Empathize with the CAPTAIN Stakeholders’ Community towards

Understanding Older Adults’ Daily Needs and How They Cope with

Them

Despoina Petsani

, Evdokimos I. Konstantinidis

1,2 a

, Antonis Billis

, Maria Nikolaidou

Nikolaos Kiriakidis

, Vassiliki Zilidou

, Despoina Mantziari

, Michalis Timoleon

and Panagiotis D. Bamidis

Lab of Medical Physics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

Nively Sas, Nice, France

vickyzilidou@gmail.com, mantziad@gmail.com, mtimoleon@auth.gr, bamidis@med.auth.gr

Keywords: Older Adults, Active and Health Ageing, Smart Homes, Design Thinking.

Abstract: This paper presents the results of the first part of the design thinking approach that was utilized within the

CAPTAIN H2020 funded project. CAPTAIN aims at developing a new technology to help older adults living

at home, by designing new technology that turns the home of older adults into a ubiquitous assistant. Six

personas were selected for the empathize session which was conducted through plenary face–to-face open

discussion meeting. 33 older adults and caregivers participated. The goal of this study was to identify the

everyday difficulties that older adults face and clarify the means they are currently using to address these

problems. The paper presents the approach, the design of the first session and the results from the Greek pilot

site.

1 INTRODUCTION

According to a Center for Disease Control study by

the State of Aging and Health in America (Centers for

Disease Control and Prevention, 2013), 64% of

surveyed American older adults want to live in their

own homes. These figures are consistent with the

preferences of the European population. However,

they often need to be institutionalized due to age-

related problems. This might have negative impact on

different aspects of person’s life such as depression,

lower quality of life, social isolation and has also been

linked with high mortality rates (Yang and Ornstein,

2015).

The use of technology has demonstrated

compelling evidence as a means of supporting aging

at home (Reeder et al., 2013). A wide range of

technologies for homecare scenarios for older adults

have been developed including but not limited to

https://orcid.org/0000-0002-5522-9553

https://orcid.org/0000-0002-1854-7560

https://orcid.org/0000-0003-1307-3252

https://orcid.org/0000-0002-4859-6996

https://orcid.org/0000-0002-9936-5805

enhancing self-management of chronic conditions

(García-Lizana and Sarría-Santamera, 2007),

objective frailty assessment (Schwenk et al., 2015),

fall detection and prevention (Chaudhuri, Thompson

and Demiris, 2014) and assistance in overcoming

social isolation (Chen and Schulz, 2016).

In this context, the H2020 funded project,

CAPTAIN (Coach Assistant via Projected and

Tangible Interface, [www.captain-eu.org]), aims at

developing a new technology to help older adults

living at home. CAPTAIN will develop a new

technology designed to turn the home of older adults

into a ubiquitous assistant. The produced system

makes use of projected augmented reality and real-

time 3D sensing technologies to monitor and

“comprehend” the user and the indoor space in order

to provide contextualized and personalized coaching

and instructions. Solutions will be designed for non-

invasive user and environmental sensing including

Petsani, D., Konstantinidis, E., Billis, A., Nikolaidou, M., Kiriakidis, N., Zilidou, V., Mantziari, D., Timoleon, M. and Bamidis, P.

Empathize with the CAPTAIN Stakeholders’ Community towards Understanding Older Adults’ Daily Needs and How They Cope with Them.

DOI: 10.5220/0007766303110318

In Proceedings of the 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2019), pages 311-318

ISBN: 978-989-758-368-1

311

emotional and behavioral recognition, indoor location

and gait analysis, physical and cognitive training

progress monitoring. Exploiting this information,

CAPTAIN will develop behaviour and AI algorithms

which will allow the system to provide personalised

advice, guidance and follow-up for key age-related

issues in daily life which impact the person's ability

to remain active and independent at their home. This

will include risk avoidance, nutrition guidance,

physical activity and cognitive training follow-up,

guidance for lifestyle and social participation. One of

the research question CAPTAIN is expected to

answer is how effectively can machine learning

techniques predict older adult’s profile and provide

behavioral guidance.

