who experience similar limitations for reasons other than their age. Lastly, we would like to increase general awareness of universal design principles by giving participants experience using products when these principles really matter. Objectives There are three primary objectives for this demonstration: 1. Develop an appreciation of the effects of age-related changes on completing IADLs such as organizing medications and using everyday technologies such as an alarm clock; 2. Promote attention to design features that can improve usability for older adults; 3. Increase awareness about the role of impairment simulations in design processes for older adults and others with physical disabilities.

DESCRIPTION OF DEMONSTRATION Simulation Tools Two tools will be used to simulate typical sensory impairments in older adults. The Arthritis Simulation Gloves developed by researchers at Georgia Tech Research Institute (GTRI) will be used to demonstrate reductions in digital dexterity due to arthritis. The Zimmerman Low Vision Simulation Kit demonstrates the impact of vision impairments. The Arthritis Simulation Gloves shown in Figure 1 were designed to simulate the reduction in functional capabilities experienced by individuals with moderate to severe symptoms of arthritis. Specifically, the gloves reduce the wearer’s grip strength, dexterity, range of motion, and tactile sensation. The gloves provide insight into the difficulties commonly experienced by individuals with arthritis of the hands when performing tasks associated with using consumer products such as removing packaging, opening bottles, or squeezing the trigger of a spray bottle. For additional information about the gloves, visit http://hseb.gtri.gatech.edu/gloves.php

Figure 1. Arthritis Simulation Gloves. The Zimmerman Low Vision Simulation Kit shown in Figure 2 was developed as a tool for non-impaired individuals to better understand the functional impact of various vision conditions. The kit contains four goggles in which the user can place various lenses that simulate low vision (20/70; 20/200; 20/500), macular degenerations, and cataracts. Three pieces are also included that simulate reduction of field of view. The wearer will gain an understanding of the challenges that might arise when doing everyday tasks with low vision such as discriminating between medications that might have similar colors and shapes or interacting with any device that has low contrast labels on controls.

Figure 3. Sample pill bottles to be used in medication management activities. Procedures

Figure 2. The Zimmerman Low Vision Simulation Kit. Demonstration stations. Three demonstration stations will be set up to encourage maximal participation with a single activity assigned to each station. Each station will be equipped with a table, chairs, a vision simulator, an arthritis glove, and materials appropriate for each activity. A facilitator at each table will coordinate placement of the impairment tools on a volunteer and the discussion following the activity between the volunteer and other observers. Demonstration activities. Three activities have been chosen for this demonstration to represent IADLs and everyday technologies commonly used by older adults: 1. Cell Phone: Participants will dial a number, add a number to the phone directory, and configure the phone with a selected ringtone and volume; 2. Alarm Clock: Participants will set the time and alarm and change the radio listen to a designated station; 3. Medication Management: Participants will move pills (colored jelly beans) from medication bottles to a weekly pill organizer according to a specified regimen. They will also select the correct pill for one day. As shown in Figure 3, technologies will be selected to showcase features that hinder (“bad design”) or facilitate (“good design”) use by older adults. Note that the cap on the left bottle is child-resistant and will be difficult to open for volunteers wearing the arthritis simulation gloves. On the other hand, the cap on the right bottle was designed for arthritis patients and will be easy to open for volunteers wearing the arthritis simulation gloves.

Our goal is to allow visitors to experience multiple simulations. Thus, demonstration visitors will rotate to another activity station after 10-15 minutes at each station. Then, the table facilitator will request a volunteer and help them to experience the impairment by donning the simulation tools. The volunteer will complete the activities noted on an instruction sheet using the “bad design” technology. As they finish an activity task, the facilitator will elicit information about the effects of the impairments with prompts such as: • “Did you have any problems with the activity?” • “Can you describe the problems specifically?” • “Why do you think you had that problem?” • “How did you feel as you tried to perform the activity?” The simulation tools will then be placed on another volunteer to repeat the activity using the “better design” version of the technology. After the group has observed interaction with both versions of the technology, the facilitator will also discuss their own observations about the volunteers’ performance while they were impaired. They will then ask everyone at the table to look at the specific features on the technology to consider if they help or hinder older adults’ use of them. If time allows, the facilitator will also solicit ideas about other possible solutions to some specific problems they have observed. They may also elicit discussion about why the solutions are not widely implemented (e.g., cost, lack of understanding of the problem). Lastly, the facilitator may discuss how better design to reduce the impact of these impairments could also affect non-impaired users (i.e., universal design). ACKNOWLEDGMENTS We are grateful to Anne Adams and Anne McLaughlin for early discussions about this demonstration that shaped our proposal. We would also like to thank Brad Fain for supporting our work on this project.

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