Virtual reality for older users: a systematic literature review
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paper_title: Prevalência e fatores associados ao déficit de equilíbrio em idosos

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The balance alterations on elderly population lead to the important limitations in the carrying out of activities daily living and are the principal cause of fall on these individuals. Since they are multifactorial in nature it is fundamental to know which elderly individuals are most vulnerable and which factors are associated to these alterations. For this reason, a cross-sectiona l study was carried out which aimed to analyze the influence of physical, mental and socio-demographics factors about the elderly balance, residents in Santa Cruz-RN-Brasil city. The sample was constituted of 310 elderly which was applied Supporting Test. Statistical analysis was performed with Pearson's Chi-squar ed test in the bivariate analysis, followed by binar y logistic regression in the multivariate analysis, with the respective odds ratio (OR). It is found a prevalence if 46,1% of elderly with alteration on balance where from a multivaried analysis it was verified association with a more-75-year age (p=0,000), female sex (p=0,006), being illiterate (p=0,006), poor health perception (p=0,006) and having hearing deficit (p=0,001). It was concluded that the identification of predecting factors to the balance disturbances is constituted in a fundamental step to the action planning which aim to reduce the effects of this condition on living quality.
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paper_title: Designing tablet-based games for seniors: the example of CogniPlay, a cognitive gaming platform

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This paper describes the analysis and design of a tablet-based gaming platform for seniors that promotes their quality-of-life and well-being by incorporating cognitive training mechanisms. A literature review of age-related changes and games for seniors indicated 'casual games' have the characteristics necessary to provide an enjoyable user experience for the senior audience. Having concluded that these games should target cognitive stimulation, the authors analysed mechanisms to achieve this purpose and compiled them into a matrix to be used as a starting point for the games design process. In parallel, the authors also gathered seniors' preferences and requirements regarding games, through observations and a game book. Low-, medium-, and high-fidelity prototypes for a gaming cognitive platform were developed, evaluated with end-users, and iteratively improved. Results showed that seniors easily interacted with the platform and were willing to use it in the future. Results and experience led to the identification of 10 rules of thumb that can be beneficial if applied to related projects. This paper concludes by identifying exciting areas for future research and development.
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paper_title: A virtual reality based tool for the assessment of “survey to route” spatial organization ability in elderly population: preliminary data

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IntroductionIt is a largely shared opinion that spatial cognition is thehuman capacity of orienting oneself in and to cope witheveryday environments. It is by actively interacting with anenvironment, in fact, that an agent is able to organizespatial knowledge in a route (egocentric) and survey(allocentric) map in order to effectively use it for explo-ration (Carassa et al. 2002). According to recent studiesspatial coping ability appears to be declining with age inhealthy elderly population. (McCaddon et al. 2001).Moreover, several studies in neuropsychology showed howone of the main consequences of cognitive decline is pro-nounced in the capacity to explore new environments,execute wayﬁnding in familiar contexts and use landmarkfor orienting themselves in complex situations.Despite the agreement in deﬁning spatial cognition asspeciﬁcally grounded in context and enacted in an activecoping with the environment, up to now most of theevaluation tools for topographical orientation introducedlaboratory methodologies in order to understand howpeople explore spaces. Analyzing literature, we can ﬁndseveral spatial tests—such as autoevaluation questionnaires(Vecchi et al. 1999; Pazzaglia and De Beni 2001), mentalrotation tasks (Just and Carpentere 1985) or speciﬁcallysuited spatial-memory tasks (Della Sala et al. 1999)—thatunfortunately do not allow an immediate and direct inter-action generally possible in the daily environment.It constitutes an important bias for the evaluation ofeveryday spatial impairments especially in elderly popula-tion and/or in neurological patients, often making to wishthe introduction of a more ecological evaluation. Thus, infact,itispossibletoobserveexplorationstrategiesofpeopleand to individuate the speciﬁc environment elements theagent utilizes during navigation in complex spaces.Unfortunately the use of an agent observation in dailycontexts (in order to investigate the explorative behaviorsstrictly related to the interaction with the speciﬁc charac-teristics of the environment), generates many questionsabout the reliability and interpretation of the collected data.Actually the problem in designing an effective assess-ment tool that links a reliable evaluation methodology witha more situated observation of human spatial behaviorsappears to be still open.We propose to integrate classical evaluation tools withcomputer-based interactive ones, such as virtual reality, inorder to evaluate complex environments explorationcapacity by observing the types of spatial representationsthat a patient is able to produce in order to adaptivelyinteract with space within a given activity. Virtual reality(VR) environments, in fact, provides a representation ofdynamic nature and these interactive environments con-stitutes the essential connection between the use of labo-ratory simulations and the possibility of evaluating the typeof explorative interactions acted during an exploration(Morganti 2003). Within these structures humans canactively act explorative behaviors ‘‘as they are’’ in daily
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paper_title: Training the elderly in pedestrian safety: Transfer effect between two virtual reality simulation devices

