Designing With and For the Elderly: An Interactive Digital

Social Activity Space Addressing Elderly Loneliness and

Encouraging Active Ageing

Yin-Leng Theng and Aung Paye

Nanyang Technological University,
Wee Kim Wee School of Communication and Information, Singapore 637718
Email; tyltheng@ntu.edu.sg

ABSTRACT
Worldwide the population is ageing and elderly today are socially isolated. This research is about using technologies to
address elderly loneliness and encouraging active ageing. Using participatory design, we worked with and for the
elderly to design an interactive social activity space for the elderly. We began by conducting a focus group to gather
inputs from nine elderly users and caregivers. Through design partnerships with the elderly and caregivers, an
Interactive Digital Social Activity Space (IDSAS) prototype was conceptualised. Initial feedback of the IDSAS
prototype with another group of seventeen elderly users and caregivers was positive and promising. We conclude the
paper by discussing the use of digital technologies and their implications in addressing elderly loneliness and
encouraging active ageing.

KEYWORDS
Elderly, participatory design, active ageing, social activity space.

1. INTRODUCTION
Worldwide the population is ageing. The United Nations has projected that the number of persons aged 60
years and above will increase from 739 million in 2009 to 2.1 billion by 2050 (UN, 2009). Therefore, as
the world population is graying rapidly, issues of ageing and the welfare of older adults require much
greater attention and care.
The world’s ageing population is a major concern not only on the economical front but also present
serious social problems in terms of isolation or loneliness. Wenger et al (1996) warned that social isolation
(minimal contact with other people), and loneliness (absence of a specific desired companion or friend) are
one of the major problems facing old age. Generally, when people get old, they participate less in social
activities due to their age-related problems such as poor vision, memory, physical movement, mental
illness, and so on. Because of the physical and mental problems elderly face, they make less contact with
friends and relatives. As a consequence, they suffer from physical and mental problems such as
hypertension, depression, to name some common-occurring problems. Zunzunegui et al (2003) postulated
that poor social connections and rare participation/engagement in social activities are predictors of the risk
of cognitive decline of elderly. In another study by Gow, et. al (2007), it was found that life satisfaction in
old age was strongly related to social support.
Hence, social contacts with others and participation in social activities play a vital role in old age.
Specifically, social participation and engagement with others are important key factors in promoting social
well-being of the elderly. Leisure activities (e.g. gardening, caring plants), cultural activities (e.g. dance
and music) and recreational activities (e.g. physical sports with minimal body movements) are some
popular social activities elderly enjoy, and may have therapeutic effects on their minds and bodies.
But, most current studies on the elderly are focused on fall detection systems to ensure that help and
care can be readily available to the elderly in case of accidents. Technologies used involve the installation
of wireless motion sensors in the apartments of elderly living alone (Gaddam, Mukhopadhyay and Gupta,
2009; etc.). Seah’s (2006) report proposes that for extreme cases of elderly staying alone or abandoned by

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their families, caring comes from social volunteers (e.g., students cleaning up homes while social groups
delivering cooked food every day; etc.), as well as system checking to ensure no one falls sick or die
unattended.
Elderly today are socially isolated. Hence, this paper is about exploring the use of digitally-mediated
games to address elderly isolation leading to loneliness, and at the same time encouraging active ageing.
Section 2 gives the motivation of the study in Singapore, explaining the serious problems of elderly living
alone and facing social isolation. The paper also reviews current research in digitally-mediated games for the
elderly to address ageing issues. Using participatory design, we worked with and for the elderly to design an
interactive space to encourage social interaction we believe is critical in promoting active ageing. Section 3
describes a focus group session conducted to gather inputs from elderly users and their caregivers, and then
based on ideas generated to design an interactive space prototype which we call Interactive Digital Social
Activity Space (IDSAS) for conciseness. Section 4 obtains initial feedback on the IDSAS prototype, and
Section 5 concludes by discussing the general use of digital technologies and their implications in addressing
elderly loneliness and encouraging active ageing.

