Developing an ICT-Based Mental Healthcare Service Platform for
Older People (IMPOP)
Euntaek Hong
1a
, Jueun Hwang
1b
, Dawoon Jung
1c
, Yong-Chun Bahk
1d
and Kee-Hong Choi
1,2 e,*
1
School of Psychology, Korea University, Seoul, Republic of Korea
2
KU Mind Health Institute, Korea University, Seoul, Republic of Korea
Keywords: Elderly, Mobile Health Monitoring, Evidence-Based Intervention, Mental Healthcare Platform,
User-Centered Design, Psychological Intervention.
Abstract: Recently mental health issues of older people became a large part of society and the demand for elderly mental
healthcare services is increasing. Non-face-to-face online mental health services are recommended because
they can respond to psychological changes at an initial stage and are highly cost-effective. In Korea, there are
few online services based on psychological evidence and considering the user experience of elderly users.
This paper describes the overall 3-year production process of the ICT-based Mental Healthcare Service
Platform for Older People (IMPOP). After preliminary interviews with practitioners and elderly users, we
identified the primary mental health service demands of the elderly. Therefore, a single service platform
considering the needs of the users and evidence-based tasks is designed. We present a detailed explanation of
the developed modules of IMPOP. In the end, we discuss the implications of IMPOP and suggestions for the
remaining research period.
1 INTRODUCTION
Life expectancy is getting longer worldwide, and the
proportion of the elderly population is also
increasing. The number of people aged 65 or older,
which was 10 percent of the total population in 2022,
is expected to increase to 16 percent by 2050 (United
Nations, 2022). Korea is the fastest-aging country,
with the elderly population exceeding 17% of the
total population (Statistics Korea, 2022). This
increment in the elderly population led to an interest
in the quality of life and mental health of the elderly
population. People in old age are known to have a
high risk of mental health problems such as
depression as well as physical health problems. Late-
life depression (LLD) is the biggest problem in
mental health in old age, especially, with about 7% of
the total elderly population suffering from depression
(WHO, 2017). In Korea, the depression experience
a
https://orcid.org/0000-0001-7738-8769
b
https://orcid.org/0000-0003-3791-9451
c
https://orcid.org/0000-0003-4009-4112
d
https://orcid.org/0000-0003-4216-5076
e
https://orcid.org/0000-0002-7526-3329
*Correspondence: kchoi1@korea.ac.kr
rate of the elderly group was found to be the highest
compared to other age groups (Korea Disease Control
and Prevention Agency, 2019). Since the mental
health problems of the increasing elderly population
generate a lot of socioeconomic costs, prevention and
initial responses to mental health in old age are
becoming more important.
Especially, depressive episodes in older adults
often appear as physical symptoms, which can easily
occur due to other reasons rather than a depressed
mood (Fiske, Wetherell, & Gatz, 2009; Husain-
Krautter & Ellison, 2021). Therefore, depression is
usually under-treated in the elderly. However, if LLD
is not recognized and treated appropriately, it can lead
to a functional disability and reduced quality of life
(Husain-Krautter & Ellison, 2021; Katon, 2003). That
is, continuous monitoring, prevention, and initial
intervention are important for emotional problems in
old age.
186
Hong, E., Hwang, J., Jung, D., Bahk, Y. and Choi, K.
Developing an ICT-Based Mental Healthcare Service Platform for Older People (IMPOP).
DOI: 10.5220/0011972400003476
In Proceedings of the 9th Inter national Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2023), pages 186-193
ISBN: 978-989-758-645-3; ISSN: 2184-4984
Copyright
c
2023 by SCITEPRESS Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)
Interestingly, online mental health service is
suitable for monitoring mood changes and making an
initial intervention. During COVID-19, interest and
demand for non-face-to-face mental health services
have emerged worldwide due to the spread of
infectious diseases and social distancing (Wind,
Rijkeboer, Andersson, & Riper, 2020). According to
the review paper, many online mental health services
have been developed; however, a few applications are
evidence-based interventions (Larsen et al., 2019).
However, online mental health services are not only
helpful in disaster situations such as COVID-19 but
also easy to be provided with high accessibility and
low cost. Especially, it is useful for people who
usually have difficulty accessing mental health
services due to social, economic, or physical reasons
such as older adults (McDonald, Eccles, Fallahkhair,
& Critchley, 2020). Therefore, developing an
evidence-based online mental health care service is an
important task in our society.
In this paper, the overall development process of
a senior mental healthcare service platform is
described. Specifically, this paper presents the points
that the research team considered in the development
process, the advantages of the platform, and the plan
for the rest of the research period.