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Abstract Objectives A virtual-reality training program has been developed to help older pedestrians make safer street-crossing decisions in two-way traffic situations. The aim was to develop a small-scale affordable and transportable simulation device that allowed transferring effects to a full-scale device involving actual walking. Methods 20 younger adults and 40 older participants first participated in a pre-test phase to assess their street crossings using both full-scale and small-scale simulation devices. Then, a trained older group (20 participants) completed two 1.5-h training sessions with the small-scale device, whereas an older control group received no training (19 participants). Thereafter, the 39 older trained and untrained participants took part in a 1.5-h post-test phase again with both devices. Results Pre-test phase results suggested significant differences between both devices in the group of older participants only. Unlike younger participants, older participants accepted more often to cross and had more collisions on the small-scale simulation device than on the full-scale one. Post-test phase results showed that training older participants on the small-scale device allowed a significant global decrease in the percentage of accepted crossings and collisions on both simulation devices. But specific improvements regarding the way participants took into account the speed of approaching cars and vehicles in the far lane were notable only on the full-scale simulation device. Discussion The findings suggest that the small-scale simulation device triggers a greater number of unsafe decisions compared to a full-scale one that allows actual crossings. But findings reveal that such a small-scale simulation device could be a good means to improve the safety of street-crossing decisions and behaviors among older pedestrians, suggesting a transfer of learning effect between the two simulation devices, from training people with a miniature device to measuring their specific progress with a full-scale one.
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paper_title: Using communication and visualization technologies with senior citizens to facilitate cultural access and self-improvement

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Abstract This paper presents the results of research that explores the social impacts and benefits of using digital visualization technologies, which include Augmented Reality (AR), Virtual Reality (VR) and Quick Response codes (QR codes). The target group for this study was senior citizens in an adult day care centre. This group was selected for two reasons: firstly, for belonging to a generation that has not grown up surrounded by digital technologies; and secondly, for therefore being at a disadvantage when it comes to adopting and using modern day information and communication technologies. Research was focused on the potential benefits of digital technologies and also on how senior citizens responded towards them, in particular how they felt these technologies were improving their social and personal well-being. Digital technologies were introduced into the day-to-day lives of senior citizens, providing them with a variety of alternative ways to access social media, communication tools or cultural content. Using digital technologies, they were also asked to perform activities related to their own personal and social well-being.
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paper_title: VR usability from elderly cohorts: Preparatory challenges in overcoming technology rejection

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Virtual Reality (VR) usability is an emerging area that has made rapid progress among early adopters, but has so far failed to address the concerns of late adopters. In particular, elderly cohorts stand to benefit greatly from VR technologies as they enter areas of assistive technology, gerontechnology, and authentic modes of training. This study examined technology rejection criteria from a sample of 19 retired persons by comparing normative and VR practices for the fundamental learning of navigation using Google Earth mapping. This research discovered that three dimensional fear was a major factor in determining the acceptance and rejection of VR as a usable instrument for training elderly people in the use of navigation by means of enhanced mapping. This study examines the hypothesis that in combination, physical and pseudo physical realities require a range of preparatory exercises to acclimatize older users towards a stress-free approach to VR adoption. This study aimed to reveal new understanding about technology rejection in older populations, in particular where the physical presence of the wearing of VR equipment, in combination with the psychological and mental fear of the 3D experience, brought about high levels of technology rejection. Hesitation to accept VR equipment across both physical and perceptual boundaries is problematic for elderly users where rich 3D experiences are a requirement for successful, purposeful, and authentic tasking.
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paper_title: Usability of a Virtual Reality Environment in Community Facilities for Assessment and Training in Persons with Acquired Brain Injury or Older People in Hong Kong