CAPTAIN has to deal also with the system’s

usability and acceptability. To this end, CAPTAIN

consortium has built an engagement and

dissemination plan in order to create a community of

stakeholders with strong support bonds to stay active

throughout the whole project. The so called

CAPTAIN community is the only official source of

requirements. While the multidisciplinary team of

CAPTAIN will suggest requirements, it will be up to

the active stakeholders’ network to decide their

adoption or not. The question raised is how to build

and maintain a network of stakeholders while gather

information that will assist on enhancing system’s

usability and acceptability.

CAPTAIN has adopted a fully user-centered,

participatory design approach based on agile

principles for technology development. Throughout

the project a combination of Design Thinking, Lean

Startup and Agile methods is applied. Design

Thinking (Plattner, Meinel and Leifer, 2011)is a

highly approved method for exploring the so called

wicked problems, which are complex problems not

adequately defined. Designers using the Design

Thinking method are also willing to redefine the

problem and investigate the frame that guides to the

solution. The Lean Startup method (Ries,

2011)allows the design team to rapidly define and

build the right things. The Build–Measure–Learn

loop encapsulates the core idea of the Lean Startup

methodology and emphasizes speed as a critical

ingredient to development. Based on the output of the

Design Thinking the team defines what they are going

to Build, followed by measuring the end-users

reactions and behaviors against the delivered system

and Learn from that in order to start Building again.

The Agile method aims to define how to build the

things right. In systems like CAPTAIN that are

complex, innovative and last for about 3 years, the

traditional software development methods are not

effective. Stable plans and accurate definition of the

components at the beginning are hard to get and might

not be needed. Agile development is based on an

iterative definition and implementation of small

functional parts of the whole system. At the end of

every iteration a working increment of the system and

validate its value.

In this work we explore the engagement of end-

users in the design process at an early stage of the

system. It is mostly an exploratory work on older

adults every day habits and problems.

2 RELATED WORK

CAPTAIN’s goal is to address a new participatory

design (PD) process to the field of funded EU projects

for providing technological solutions to older adults

and create a protocol that can lead to innovative

solutions. The idea of user-driven innovation

introduced by von Hippel (Hippel, 2005) seems to have

a higher appeal in the general marketplace. The

diversity of participatory design schemas (Halskov and

Hansen, 2015) and the particularities of EU funded

projects raise the need to find new design practices.

In (Kanstrup, 2012), Kanstrup presents the maXi-

project in which designers has worked with 17

families with one or more diabetic aiming to create an

interactive system to support everyday life with

diabetes. In the COGKNOW project (Mulvenna et

al., 2007) the design team iterates the development

three times and the goal of each cycle is to improve

the final system engaging also end users through

workshops and field trials. (Zouganeli et al., 2017)

support that the users should be involved all the way

in the design. Their work aims at involving people

with mild cognitive impairment, dementia and their

caregivers and family in the design of a technological

approach providing support in various aspects of the

everyday life.

CAPTAIN tries to go beyond that approaches by

defining a protocol of user-driven innovation

approach based on business innovation model

(Design Thinking, Lean Startup and Agile) and

responsible research and innovation (RRI).

3 MATERIALS AND METHODS

This work presents the methodology and results of the

session of the Design Thinking process for

CAPTAIN project for the Greek pilot site hosted by

the Thessaloniki Active and Healthy Ageing Living

ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health

312

Lab (Thess-AHALL). The first phase of the Design

Thinking session, the Empathize, was carried out in a

single session with the participation of primary (older

adults) and secondary (formal and informal

caregivers) end-users followed by the Define phase

which was carried out by the CAPTAIN team.

3.1 Material Preparation

The method selected for the Empathize session was

based on the use of personas. Six personas were

created that adequately depict CAPTAIN’s main

targeted end-users.