2 RELATED WORK
2.1 Autobiographical Memory
Training
Autobiographical memory refers to the recollection
of specific events in a person's life, including details
about the time and place in which they occurred, and
the emotions associated with memories (Rubin, 2005).
Less specific autobiographical memories are
associated with increased feelings of depression and
a tendency to engage in ruminative thought patterns
(Lemogne et al., 2006; Kim et al., 2014). Research
has demonstrated that one's ability to recall
autobiographical memories tends to decline with age
(Craik & Park, 2000), however, this can be mitigated
through training.
Encouraging older adults to remember and
discuss their autobiographical memories can improve
their psychological well-being and stimulate
cognitive function through the act of recalling
memories (Yen & Lin, 2018). Reminiscence training
such as autobiographical memory training was
effective for elderly people with mild to moderate
Alzheimer's dementia as well as for elderly people
with depression (Jung, 2022; Raes et al., 2009).
2.2 Cognitive Training
Experts and researchers in various fields such as
medical care, nursing, rehabilitation, elderly welfare,
and social sports have developed various dementia
prevention programs and have had significant
research results so far. However, offline dementia
prevention programs have limitations. A space for the
program is essential, participants must visit there in
person. If they cannot visit there continuously, the
expected effect is lowered, and participation is
limited if the participant has a physical disability.
Therefore, using a smartphone-based dementia
prevention app can be an alternative to compensate
for the limitations of offline prevention programs
(Kim & Choi, 2019). According to Yoon et al. (2014),
the smartphone game application for diagnosis,
prevention, and mitigation of dementia effectively
suppresses brain cell reduction and an initial
symptom of dementia, by performing mental
activities of memory, logic, arithmetic, and spatial
cognitive ability.
The most cognitive training apps are limited in
their ability to evaluate and manage users' progress.
Therefore, there is a need for a cognitive training app
that can be continuously managed and evaluated
based on data. The transfer effect, the degree to which
the cognitive enhancements through the app lead to
actual improvements, is crucial in evaluating the
effectiveness of brain training apps. Studies have
shown that repetitive training within the app may not
always transfer to cognitive abilities in everyday life
(Owen et al., 2010). It is important to consider the
type of training, difficulty level, task context, and
individual cognitive profile when assessing the
transfer effect of a brain training app.
2.3 Mental Health Screening Tools
Screening tools to diagnose mental disorders are
crucial in addressing the significant problem of
mental health among older adults. However, the test
tools currently employed in Korea are frequently used
without undergoing a validation process. They are
often imported by simply translating tools in Korean
which are utilized in foreign countries. Additionally,
since these tools are imported and translated into
Korean, there is a limitation in that they may not
effectively capture the unique characteristics of
depressive symptoms that Koreans experience due to
cultural differences. For this reason, this study used
mental health screening tools for depression disorders
(MHS:D) and mental health screening tools for
anxiety disorders (MHS:A) to identify depression and
Developing an ICT-Based Mental Healthcare Service Platform for Older People (IMPOP)
187
anxiety in the elderly population in Korea, overcome
these limitations, and better reflect population-
specific characteristics (Choi et al., 2019; Park et al.,
2022).
The symptoms of depression were assessed using
the Mental Health Screening Tool for depression
disorders (MHS:D) (Choi et al., 2019; Park et al.,
2022). The MHS:D is a 12-item self-report
questionnaire using a 5-point Likert scale (0 = never;
4 = most of the time). The MHS:D exhibited a good
internal consistency coefficient in this study (α =
0.94). Anxiety symptoms were assessed using the
Mental Health Screening Tool for Anxiety disorders
(MHS:A) (Choi, Lee, & Choi, 2019; Kim et al., 2021;
Kim et al., 2018). The MHS:A is an 11-item self-
report questionnaire using a 5-point Likert scale (0 =
never; 4 = most of the time). The MHS:A exhibited a
good internal consistency coefficient in this study
= 0.96).
2.4 Considerations on the App
In designing apps for the elderly, vivid and high-
chromaticity colors are important. Warm colors are
easy for older adults to recognize and increase
readability and distinguishability (Back, 2006). In
addition, older people tend to prefer icons that feature
2-3 calm colors that they are familiar with because
using a variety of colors for small icons can be
perceived as complex or childish (Chung & Kang,
2020). To minimize information processing overload,
the navigation depth of a single screen should not
exceed three steps (Ministry of the Interior, 2017).