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Background: A web-based virtual environment in the use of community facilities like automatic teller machine (ATM), mass transit railway (MTR), and convenience store was designed for assessment and training in people with cognitive disabilities in Hong Kong. A previous study in people with acquired brain injury (ABI) has shown that a virtual environment can facilitate the generalization of learned skills to real life. The objective of this study was to examine the usability of a newly designed virtual reality (VR) environment that simulated the operation of an automatic teller machine (ATM) for training in healthy older persons. Methods: 126 participants, who were healthy older people, resided in community dwellings, were consecutively recruited by convenience sampling from a regional elderly social centre – the ELCHK Shatin Multi-service Centre for the Elderly in Hong Kong in one year. All participants received a two hour group training session for a total of 2 sessions, 2 hours per session, at the ELCHK Shatin Multi-service Centre for the elderly over one year period. They were trained by a qualified IT instructor using the VR-ATM programme for cash withdrawals, money transfers and electronic bill payment tasks. Results: Significant differences were found in average reaction time, total time use, and correctness before and after training in the VR-ATM. There was also improvement in self-efficacy in using the ATM in real life. Conclusion: The authors found the VR-ATM to be usable as a valid assessment and training tool for relearning the use of ATMs prior to real-life practice in the healthy elderly population. Web-based VR system, which can be openly accessed anywhere through the internet, is important for training skills in a protective environment, increasing the confidence of clients, and providing training opportunities for people with or without cognitive disabilities prior to real-life practice in the community.
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paper_title: A virtual reality paradigm for the assessment and rehabilitation of executive function deficits post stroke: Feasibility study

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The ability to perform successive or simultaneous tasks is a common and necessary aspect of everyday life. This ability is often impaired in people suffering from brain lesions affecting, in particular, the frontal regions. The assessment and recovery of executive functions and dual task abilities conducted in laboratory settings do not always succeed, in part, due to the ecological and contextual nature of the abilities impaired. The present study was designed to develop and test a virtual reality based tool for the rehabilitation of shifting of attention and action planning functions using tasks reminiscent of daily life tasks. The virtual environment employed in the study is a supermarket developed using NeuroVR software. While actively exploring this environment, participants were requested to collect some items from a list while attending to different audio announcements that would modify the sequence or number of items collected. This executive function evaluation and rehabilitation procedure has been conceived as a hierarchical series of tasks, starting from a single-task condition and ending with successive multiple tasks. In this paper, we present the results of a small-scale pilot trial where we investigated the feasibility of the procedure in a healthy elderly population. These results provided important usability data for a subsequent randomized clinical trial.
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paper_title: Understanding wayfinding for the elderly using VR

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This study suggests that Virtual Reality (VR) technology can be used for the wayfinding study and design in the building industry with the special interest for the elderly people. Designers can benefit from this research's wayfinding study tools in their own designs for the aging population. This study focused on the way finding design in healthcare facilities. Wayfinding in healthcare facilities is particularly challenging for older adults who have limited physical and cognitive abilities. To test and compare wayfinding performances between the elderly group and the young-aged group, this study developed simulated VR environments: 1) series of VR environments with minimal design features for wayfinding and 2) series of VR environments with several design features that aid wayfinding. Participants viewed the walkthrough VR movies that lead from one location to the destination and were tested to find the route back to the original starting location. Tests were conducted at three decision making points.
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paper_title: Mobile Cognitive Training Games for older adults with mild cognitive impairment

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This paper presents an integrated mobile cognitive training platform to monitor and support the training of cognitive training interventions targeting people with Mild Cognitive Impairment (MCI). Our solution aims (a) to automatically detect patterns of mental behaviour based on game-play metrics of large groups of older players, (b) to establish novel game design and development paradigms integrating a continuous and ongoing cognitive training process for older individuals with mild cognitive impairment, (c) to monitor the player's capacity to perform real-life training exercises through the adoption of Virtual reality technologies and provide objective feedback and (d) to identify a methodological user centered design framework for building VR games for older adults.
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paper_title: A virtual reality based tool for the assessment of “survey to route” spatial organization ability in elderly population: preliminary data

paper_content:

IntroductionIt is a largely shared opinion that spatial cognition is thehuman capacity of orienting oneself in and to cope witheveryday environments. It is by actively interacting with anenvironment, in fact, that an agent is able to organizespatial knowledge in a route (egocentric) and survey(allocentric) map in order to effectively use it for explo-ration (Carassa et al. 2002). According to recent studiesspatial coping ability appears to be declining with age inhealthy elderly population. (McCaddon et al. 2001).Moreover, several studies in neuropsychology showed howone of the main consequences of cognitive decline is pro-nounced in the capacity to explore new environments,execute wayﬁnding in familiar contexts and use landmarkfor orienting themselves in complex situations.Despite the agreement in deﬁning spatial cognition asspeciﬁcally grounded in context and enacted in an activecoping with the environment, up to now most of theevaluation tools for topographical orientation introducedlaboratory methodologies in order to understand howpeople explore spaces. Analyzing literature, we can ﬁndseveral spatial tests—such as autoevaluation questionnaires(Vecchi et al. 1999; Pazzaglia and De Beni 2001), mentalrotation tasks (Just and Carpentere 1985) or speciﬁcallysuited spatial-memory tasks (Della Sala et al. 1999)—thatunfortunately do not allow an immediate and direct inter-action generally possible in the daily environment.It constitutes an important bias for the evaluation ofeveryday spatial impairments especially in elderly popula-tion and/or in neurological patients, often making to wishthe introduction of a more ecological evaluation. Thus, infact,itispossibletoobserveexplorationstrategiesofpeopleand to individuate the speciﬁc environment elements theagent utilizes during navigation in complex spaces.Unfortunately the use of an agent observation in dailycontexts (in order to investigate the explorative behaviorsstrictly related to the interaction with the speciﬁc charac-teristics of the environment), generates many questionsabout the reliability and interpretation of the collected data.Actually the problem in designing an effective assess-ment tool that links a reliable evaluation methodology witha more situated observation of human spatial behaviorsappears to be still open.We propose to integrate classical evaluation tools withcomputer-based interactive ones, such as virtual reality, inorder to evaluate complex environments explorationcapacity by observing the types of spatial representationsthat a patient is able to produce in order to adaptivelyinteract with space within a given activity. Virtual reality(VR) environments, in fact, provides a representation ofdynamic nature and these interactive environments con-stitutes the essential connection between the use of labo-ratory simulations and the possibility of evaluating the typeof explorative interactions acted during an exploration(Morganti 2003). Within these structures humans canactively act explorative behaviors ‘‘as they are’’ in daily
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paper_title: Reminiscence Therapy using Image-Based Rendering in VR

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We present a novel VR solution for Reminiscence Therapy (RT), developed jointly by a group of memory clinicians and computer scientists. RT involves the discussion of past activities, events or experiences with others, often with the aid of tangible props which are familiar items from the past; it is a popular intervention in dementia care. We introduce an immersive VR system designed for RT, which allows easy presentation of familiar environments. In particular, our system supports highly-realistic Image-Based Rendering in an immersive setting. To evaluate the effectiveness and utility of our system for RT, we perform a study with healthy elderly participants to test if our VR system can help with the generation of autobiographical memories. We adapt a verbal Autobiographical Fluency protocol to our VR context, in which elderly participants are asked to generate memories based on images they are shown. We compare the use of our image-based system for an unknown and a familiar environment. The results of our study show that the number of memories generated for a familiar environment is higher than that for an unknown environment using our system. This indicates that IBR can convey familiarity of a given scene, which is an essential requirement for the use of VR in RT. Our results also show that our system is as effective as traditional RT protocols, while acceptability and motivation scores demonstrate that our system is well tolerated by elderly participants.
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paper_title: 360 virtual reality travel media for elderly

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The objectives of this qualitative research were to study the model of 360-degree virtual reality travel media, to compare appropriateness of moving 360-degree virtual reality travel media for elderly with both still and moving cameras, and to study satisfaction of elderly in 360-degree virtual reality travel media. The informants are 10 elders with age above and equal to 60 years old who live in Bangkok regardless of genders. Data were collected through documents, detailed interview, and non-participant observation of elders to 360-degree virtual reality travel media with data triangulation. 1. From the literature review 1. The creation must primarily consider the target consumers on their physics 2. must have fluidity on changing the view of the camera by calibrating with the target consumers 3. The image displayed must not move too fast to prevent dizziness and improve the comfort of the target consumers. It is also highly recommended to implement a function to customize the movement rate for the customer. 2. From the in-depth interview with the target consumers, the results found that 1. They are worried and not used to the equipment 2. They have no idea where to look 3. They feel excited 5. They are interested in what is more to see 6. They feel like they did actually travel there 7. They can hear the sound clearly 8. They do not like when the camera is moving and find still camera more comfortable. 3. From the non-participant observation and found that they are always excited, laughed, and smiled when watching the media. They always asked where this is and why they cannot see anything when turning around.
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paper_title: Can exercises using virtual reality games reduce risk and fear of falls among older women