Figure 1 presents the personas

created for the session. For the preparation of the

personas the whole multidisciplinary CAPTAIN

consortium provided insights during a plenary face–

to-face meeting open discussion. Also, 6 end-users (2

older adults, 2 caregivers, 2 facilitators) were

involved in order to distinguish issues about

presentation and content. After integrating their

feedback, the personas concluded in their current

version presented in the next session.

Figure 1: Example of CAPTAIN persona.

The main goal of this session was to define the

problems that older adults face in their everyday lives

at home based on 4 main axis: nutrition, physical and

cognitive activity, social participation and risk

avoidance, and then recognize how they currently

solve these problems. As older adults are defined

people of age greater than 60 years old (World Health

Organization, 2010). The protocol for the session was

initially drafted and tested with 2 older adults in

Thess-AHALL in order to detect any issues that may

arise and improve the whole procedure.

3.2 Personas

The personas’ role is twofold: on one hand they help

partners to gain deeper understanding of the system’s

end-users and on the other hand they are created to

aid participants develop empathy and initiate

discussion about their own lives, too.

3.3 World Café

A World Café is a structured process that enables

conversation and knowledge sharing in which groups

of people discuss a topic at several tables. The

participants are switching tables periodically (one or

more times) and getting introduced to the previous

discussion at their new table by a "table facilitator"

(Brown, J. Isaacs, 2010). The methodology followed

in this work adopted the World Café conversational

framework in order to enable the participants to hear

about different user personas and increase the

empathy that they feel without limiting their opinion.

The procedure was managed and moderated by 5

table facilitators, one moderator and two assistant

personnel. Each table facilitator was in charge of a

single persona and for moderating a group of 5-6

people. At the beginning of the session the

participants were all sitting together and they attend a

small presentation of the CAPTAIN project and the

aim of the session. Subsequently, the participants

were divided randomly into 5 groups of 5-6 people.

Each group was seated in a different round table with

one facilitator. One persona was excluded from the

Greek session due to the number of participants.

After the participants have been divided into

groups and were sited in different tables, the table

facilitators presented the persona to their tables. The

personas were presented orally to the participants by

the table facilitator and were also placed in the table

in a printed version (Figure 2) .The facilitator

presented the basic information about the personas

(age, relationship, children, health status and likes)

and explained the purpose of the exercise: ‘Imagine,

define and describe the problems that this specific

persona faces in his/her everyday life”. Facilitators

avoided sketching more details on their personas than

the ones shown in the printed paper (Figure 2).

Additional information was available only for the

table facilitator (Figure 1) while other details or

questions remain unspecified, by replying for

example “We do not have this information about X”.

Figure 2: Canvas for problem definition.

Empathize with the CAPTAIN Stakeholders’ Community towards Understanding Older Adults’ Daily Needs and How They Cope with

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313

The facilitator encouraged the participants to

answer the following question “Which do you think

are this persona’s problems regarding the 4 main axes

(Figure 2)?”, participating also in the discussion and

helping the participants to write down their ideas. The

facilitators’ incumbent was to moderate the

conversation and make sure that it does not diverge

from the target. Each problem was written in a

separate post-it as an one short, clear phrase. The

discussion lasted for 30 minutes and was followed by

a short break to avoid straining the participants.

Afterwards, the participants switched tables so

that everyone had a new table facilitator. Each table

facilitator kept the same persona which explained to

the newcomers. Then every problem was presented

separately, inviting the participants to provide

solutions. The main objective of this round was to

find out how people are dealing with the problems

defined in the previous round. The facilitators were

encouraging the participants to talk about their own

experiences or from their environment on how they

handle similar problems (Fitzpatrick, 2014). The

team suggested a couple of solutions for each

problem and wrote them on another post-it paper

using short, clear phrases. This discussion lasted 30

minutes too.

3.4 Participation Satisfaction

Evaluation

At the end each participant was asked to answer a

short questionnaire regarding his/her satisfaction and

approval of the procedure.