Older adults tend to have reduced visual acuity
compared to younger individuals and to stick to
specific content for prolonged periods. When
designing mobile devices, a letter size of 13-19pt is
considered appropriate to ensure readability.
However, seniors who use the Internet relatively well
may not have much trouble with the small font size of
9-13pt (Hwang & Park, 2007).
2.5 Design on the App
The application was developed with careful
consideration of the factors that are important when
designing an application for older people. In this app,
we used green and red, which are preferred by male
and female seniors, respectively. In addition, a
combination of icons and text was used to increase
the ease of recognition. The main function was made
larger than other icons. The UI used an easy and
intuitive one-click indicator, not a double-click or
drag that requires a sophisticated operation. By
creating a design that minimizes the amount of
content displayed on a page, seniors focus only on the
information they need and get confused less.
Therefore, this application used 13pt and San serif
typography to be read easily. In addition, an option
was provided to change the screen font size in
consideration of the elderly with severe vision
deviation.
3 PRELIMINARY INTERVIEW
The team is developing an ICT-based Mental
healthcare service Platform for Older People
(IMPOP) to provide personalized non-face-to-face
mental health services for the elderly in the
community. To apply user-centered design to the
platform, it is necessary to identify the mental health
service demands of the elderly, the main target of
IMPOP. In addition, it is also essential to identify the
service needs of the elderly from the perspective of
social workers who provide the service to older
clients. In the first year of development, in-depth
interviews were conducted with elderly users and
elderly welfare providers.
For the preliminary interview, participants were
recruited through convenience sampling for both
users and workers. The inclusion criteria of the users
were 65+years old and retired seniors who were
members of the welfare center. All interviews were
conducted online (via Zoom) for about 90 minutes.
After a brief explanation of IMPOP, the participants
freely answered the questions about the difficulties of
mental health they had experienced and the elements
that they would like to add to the platform. After
hearing a brief explanation of the study, the
participants provided responses freely about the
mental health service demand of elderly users in the
field and the functions they would like to add to the
platform as case managers.
The mean age of the senior participants was
70.8(SD=4.02) years and the participants consist of 4
females and 2 males. Three were residents of the
retirement village, and three were members of the
senior welfare center. At the beginning of the
interview, questions about the mental health issues
they experienced as they grew older were asked.
About half expressed concerns about the decline in
physical health and cognitive ability that occurs in old
age(“I feel tired and worried because my body gets
sick as I get older”, “I am worried about making
decisions and judgments about things”), and some
participants complained of helplessness and
loneliness after retirement (“There is no one to share
ICT4AWE 2023 - 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health
188
honest stories with”, “I become helpless when I have
nothing to work”). To cope with these, participants
actively try to maintain their memory or create new
relationships, but they experience limits (“I learned
various things and got along well, but it's hard to tell
the deep story inside of me”). Next, they were asked
what elements would be good to be added if an
application would be made. The most participants
requested psychological services that emphasize
positive contents such as vitality, laughter, and
memories, rather than dealing with negative issues
such as 'disease' or 'dementia' (“Rather than aiming
at healing disorders, it would be nice to create
programs that find the fun”, “It would be interesting
to participate a program that helps remember good
things rather than bad things”). Also, there was a
participant who said, “We need a program
‘rejuvenating the elderly’, rather than a program
stuck in the stereotype of the elderly”. Participants
stressed the need for an app allowing them to view
information and interventions necessary for old age
all at once.
The interview for practitioners was also
conducted. Two are social workers working at to an
elderly welfare center, and two are workers at an
academy for the elderly. After the explanation of the
platform, opinions were freely expressed about the
service demands of elderly users, and their experience
in the field as case managers.
Regarding the question about the demand for
mental health services in the field, they answered that
users' interests in social relationships and
psychological concerns had grown in the non-face-to-
face situation of COVID-19. However, there was an
absolute lack of reliable mental health information
and psychological experts in the field, so they
highlighted that a platform providing professional
services is needed in the field. They suggested that
assessment programs be created in consideration of
the characteristics of the elderly because it is often
difficult for the elderly to read or understand the texts
of the items. In addition, they emphasized that
education for case managers about supporting elderly
users who find it difficult to use smartphone apps is
needed. Furthermore, in the case of users
experiencing psychological crises, they said a service
that can connect users to a mental health specialist
more quickly is also needed.
To summarize, both elderly users and
practitioners agreed that the demand for psycho-
emotional services was increasing due to the non-
face-to-face situation of COVID-19 and emphasized
the need for mental health information and services
specialized for older people. A notable demand from
older users was that they wanted the platform to focus
on the positive aspects of mental health and reflect
'young' senses to the design. Particularly pointed out
by practitioners were the connection with experts
through the service, and the provision of professional
psychological assessment/intervention. The training
led by practitioners was also emphasized so that users
could use the platform usefully.