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Background & Aim: The objective of this study was to compare the risk and fear of falls among older women pre and post intervention using virtual reality games. Method: Thirty six community dwelling older women aged 56 and above were randomly divided into experimental (exercises using virtual reality games focus on improving balance) and control (conventional balance exercises) groups. Both groups attended an hour exercise session, twice a week for 6 weeks. Risk and fear of falls were measured using Physiological Profile Assessment (PPA) and Activity Specific Balance Scale (ABC-6). Pre and post intervention differences between the groups were examined. Results: Both the groups, virtual experiment and control group, had significant decrease in fall risk score after the interventions of exercises using virtual reality games and conventional balance exercise respectively (Z = - 3.38, p = 0.001 for experimental group; Z = - 2.50, p = 0.01 for control group). Significant difference was only demonstrated in the experiment group for ABC, t(17) = -2.78, p = 0.013. No significant differences were shown between the groups in risk and fear of falls post intervention. Conclusion: Practicing fun and interactive exercises using virtual reality games can focus on improving balance at home and reducing risk of falls in older adults.
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paper_title: Treatment of Alzheimer's, Cognitive, Chronic Pain Rehabilitation, Depression and Anxiety disorders in One System for Elderly Using VR

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There is straightforwardly relation between the elderly developing populace and mental disorders all through the world particularly by those effected by Alzheimer's disease, cognitive issues, depression and anxiety and in addition chronic pain and it's turned into a test for medicinal services and social help administrations is also a serious concern for the medical practitioners. On the other hand, taking care of that demand for the serious game industry can essentially profit by the organization of creative, computer-based applications fit for tending to need, especially in the zone of psychological disorders and its recovery. In that specific situation, we have planned to help the restorative faculty, health care specialist and different guardian in enhancing the nature of every life activities people with psychological disorders and we present one 3D game using virtual reality VR tool. In this paper, the authors will talk about the practical idea of serious games for elderly patients. The main task of our study is to merge all other studies previously done and implemented in the form of various games, to bring them under one umbrella. The factors used to gain the retention of elderly in the game play for longtime training are discussed. In addition, efficient productive design criteria and formative methodologies will be discussed by which we made a game using VR tool.
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paper_title: Studying the technological barriers and needs of people with dementia: A quantitative study

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The fruitful adoption of technology is winding up progressively critical to practical autonomy and independence of elderly people with dementia. A superior comprehension of the technological boundaries and the necessities of cognitively impaired individuals will help the researchers to yield more suitable interventions and will prompt the avoidance of institutionalisation. The purpose of this study is to perceive those technological barriers and needs of people suffering from dementia. A methodology based on a combination of guided questionnaires and experiments with two technological devices, tablet and virtual reality head-mounted display (VR HMD), was applied. Data were collected through individual structured interviews that occurred in a care centre in Athens. Their unfamiliarity with the technology might be the major factor that prevents its utilisation. The positive results of the technological experiment suggest that the technology adoption could be feasible once the benefits are known.
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Title: Virtual reality for older users: a systematic literature review

Section 1: INTRODUCTION
Description 1: Provide an overview of the impact of ICT on daily lives, importance of VR for older users, and outline the purpose of the paper.

Section 2: BACKGROUND
Description 2: Present characteristics of older users and fundamentals of user experience relevant to the study.

Section 3: METHOD
Description 3: Detail the systematic literature review process including research questions, search strategy, selection of primary studies, quality assessment, and data extraction.

Section 4: RESULTS
Description 4: Present findings from applying the search filters, including a quantitative summary of the search results and detailed answers to the research questions.

Section 5: DISCUSSION
Description 5: Discuss the implications of the findings, including the concentration of studies in certain areas, and suggestions for design characteristics and user experience improvements for older users.

Section 6: CONCLUSIONS
Description 6: Summarize the results of the systematic literature review, the main applications of VR for older people, the limitations of the study, and suggest future research directions.