The questionnaires were designed to be short

enough, to not burden the participants but include

some critical questions.

The first question was about the overall

satisfaction of the current meeting. The answers were

given in a 5-point Likert scale: 1 (Very Unsatisfied),

2 (Unsatisfied), 3 (Neutral), 4 (Satisfied), 5 (Very

Satisfied).

The second question was about the willingness to

keep attending the CAPTAIN community meetings.

This question is an indication of how interesting they

found the session and the value they find in being part

of the community.

The third question was based on Net Promoter

Score (NPS) (Promoter, 2017). NPS is a management

tool for measuring the willingness of a customer (in

our case participant) to propose a product or service.

It is an indicator of the customer’s loyalty and overall

satisfaction. It can also measure the word of mouth

accountability. Regarding CAPTAIN session, NPS

score is used as an indication of satisfaction and can

also provide an insight of the possibility to broaden

the CAPTAIN community. To calculate NPS, the

participants are divided into three categories based on

their answers.

1. Detractors are the participants that gave score

lower or equal to 6 and are more likely to

damage session’s reputation by negative word

of mouth

2. Passives that gave score 7 or 8. They most

probably enjoyed their participation but they

are not that enthusiastic to actually promote it.

3. Promoters that answered 9 or 10 who are the

most probable to encourage other people to join

too.

3.5 Participants

Thirty three Participants were recruited using

voluntary sampling (O’Leary, 2004) and were older

adults (n=26) (above the age of 60), as well as formal

and informal caregivers (n=7). As formal caregivers

are considered all types of professionals, e.g. doctors,

nurses, psychologists and physical therapists while

informal caregivers include both family members

living or not with the elderly and paid healthcare

workers, not necessarily undergoing qualified

training, who provide day-to-day help/assistance to

elderly people.

4 RESULTS

At the end of the session each facilitator gathered the

post-its that were describing the problems and the

solutions defined in the session for each persona.

These, along with the facilitator’s personal notes was

digitalized and categorized based on the objective and

not the persona. Same problems, even those defined

with different words, were consolidated in one. For

each problem various solutions were presented.

4.1 Session Output

In the following section, the problems and solutions

defined by participants of the session are presented.

4.1.1 Nutrition

In the nutrition category are included all problems

related to eating disorders, difficulties in food

preparation and consumption that may lead to eating

disorders and mental health problems that can limit

the ability of organizing food routines and eating. The

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314

problems gathered are summarized in the following

four categories.

1. Problems in food preparation (e.g. confuse

food ingredients, burn food, do not know how

to function some devices)

2. Problems with food that are stemming from

memory issues (skip some meals, dehydration,

poor nutrition, poisoning, forget what is

permitted to eat)

3. Gain/lose weight (not balanced diet due to lack

of information, used to not healthy diet,

sensitivity in food consumption, not scheduled

meals)

4.1.2 Physical and Cognitive Activity

All the problems concerning the physical and

cognitive difficulties that an older adult might face

when dealing with everyday life activities are

included in this category. By physical activity we

mean all the activities requiring body movement and

physical strength and by cognitive all the activities

that require complicated reasoning and logic.

1. Memory issues (forget medication, forgets

where he/she stored things)

2. Decrease of body strength (lack of physical

activity, balance difficulties, fear of getting

hurt/injured, fear of falling, aches in different

body parts)

3. Psychological issues (difficulty when he/she

needs to ask for help, lack of confidence, stress,

anxiety, sadness)

4. Loss of personal capacities (sleep problems,

lose ability of solving problems, problems in

reading books/the news, problems with

personal hygiene, problem with organizing

outings, use of toilet, difficulties with

shopping)

4.1.3 Social Participation

This category focus on defining the main parameters

and variables for lifestyle and social participation.

The difficulties that came out in social inclusion and

maintain an active social life as the people age was

the main purpose of this category. This category

includes also issues that have as an impact the

possibility to lose or reduce social contacts.