2. MOTIVATION: CASE STUDY IN SINGAPORE

2.1 Elderly Staying Alone

The population in Singapore is also graying rapidly as seen worldwide Ageing issues have prompted
immediate government initiatives in Singapore to encourage and promote active ageing, wellness and care
for the elderly. The 2005 General Household Survey found that more elderly persons aged 65 and above
live alone with minimal or no social network support, and the number has gone up from 15,000 to 22,000
from 2000 to 2006 with 41 cases of elderly whose bodies laid unclaimed in 2006 (Radha, 2006), and this
number is rising in recent years. The Ministry of Community Development, Youth and Sports in their
report states that by 2030, the proportion of elderly (65 years and above) is estimated to be 18.7% (MCYS,
2010b). The 2005 General Household Survey shows that the number of elderly who live alone had gone up
from 15,000 to 22,000 between 2000 and 2005 (Radha, 2006).
As reported in the Social Isolation, Health and Lifestyles Survey by MCYS, there is an estimate of
35,000 elderly aged 60 and above staying alone with no one to look after them (MCYS, 2010b). Hence, the
number of cases of elderly dying at home and discovered days later is becoming increasingly common (PR
Log, 2010). Seah’s (Aug 6, 2006) report posed some hard questions: Could a lonely senior citizen die at
home in over-crowded Singapore before someone found the body a year later? How was that possible?
Where were the loved ones? One extreme case highlighted in the report is discovery of the skeleton of an
elderly woman one year later in her home, estimated according to the date when water and electricity were
last used. She was staying alone two years before her death.
At the Committee of Supply 2010 Meeting on Ageing Issues held on 4 March 2010 at the Parliament
House, Mr Lim Boon Heng, then Minister for the Prime Minister’s Office, said that the government would
be taking steps to prepare for an ageing society and he stressed the urgency to do in the way of active
ageing leading to full and meaningful lives, lifelong learning and employability of our seniors,
intergenerational relations at the family, workplace and community, and wellness. In another report by
MCYS (2010a), it suggests that neighbourliness is the best defence against social isolation and loneliness.

2.2 Related Studies on Digitally-Mediated Games for the Elderly

In a new book by Cann (forthcoming), he stresses that unequal ageing in UK has created gaps of treatment
and outcomes between older and younger people, and between different groups of older people, providing
strong evidence of current disadvantages and suggesting actions that could begin to change the picture of
unequal ageing. As technology gets complicated and more complex, the gap between the elderly and modern
technologies becomes seriously wider, and most of the elderly (65 years old and above) have yet to take
advantage of what technologies can offer (Pieri and Diamantinir, 2010).
Consequently, recent studies begin to harness the great promise of technologies to improve the lifestyles
of the elderly, for example, assistive living solutions for the elderly employing ambient intelligence
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technology and social robots for better quality of life and safer environments. Ijsselsteijn et al (2007)
advocate that digital games hold great promise to enhance the lives of the elderly and potentially may
improve their mental and physical well-being, and social connectedness with others. Other examples include
studies involving digitally-mediated games for exercise, health, entertainment, social interactions, etc. to
engage the elderly in active ageing:
 To promote social interaction and support, Khoo and Cheok (2006) discovered that inter-generational
games could help elderly form social bonding with the young.
 Lawrence et. al. (2010) and Theng, et. al (2009) found that the Nintendo Wii was suitable for senior
homes providing exercise opportunities to the elderly who would otherwise not exercise.
 Al Mahmud et. al (2008) designed and evaluated an augmented tabletop game intended especially for
the elderly and aimed at providing leisure and fun.
 Ijsselsteijn et. al. (2007) concluded that the digital version of the tabletop game could provide more
immersive and engaging experiences for elderly users. Häikiö (2007) also confirmed that touch-based
user interface was easy to learn and adopt, and the users were able to use it effectively regardless of
their physical or cognitive limitations.
 Ortiz at. al. (2007) went beyond gameplay but investigated the effects of avatars, virtual
representation/projections, on the elderly gamers. Contrary to belief, findings indicated that the elderly
could follow instructions easily when they were interacting with the avatar.