4 DEVELOPMENT OF IMPOP
The team IMPOP is developed to provide integrated
psychological services for older people in the
community. It will be provided through a stand-alone
mobile application titled "Spring Again", which will
be developed for use on Android platform. Figure 1
shows the brief information architecture(IA) of
IMPOP.
Figure 1: Brief IA of IMPOP.
The research team designed the platform and
content focusing on the experience of the elderly.
When the texts are presented, voice-support functions
are included so that elderly users with vision
difficulties can easily read the contents. The team
designed a single platform that provides various
psychological services all at once. We included
information and programs that remind one’s
meaningful memories and encourage spontaneous
mental healthcare, which stresses older users’ lively
and cheerful life rather than their physical/cognitive
declines. Below are the specific descriptions of the
platform modules, composed of assessment and
intervention, and methods offering personalized
services.
Developing an ICT-Based Mental Healthcare Service Platform for Older People (IMPOP)
189
4.1 Assessment Module
The emotional assessment module consists of three
submodules: depression, anxiety, and vitality. Each
submodule was created based on screening tools
validated by Korean adult standards, such as MHS:D
(Park et al., 2022) and MHS:A (Kim et al., 2021).
MHS:V (Mental Health Screening Tool: Vitality, its
validation process is in progress) is also included to
measure one’s vitality level, strongly related to
psychological well-being such as satisfaction and
security (Peterson & Seligman, 2004). When users
work on a module for the first time, they are
recommended to complete the whole module so that
they can get the overall report of the emotional
assessments. The cognitive assessment module is
composed of four submodules: verbal memory
(recognition), verbal memory (recall), attention,
working memory, and logical memory. Like the
emotional assessment module, this module is
intended to provide cognitive assessments that can be
conducted without experts.
After the first assessment, users can complete any
submodules they want. According to the assessment,
an easy-to-understand result report is provided so that
users can accurately understand the results without an
expert's explanation. Figure 2 shows the designed
screen of assessments modules, an assessment item,
and a result report.
Figure 2: Screenshots of the assessment module.
4.2 Intervention Plan Model Using
Assessment Results
When the user carries out assessment modules, an
algorithm automatically recommends the order and
difficulty of the module to the user according to the
result of the assessment as illustrated in Figure 3.
Prevention modules are automatically recommended
for users whose results indicate that they are at the
normal level of mental health (Case 1). When the
report finds out that the user is in the mental health
risk group, it is considered that the intervention with
a mental health expert is urgent, and a guide text is
printed so that they can directly get help from online
or offline services (Case 3). For users who are on the
mild to moderate level in one or more mental health
issues, education and intervention modules fit for
one’s weak areas are automatically recommended
(Case 2). For example, for a user whose attention
score is relatively low, a game which is focusing on
attention skills (‘number in order’) is shown on
her/his recommendation list. Its difficulty level is also
set according to the score of the previous assessment.
Figure 3: Summarized plan model of IMPOP.
4.3 Intervention Modules
Various intervention programs have been developed
and included so that users can run customized
programs on their own without the help of mental
health professionals. There are four intervention
modules: psychoeducation, autobiographical memory
training, cognitive training, and non-face-to-face
counselling.
In the psychoeducation module, the materials
include psychological information about the
emotional and cognitive characteristics of the elderly
and a brief introduction to various psychological
services included in IMPOP. Users may be educated
to increase their insight into their psychological
concerns such as depression and anxiety and motivate
them to participate more actively in treatment and
prevention programs on the platform.
The autobiographical memory program module
was developed based on autobiographical memory
training (AMT), a training program proven to
effective in improving depressive symptoms and
cognitive function. Its effect has also been verified for
the elderly. The existing AMT should be conducted
under the guidance of mental health professionals, but
the program in the module was organized so that
people could engage in training on their own without
ICT4AWE 2023 - 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health
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the guidance of an expert. For users to understand the
quality of their autobiographical memories and create
accurate memories, it was designed to calculate
scores on memories recorded by algorithms
developed by the research team. A growth-type
character, which grows as the number of training and
the quality of memory increases, was used for users
to be motivated to repeat the training and experience
a sense of accomplishment. Figure 4 shows the app
screens of the AMT module.
Figure 4: Screenshots of AMT module.