1. Reluctance for group gatherings (reduced

ability to talk and communicate, trouble in

expressing/managing emotions, fear about

forgetting important things about

friends/family)

2. Change in social activities due to loss of

personal capacities (difficulties in mobility,

lack of personal time due to health

deterioration, forgets important meetings, loss

of ability to drive)

3. Change in social activities due to psychological

issues (depressive symptoms, sadness, lack of

self-esteem, fear of being a burden)

4. Unawareness (not able to find information

about local events, not familiar with

technology)

4.1.4 Everyday Risks

The scope of this category was to define everyday

issues that may lead to dangerous situation and what

older adults do in order to avoid or prevent these

situations.

1. Risks stemming from memory issues (forget to

turn off an electrical device, take wrong

medication, food poisoning, forget to lock the

front door)

2. Risks associated with physical capacity (risk of

falling, slip over cables, carpets, scattered

objects in the physical environment, dizziness

when climbing stairs, when picking something

up)

3. Risk of being deceived (abusive phone calls

and visits e.g. sales, mistakes when dealing

with money)

4.1.5 Solutions

Regardless the objective, all solutions were grouped

in four categories:

1. Reminders/Alarms, including solutions for

creating various reminders and notifications

2. List/calendars/instructions, including proposed

solutions for scheduled events, information and

lists for events or people

3. Role of relatives/friends/experts in providing

assistance or solutions to various problems.

Their role could be advisory, motivational or

educational

4. Personal motivation, concerning solutions that

require self-stimulation without the aid of

external factors. These solutions also include

behavior change.

The solutions that came up from the

discussion are presented in Table 1, Table 2, Table 3

and Table 4.

Empathize with the CAPTAIN Stakeholders’ Community towards Understanding Older Adults’ Daily Needs and How They Cope with

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315

Table 1: Solutions for the problems defined for nutrition.

Problem Solution

Type

Description

Gain/lose

weight

Lists

Calendars

Instructions

- set specific hours for

meals

- friends or relatives take

care of his/her diet

- psychoeducation

Relatives

Experts

- advice from nutritionist

Personal

motivation

- exercising

- information from internet

about herbs and healthy

diet

- step by step change

Memory

issues

Reminders

Alarms

- to drink water

- to eat meals

Lists

Calendars

Instructions

- list with diet in the fridge

- list with permitted foods

Food

preparation

Relatives

Experts

- simple guidelines

- pictures on cupboards

with ingredients

- gather all the ingredients

in the table before starting

to cook

Personal

motivation

- direction from relatives on

how to use electrical

devices

Table 2: Solutions for the problems defined for physical and

cognitive activity.

Problems Solution

Type

Description

Loss of

personal

capacities

Lists

Calendars

Instructions

- create routines (time

going to bed)

Personal

motivation

- organize personal space

(place of things, furniture)

- use audio books to read

-change routines (not lifting

weight)

Psychologic

al issues

Relatives

Experts

- help from professional for

confidence issues

Personal

motivation

- Strategy games for

problem solving

- breathing exercise

Reminders

Alarms

-reminders to go walking

Decrease

of body

strength

Relatives

Experts

- help from friends/relatives

in household

Personal

motivation

- exercising

- walking, yoga, pilates

- household as a form of

exercise

Memory

issues

Reminders

Alarms

- reminders for medication

Lists

Calendars

Instructions

- pillbox to organize

medicine

- signs and labels in things

Table 3: Solutions for the problems defined for social

participation.