3. FOCUS GROUP SESSION

3.1 Adapting Participatory Design for the Elderly

According to Trigg and Clement (2008), participatory design is based on innovations and agreements of
participants even though they differ much in backgrounds and perspectives, while Druin (1999) sees
participants involved in a participatory design process as experts.
In our study, we employed a participatory design methodology as we were interested to design the game
with and for elderly users. We recruited 6 elderly participants, aged between 65 and 85, for the session.
There were 3 male participants and female participants. The participatory design team had 9 persons: 6
elderly participants; 1 designer, 1 facilitator, 1 administrator/caregiver of the senior activity centre. All the
participants were involved in the roundtable discussion and the ideas, feedback, and the innovations
highlighted by the elderly participants were collated by the facilitator and the designer. Before the session
started, they were asked to fill up the consent forms followed by a brief introduction of all participants.
Then, all the elderly participants were asked questions concerning social activities they were involved in. In
particular, feedback from the elderly participants was recorded.
In the second half of the participatory design session, all the elderly participants shared their experiences
in social events and activities at the senior activity center and then they mentioned their favorite social
games and social activities they used to take part. In addition, they were asked to sketch games to promote
social interactions with other elderly. All the drawings completed by the elderly participants were discussed
to get a clear picture and proper understanding of the design ideas. The participants were also asked personal
interests and social activities they normally participated in. The session took about 90 minutes. Each
participant was given an incentive of $5 shopping voucher for their contributions in the focus group session
(see Figure 1).

3.2 Conceptual Design

Findings from the focus group session showed that in general, the elderly were keen to participate in the
social activities and they liked to engage with others such as friends, family members, and peers in social
activities (e.g. church, elderly homes). All the participants mentioned that they enjoyed good social
relationships with friends, peers, and the family members. All six elderly participants joined social games
and events arranged by the TOUCH Seniors Activity Center (Singapore).

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 It was found out that some of the elderly participants liked to play physical games (e.g. bowling, mini-
golf, table tennis, etc.,) whereas some preferred cognitive games (e.g. games playing cards, mix and match,
memory games, etc.) involving the use of long-term memory.
Based on the sketches drawn by the elderly participants, they were keen to maintain and increase
activities that would promote social interactions with friends. The ideas proposed by the elderly participants
in the participatory design session suggested activities for social interaction involving quizzes, gardening,
memory games, etc. Our proposed Interactive Digital Social Activity Space (IDSAS) consists of a series of
these social activities proposed by the elderly participants. We then developed the IDSAS prototype with
clean, simple and colourful interfaces, using the Microsoft .Net technology using C#.Net 3.0 Microsoft .Net
Framework 3.5 and the Microsoft Visual Studio 2008, Integrated Development Environment (IDE). Figures
2 and 3 show interfaces of two games, Scissor-Paper-Stone game and the Virtual Social Pet, designed in the
IDSAS prototype.

Figure 1. Participatory Design Session with Elderly Participants

Figure 2. Scissor-Paper-Stone Game in IDSAS Figure 3. Virtual Social Pet in IDSAS Prototype
Prototype

4. INITIAL FEEDBACK OF IDSAS PROTOTYPE

Initial testing was to find out whether the elderly users liked the social activity games implemented in the
IDSAS prototype. In the initial testing of the IDSAS prototype, we recruited another group of 17 (9 male and
8 female) elderly participants.

