Abstract
The population is aging and a subset of older adults will have some level of cognitive impairment. Human factors/ergonomics (HF/E) practitioners must consider them in the design process but often are not prepared to do so, lacking relevant experience or training. In this panel, an interdisciplinary team with expertise in aging, in general, and cognitive impairment, in particular, will (a) provide insights into cognitive challenges confronting older adults with cognitive impairments; (b) discuss impacts of these challenges on everyday performance (e.g., transportation, computer use, health); (c) explore the design cycle as it relates to cognitive impairment; and (d) provide examples of accommodations necessary for research and user testing for this population. Interactive audience discussion will focus on future directions and challenges for design and testing of emerging technologies for persons aging with cognitive impairment. This panel will be of interest to a broad range of HF/E domains.
Introduction
The demographics of the U.S. are changing quite dramatically. In 2000, the largest percentage of the population was the middle-aged adults, and age groups older than 54 were dramatically smaller than younger age groups. By 2030, however, the U.S. Census projects that the distribution of individuals among age groups will be much more similar across age ranges until age 74. According to the Administration on Aging, over one in every eight individuals (13.1%) of the US population is now an older adult (65+); older women outnumber older men. This population aging is a wonderful societal achievement, but also poses challenges for systems, families, and older adults. Because of age-related changes in abilities, many older adults encounter difficulties with everyday activities, which threaten independence. They face challenges of social isolation, loneliness, and the ability to engage in meaningful activities. Likelihood of developing a cognitive impairment or chronic condition increases with age. Current estimates (Pew, 2021) indicate that ~17% of those aged 65 and older have mild cognitive impairment (MCI), which is a risk for Alzheimer’s disease (AD).
Technology will continue to play a key role in meeting the challenges of population aging in terms of facilitating access to services; enhancing health; improving well-being and safety; providing support for age-related cognitive impairments; and enhancing opportunities for engagement (Czaja et al., 2019). The landscape of aging and technology has changed dramatically. Uptake of technology is increasing among aging adults, with ~75% age 65+ using the internet and ~61% using smartphones (Vollmer Dahlke, & Ory, 2020).
More researchers are focusing on this topic; technology is increasingly being considered as a solution for the support needs of aging adults; and more technology products are marketed to seniors. Yet, aging adults are often ignored in design and there is limited robust research evaluating the usability, safety, and efficacy of emerging systems with older adults, especially those with cognitive impairments (Schmidt & Wahl, 2019). Despite the general uptake of technology by aging adults, there is a continued lag in uptake among many older adult sub-groups, including ethnic minorities, older cohorts, those of lower socio-economic status, those living in a rural location, or with a cognitive impairment such as MCI or AD (e.g., Vollmer Dahlke & Ory, 2020). Common barriers to technology uptake include lack of awareness of technology’s value, usability issues, and lack of training and support (Kuruvilla, Mays, & Walt, 2007). The critical question is not whether older adults will interact with technology but rather how to best shape and optimize these interactions. Human factors (HF) practitioners and user experience (UX) professionals are typically not trained to conduct research or usability evaluations with persons with cognitive impairments.
The panelists are the principals in two federally-funded research centers:
The Center for Research and Education on Aging and Technology Enhancement (CREATE; www.create-center.org) is a multi-disciplinary and collaborative center founded in 1999, dedicated to ensuring the benefits of technology can be realized by older adults to support and enhance their independence, productivity, health, safety, social connectedness, and quality of life. CREATE is funded by the National Institute on Aging (National Institutes of Health).
The Enhancing Neurocognitive Health, Abilities, Networks, and Community Engagement (ENHANCE; www.enhance-rerc.org) Rehabilitation Engineering Research Center was founded in 2019 by the same principal investigators and is focused specifically on developing novel technology solutions to help older adults with a cognitive impairment live independently. Target populations of ENHANCE are older adults with cognitive impairment due to MCI, traumatic brain injury (TBI), or stroke. ENHANCE is funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Collectively, the CREATE/ENHANCE investigators have over one hundred years of experience working with older adults, including those with cognitive impairment. Our process is based on a user-centered approach to design, and focuses on design to meet the needs, preferences, capabilities, and limitations of the user (Boot et al., 2020; Czaja et al., 2019). We believe that this approach will result in successful design for older adults with cognitive impairment – products, tasks, environments, and systems that are both usable and useful to diverse older adult populations.
Overview of the Invited Panel Members
Sara J. Czaja, Ph.D. is the Gladys and Roland Harriman Professor of Medicine and the Director of the Center on Aging and Behavioral Research in the Division of Geriatrics and Palliative Medicine at Weill Cornell Medicine. Sara received her Ph.D. in Industrial Engineering, specializing in Human Factors Engineering, at the University of Buffalo in 1980. Sara has had extensive experience doing research with older adults with cognitive impairment. This includes assessment and training of functional skills (e.g., Czaja et al., 2020), examination of strategies to remediate social isolation (Falzarano et al., in preparation), and use of virtual reality to enhance social engagement (Kalantari et al., 2022). She is the Principal Investigator of an on-going randomized control trial examining a dyadic intervention for aging adults with mild AD and their family caregivers, and is a leader in research examining interventions to support informal caregivers of adults with AD (e.g., Czaja et al., 2018).