Problem Solution

Type

Description

Unawarene

Lists/calend

ars/instructi

ons

- learn to search for local

events on the internet

Relatives

Experts

- friends/family to inform

him/her about local events

Change in

social

activities

due to

psychologic

al issues

Relatives

Experts

- meet friends through

groups and activities

Personal

motivation

- entertainment activities

- reading, writing thoughts

in a diary

- traveling

Change in

social

activities

due to loss

of personal

capacities

Reminders

Alarms

- reminders to call

relatives/friends

Lists

Calendars

Instructions

- simple instructions on

how to use technology to

communicate

- speed dial

Relatives

Experts

- friends/ relatives help in

transportation

Personal

motivation

- new hobbies (e.g. reading

group, local social group)

Reluctance

for group

gatherings

Reminders

Alarms

- reminders to meet/visit

friends

Relatives

Experts

- "dementia-awareness"

training for family and

friends to improve

knowledge of condition

- scheduled meetings with

relatives/friends

- friends to motivate to go

out/socialize

Personal

motivation

- education about the

benefit of social life

- visits in his/her former job

environment

ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health

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Table 4: Solutions for the problems defined for everyday

risks.

Problem Solution

Type

Description

Risk of

being

deceived

Lists/calend

ars/instructi

ons

- note down money

transactions

Personal

motivation

- not having a lot of money

at home

Risks

associated

with

physical

capacity

Reminders

Alarms

- emergency button

- automatic fall detection

system

Relatives

Experts

- help from relatives/friends

in households

Personal

motivation

- ergonomics

- avoid households that

he/she cannot do

- place useful items lower

Risks

stemming

from

memory

issues

Reminders

Alarms

- reminders to lock doors

- reminders to turn off

devices

- sign on the door to lock

Lists

Calendars

Instructions

- instructions on how to use

devices

- easily accessible list with

emergency phones

4.2 Questionnaires

As far as the participation satisfaction questionnaires

are concerned, 32 out of the 33 participants (97%)

express the will to keep attending the CAPTAIN

community meetings. The Net Promoter Score (NPS),

determined by subtracting the percentage of parti-

cipants who are detractors from the percentage who are

promoters, was NPS= 41%-22%=19 (Figure 3).

Figure 3: Answers to question 2answers.

Last but not least, there was an open question

about possible suggestions for the next session. The

participants mentioned:

“Very useful, helpful for development of

technological solutions as well as everyday practical

actions because the session makes you think deep in

problems”

“I really enjoyed it, congratulations to the

coordinators. I would like this to be repeated again

and again”

However, most of the participants did not write

any comment or recommendation.

5 DISCUSSION

This paper presents the 1

Design Thinking session of

the Greek pilot site of the CAPTAIN community. The

CAPTAIN consortium adopting a user-centred, agile

methodology will carry out a number of meetings

with the end-users in which participants and the

CAPTAIN team will co-design the system that older

adults would like to use.

This session’s goal was to identify the everyday

difficulties that older adults face and clarify the

means they are currently using to address these

problems. At this stage of the design, the input

gathered did not concerned technological issues. It is

very important to understand older adults’

preferences and routines and create a system that

facilitates and assists them, not a system that uses the

most innovative technology but nobody wants to use.

Some very interesting outcomes came out from

the discussion with CAPTAIN’s end-users. The fact

that a classification of solution in four main

categories was noticeable, rises the research interest

of investigating technological solution in that four

directions. Furthermore, it is clear that social life and

communication have a prominent role in older adults’

everyday lives. To this extend, a technological

solution should support their social inclusion and

interaction with other people and not try to substitute

human presence.

However, the results did not deviate from the

existing literature regarding older adults’ everyday

needs. A detailed comparison of the existing

literature, which has already been studied among the

CARTAIN consortium and the results from the

Design Thinking session is the next step.

Another important outcome of this session was

the satisfaction of involvement depicted on the

questionnaires. The goal is to create and maintain a

community throughout the project and the first step

was this session.

11%

19%

37%

n/a

Empathize with the CAPTAIN Stakeholders’ Community towards Understanding Older Adults’ Daily Needs and How They Cope with

Them

317

ACKNOWLEDGEMENTS

This project has received funding from the European

Union’s Horizon 2020 research and innovation

programme under the Grant Agreement No. 769830.

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