4.1 Design of Survey Instrument

The survey instrument contains question items on elderly’s social activities, their attitudes, and perception
towards positive ageing. Table 1 shows question items on “affective responses” used in the survey
instrument. The items were taken from the following references:

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  Social engagement questions were based on the study of “Social Networks, Social Integration, and
Social Engagement Determine Cognitive Decline in Community-Dwelling Spanish Older Adults
(Zunzunegui et. al., 2003).
 Social participation questions were based on the book “Social support measurement and
intervention” (Rook and Underwood, 2000).
 Affective questions were developed based on The PANAS-X, Watson and Clark (1994).
 Positive ageing questions were developed based on the seven strategies proposed by Hill (2008).

Table 1. Sample Question Items on “Affective Responses” in Survey Instrument

Affective Responses
Please rate the following emotional reaction on a scale of 1 – 7 that you feel when
interacting with the avatar in the social activity space, with “1” being the “Strong
Disagreement” and “7” being the “Strong Agreement”
I feel happy:
a) interacting with Avatar
b) playing social activity games.
I feel confident:
a) interacting with Avatar
b) playing social activity games.
I feel alert:
a) interacting with Avatar
b) playing social activity games.
I feel attentive:
a) interacting with Avatar
b) playing social activity games.

4.2 Study Design

Figure 5 shows a demonstration by a student assistant to the elderly participants in the feedback session on
how to play the digital social activity games implemented in the IDSAS prototype. The tutorial session took
15 minutes to complete. After completing the tutorial session, the elderly participants were asked their
previous experiences when playing games that involved social participation, and social engagement at the
TOUCH Senior Activity. Feedback from the elderly participants was recorded by the student assistants.
The elderly participants then played the social activity games in the IDSAS prototype. After playing the
different games, the elderly participants were asked to complete the survey instrument with the help of the
student assistants. Finally, a short interview session was conducted to gather feedback on the IDSAS
prototype. The elderly participants were given incentives for participating in the study.

Figure 5. Evaluation Session with Elderly Participants

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4.3 Initial Findings
All the elderly participants (9 male elderly participants labeled M1 to M9, and 8 female elderly participants
labeled F1 to F8) in this feedback session were aged between 65 and 85. All 17 elderly participants went
frequently (at least once a week) to meet friends and peers and participate actively in the social events
organised by the Centre. All did not have prior experiences using computers or playing digital games.
Responses from the elderly participants show they had optimistic views and positive outlook towards
ageing. For example, the “perceptions of positive ageing” construct scores above 89.9% for each of the
question items (see Figure 6) (Hill, 2008): (i) meaning in old age (Q1); (ii) never too old to learn (Q2); (iii)
past experiences to cultivate wisdom (Q3); (iv) strengthen lifespan relationships with friends (Q4); (v)
promote growth through giving and receiving help (Q5); (vi) forgive yourself and others ((Q6); and (vii)
possess a grateful attitude (Q7).
The elderly participants’ responses were positive towards the IDSAS prototype. All of them
recommended that the social activity games in IDSAS were elderly-friendly and they did not experience
significant difficulties with the IDSAS prototype. Majority of the elderly participants except M1 and F6
pointed out that the avatar was not interactive but liked the virtual friend or avatar in IDSAS. The
participants were happy to communicate with the virtual friend while playing the social activity games. They
suggested that they preferred more animated virtual friend rather than simple avatar. Noticeably, all the
elderly participants pointed out that it would be more interesting and engaging if the avatar or virtual friend
in IDSAS would be more intelligent. Except M5, M6, and F2, the elderly participants suggested that they
preferred the avatars to be more interactive, responding in real-time to the emotions of the elderly
themselves.
With the exception of M7 due to his poor eye vision, they expressed that they were interested in playing
social activities games in IDSAS, especially the virtual pet and virtual gardening.
Another significant comment made by the elderly participants was that they liked to see more colorful
icons, pictures, and images on the screen. Besides, they also preferred music in the background while
playing the games. In general, IDSAS could create an enjoyable social space for the elderly users as seen by
the satisfaction scores averaging above 90% (see Figure 7) for positive emotions (e.g. happiness, excitement,
liveliness, confidence and alertness) expressed by the elderly after playing the social activity games.