Neil Charness, Ph.D. is William G. Chase Professor of Psychology, Director of the Institute for Successful Longevity and Associate Director of the University Transportation Center (Accessibility and Safety for an Aging Population, ASAP) at Florida State University. He received his BA from McGill University (1969), and MSc and PhD from Carnegie Mellon University (1971, 1974) in Psychology. Early in his career Charness designed computer-based interventions to train a complex calculation skill for an individual with Korsakoff's amnesia (Charness, Milberg & Alexander, 1988) and people with dementia (McGlinchey-Berroth, Milberg & Charness, 1989). In the ENHANCE project he leads a team designing tutorials to teach older adults with cognitive impairment how to use mobile apps such as Google Maps and Uber to support independent navigation.
Walter R. Boot, Ph.D. is a Professor of Psychology at Florida State University and director of the university’s Attention and Training Lab. He received his PhD from the University of Illinois Urbana-Champaign in Visual Cognition and Human Performance in 2007. He is co-Director ENHANCE, which has a focus on designing technologies to support older adults with cognitive impairments. Within ENHANCE, he is the lead investigator of the Digital Reminders for Everday Activity Memory (DREAM) project, which aims to provide technology-based prospective memory support for older adults living with a cognitive impairment (Sanders et al., 2022). He is also Principal Investigator of an ongoing clinical trial aimed at developing adherence support systems for older adults with and without cognitive impairments, with the aim of fascilitating the early detection and treatment of cognitive impairment by supporting adherence to home-based cognitive assessment and training (He et al., 2023).
Wendy A. Rogers, Ph.D., is the Shahid and Ann Carlson Khan Professor of Applied Health Sciences at the University of Illinois Urbana-Champaign, with appointments in Community Health, Educational Psychology, Illinois Informatics Institute, the Center for Social & Behavioral Sciences, Women and Gender in Global Perspectives Program, the Beckman Institute, and the Coordinated Science Lab Robotics Group. She received her B.A. from the University of Massachusetts - Dartmouth, and her M.S. (1989) and Ph.D. (1991) from the Georgia Institute of Technology. She is a Certified Human Factors Professional (BCPE Certificate #1539). Her HF/UX experience with older adults with cognitive impairment has covered the lifecycle of technology development and evaluation, including, (a) qualitative interviews to evaluate user needs for a range of everyday activities (Harris et al., 2022); (b) usability evaluations of a video chat platform for social engagement (Nie et al., 2019) and an integrated mHealth system for hypertension management (Al-Saleh et al., in press); (c) designing interventions to assess social engagement for older adults with and without MCI (Lydon et al., 2022); and (d) design of assistive robots for older adults and their family care partners (Rogers & Mitzner, 2019).
Panel Discussion Plan
The purpose of this panel is to share our experience working with older adults with cognitive impairment. We will begin with a series of brief presentations to set the context for the panel discussion. The main objectives will be to provide (a) insights into the cognitive challenges confronting older adults with cognitive impairments; (b) discuss the impacts of these challenges on everyday performance (e.g., transportation, computer use, health); (c) explore the design cycle as it relates to cognitive impairment; and (d) provide examples of accommodations necessary for HF/UX research and user testing with older adults with cognitive impairment. These topics will be addressed respectively by Czaja, Charness, Boot, and Rogers.
We will allow substantial time for discussion with the audience. We would like to elicit examples from practitioners and designers in the audience about their experiences, challenges, and successes working with older adults who have cognitive impairment. We will then have the panel members provide guidance and insights based on their experiences. The goal is for the panel session be highly interactive and engaging with the audience.
This panel will provide a forum to discuss best practices and design guidelines for technology systems to support older adults with cognitive impairment. The participants represent the fields of psychology and industrial engineering, with additional expertise in health, human factors, and gerontology thereby providing interdisciplinary discussion. The interactive nature of the session will provide valuable insights for audience members. The plan for the panel is for it to be an exchange of ideas and experiences to advance design for older adults with cognitive impairment. This panel discussion will be of interest to a broad range of technical groups and conference attendees.
Footnotes
Acknowledgements
The panel members are supported in part by grants from (a) the National Institutes of Health (National Institute on Aging) Grant P01 AG073090 under the auspices of the Center for Research and Education on Aging and Technology Enhancement (CREATE; www.create-center.org), and (b) the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Grant 90REGE0012 Rehabilitation Engineering Research Center on Enhancing Neurocognitive Health, Abilities, Networks, and Community Engagement (ENHANCE; 
).