The cognitive training module is based on
evidence-based face-to-face cognitive training. The
program provides instructions on the training and
content with high accessibility so that users can use it
without an expert’s guidance. The cognitive training
program is provided in the form of a game, and users
may carry it out with the level of difficulty suitable
for the previous cognitive assessment/training score.
Like the cognitive assessment, the module consists of
four submodules (attention, working memory, logic
memory, and verbal memory).
For special situations that require non-face-to-
face help from mental health professionals such as
crisis intervention, a non-face-to-face counseling
module (mental health professionals) is provided on
a 1:1 basis, and users can receive help from experts
by linking the module if necessary.
Users may use the modules following the
recommendation algorithm that provides the order of
the modules or may directly select the modules and
run the program that they want.
5 CONCLUSIONS AND FUTURE
WORKS
This paper describes the need for non-face-to-face
psychological services for the elderly and the
development process of IMPOP. The senior user-
experience-oriented design was applied to the entire
platform, and psychological assessment and
intervention modules specialized for the elderly were
loaded into the platform. Development of IMPOP is
underway with a total three-year plan and this is the
end of the second year. In the first year, the team
established the outline of service development, did
preliminary interviews with potential users, and
reviewed the outline. In the second year, detailed
modules and the main platform were developed, and
the preliminary implementation of IMPOP was
carried out. In the final year, the field test of IMPOP
will be conducted, the development of educational
manuals for social and mental health workers, and the
dissemination and utilization of IMPOP will be
carried out.
Implications of the platform are as follows: First,
an age-friendly digital mental health platform is
developed. Now the penetration rate and usage time
of smartphones among the elderly are increasing, but
they are alienated from the digital market due to the
app content/design focused on the younger
generation. IMPOP applies an elderly-friendly design
in the app, and it is expected that an elderly individual
will be able to become an independent user.
Second, IMPOP extends the coverage of the
elderly welfare system by strengthening the mental
health aspect of the existing elderly integrated care
service. To date, welfare services for the elderly have
focused on the immediate problems (physical and
cognitive decline in old age, economic insecurity,
isolation), but they paid less attention to
psychological difficulties (i.e., depression) occurring
in the aftermath of well-known challenges. IMPOP
may be provided in connection with existing welfare
services, thereby meeting the elderly’s needs for
mental health services highlighted due to COVID-19.
Third, the platform is developed as a single
mobile app that can provide personalized
assessment/intervention services at once. Existing
non-face-to-face mental health services provide 'one-
size-fits-all' programs rather than considering
individual characteristics. Many of these lack
evidence and non-evidence-based mental health apps
may cause harm to users (Baumel et al., 2020). Based
on the overall results of users’ assessments, IMPOP
provides personalized and integrated program
combinations tailored to the individual. In addition,
Developing an ICT-Based Mental Healthcare Service Platform for Older People (IMPOP)
191
this platform consists of prevention and intervention
programs based on evidence-based techniques used in
clinical settings. It is expected that elderly users in the
community will be able to use integrated and
specialized mental health services on their own.
Further work includes developing a manual of
IMPOP for welfare providers. The team plans to
provide education to social workers in welfare centers
for the elderly, which explains how to use the
platform and interpret the result of the
emotional/cognitive assessments. We plan to provide
follow-up training on support for community centers
that need additional help or want the connection to
other experts. As a result, the basic understanding of
the provision of psychological services for elderly
welfare-related personnel will be enhanced.
Additionally, we plan to conduct a field test to
verify the effectiveness of IMPOP. The effectiveness
of the online assessments will be checked by
measuring the internal reliability, test-retest
reliability, criterion validity, and construct validity of
each submodule. Based on a recent meta-analysis
study conducted on depressive and anxiety disorders
(Andrews et al., 2018), the size of the therapeutic
effect of online psychological intervention compared
to the control group was reported as g = 0.80.
Considering the effect size of the study, a total of 64
people will be required to participate in the study until
follow-up evaluation.
Lastly, to increase the utilization of services in the
field, specific strategies for disseminating and
utilizing the service in the field should be set out
during the platform development process. We will
establish agreements with various elderly welfare
centers and local governments specialized in senior
caregiving. If the IMPOP service model succeeds to
relate to local governments and carries out integrated
mental healthcare for seniors in the community, it can
be a nationwide non-face-to-face mental health
caregiving model for the elderly.
ACKNOWLEDGEMENTS
This research was supported by a grant from the
Korea Health Technology R&D Project through the
Korea Health Industry Development Institute
(KHIDI), funded by the Ministry of Health &
Welfare, Republic of Korea (grant number:
HI21C0268).
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