100.00% 100.00%
98.00%
98.00%
96.00%
96.00% 94.00%
94.00% 92.00%
90.00%
92.00%
88.00%
90.00% 86.00%
84.00%
88.00%
82.00%
86.00% 80.00%
84.00%
Q1 Q2 Q3 Q4 Q5 Q6 Q7

Figure 5. Perceptions of Elderly Participants towards Figure 6. Emotional Responses of Elderly Participants
Positive Ageing

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5. DISCUSSION AND CONCLUSION
With an increased graying population, worldwide governments and authorities are becoming interested in
promoting social engagement of elderly people. A lack of social participation and engagement could trigger
loneliness and depression in the elderly. The effect of this demographic change not only concerns the elderly
and their families, but also society as a whole, from private sectors to infrastructure building and planning.
The wide implications of an ageing population have such profound societal and economical effects that
research on ageing and the elderly have expanded immensely. Abundant literature could be found discussing
the consequences of the ageing population and suggesting ways to prepare for it, at international, national,
community, or personal levels.
The importance of information and communication technologies in the drive towards the realization of
information societies was appropriately and timely reinforced at the first UN World Summit on the
Information Society (WSIS) in Geneva, Switzerland, on December 10-12 in 2003
(http://www.itu.int/wsis/index.html). The 54 heads of state and government, ministers, and vice ministers
from 176 countries that met at the WSIS reached a significant consensus on the importance for the
development and cultivation of information communication technologies (ICTs). Two resulting documents,
Declaration of Principles, and Plan of Action, outline the principles adopted and the plan to build an
inclusive Information Society for all. The goals include the need to create global connectivity (connecting
villages, universities, colleges, schools, scientific and research centres, public libraries, cultural centres,
museums, post offices, archives, health centres, hospitals, local and central government departments with
ICTs), adapt all schools’ curricula to meet challenges of the Information Society, giving the world’s
population access to television and radio services, and encouraging development of content and facilitating
the presence and use of all world languages on the Internet.
Worldwide, governments in countries realise that for the elderly to remain an active part of society,
efforts have to be undertaken to ensure active aging. It is recognised that active ageing leading to social
integration and healthy living among the elderly is dependent on major health behaviours such as regular
exercise, healthy consumption and social interactions. The issues of population ageing no longer only
concern the developed countries; many developing countries in Asia, are facing economical and societal
challenges brought forth by the population ageing phenomenon. The vast number of baby boomers who will
be entering old age in less than a decade calls for immediate actions from government and private sectors to
look into ways to encourage active ageing. One of the efforts is the synthesis between information
technology and old age.
Using participatory design, our study designed and developed the IDSAS prototype with social activity
games to address elderly loneliness and encouraging active ageing. Initial feedback of the IDSAS prototype
was positive and promising. In addition, playing social activity games, positive emotions of the elderly
participants could be evoked. Fernandez-Ballestero (2008) and Hill (2008) advocated that positive emotions
play a vital role for the elderly to be happy and optimistic. Positive ageing is very important for the elderly to
live later life peacefully and meaningfully, as positive ageing is strongly connected to positive emotions such
as happiness, joy and so on (Hill, 2008).
Although the IDSAS prototype was implemented based on the requirements of the elderly, there were
limitations. First, there were not enough social games in the IDSAS prototype. This is on-going work. The
elderly participants would like to play more social games such as physical exercise games, card games,
shopping games, etc. Second, the elderly participants suggested that because of poor vision, sometimes they
could not see what to do next because the text-based messages shown to the elderly users were too small.
On-going work involves making the IDSAS prototype more elderly-friendly so they could play without
much assistance. Third, all the social games in IDSAS should be more realistic as real world physical social
activities so that the elderly can engage with these games.

ACKNOWLEDGEMENTS
The authors would like to thank the elderly participants and TOUCH Centre for their feedback. This project
is partially funded by the Tsao Foundation.

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