International Journal of Human-Computer Studies
Designing audio-enhanced paper photos for older adult emotional wellbeing in communication therapy
Introduction
The global trend of an increasing older adult population makes it a priority not only to design interactive experiences that are sensitive to the social and emotional needs of people in late adulthood but also enhance overall wellbeing in late life. The proportion of people over age 60 compared to younger populations is growing at a rapid rate. For the United States, the older population in 2030 is projected to be twice as large as the population was in 2000, growing from 35 million to 72 million, representing nearly 20% of the United States population (NCHS, 2012).
Much research examines the relationship among aging, social interaction, and late life wellbeing. Interpersonal relationships play an important role in emotional wellbeing (Asay and Lambert, 1999, House et al., 1998), yet there is strong evidence that one′s social network shrinks as a function of age (Gordon and Gaitz, 1976, Harvey and Singleton, 1989, Carstensen, 1992). This may be due to a limited number of surviving relatives and peers as well as physical or cognitive declines that present barriers to social participation. There are many benefits for maintaining social support and engagement in social activities, including living longer and improved mental and physical health (Stuck et al., 1999, Ferlander, 2007). Frequent social interactions may create an increased sense of wellbeing in older adults (Czaja et al., 1993), and in contrast, a lack of social interaction may contribute to higher rates of disability, slower recovery from illness, and even early death (Lubben and Gironda, 2003, Blazer, 1982).
An important topic of research related to emotional wellbeing is understanding design for the changing social and emotional needs across the lifespan. Here, we focus on design for people in late adulthood. In our work, the end goal is to prevent social isolation and loneliness through communication therapy, which may include structured speech-language therapy, reminiscence or narrative therapy (White and Epston, 1990), and audio-visual prompts for grounding face-to-face interaction. When designing technologies for people in late adulthood, it is important to consider the unique social and emotional qualities of older adults (Carstensen, 1995, Carstensen and Charles, 1998). While social interaction may decrease in late adulthood, many older adults report overall satisfaction with their life as well as sustained or improved satisfaction with interpersonal relationships (Diener and Suh, 1997, Carstensen and Charles, 1998). Older adults are motivated to stay connected with people with whom they already have a strong emotional connection (Carstensen et al., 2003) and contact with family becomes increasingly important (Cicirelli, 1989). Furthermore, Carstensen et al. (2003) argue that aging is associated with an increase in motivation to derive emotional meaning from life.
This paper describes the design and use of audio-enhanced paper photos to support and understand older adult emotional wellbeing. The creation of and interaction with audio-enhanced paper photos is enabled by digital pen technology and custom software (Piper et al., 2012) we developed for the Livescribe pen,1 a widely available digital pen that enables recording and playback of audio. We introduce this technology into two contexts and present case studies of how caregivers design audio-enhanced paper photos based on the interests and emotional needs of the older adults for whom they are caring. In both case studies we printed paper photos on Anoto digital paper2 and we used sticky labels pre-printed with Anoto pattern to augment existing paper photos and interact with them through the Livescribe pen. The first case study examines how a speech-language therapist designs custom audio-enhanced paper therapy activities for an older adult with aphasia. In this context, the therapist designs activities that leverage personal artifacts in the older adult′s life. He balances the need to engage the older adult in therapy without incorporating overly emotional content. Negative emotions (e.g., sadness about not seeing a family member) severely impact the older adult′s ability to communicate and willingness to participate in therapy. In the second case study, we describe the creation and use of audio-enhanced paper photos involving a person of advanced age with memory loss and her extended family and care staff. Family and care staff attach personalized audio messages to printed photos of people in the older adult′s life. This approach successfully engages the older adult in reminiscence activities and improves her awareness of people in her social circle. Taken together, these case studies provide new insights into the design of audio-enhanced photos for late life communication therapy, exploring the ways in which this media form supports emotional expression, reflection, and interpersonal communication.
Section snippets
Related work
This research brings together literature on aging and the social and emotional goals of older adults, photographs and audio as media that carry and evoke emotion, and technologies for older adult communication, reminiscence, and therapy. We also describe related work on digital pen technology as an interaction technique for older adults.
Authoring audio-enhanced paper documents
Audio-enhanced paper photos are physically printed photos that become interactive. Audio messages are linked to particular regions of a printed photo and can be played back by using a Livescribe digital pen.1 Livescribe pens come equipped with a microphone and an integrated speaker that allow users to record and playback audio. The digital pen can also be programmed—through a special SDK—with dedicated software that can further process the captured written information and recorded audio.
We
Case studies
This article is the first to synthesize findings from our larger research project on end-user authoring of audio-enhanced paper documents, and through this we find that audio-enhanced paper photos are a powerful interaction paradigm for engaging older adults in communication therapy and related social interaction. The contribution of this paper is a new examination of audio-enhanced photos in two respects. First, we examine how emotional information may be embedded in this media form as a way
Discussion
This paper presents two contrasting case studies that describe the design and use of audio-enhanced paper photos for older adult emotional wellbeing. In both case studies caregivers are the primary content designers; however, the two case studies differ in terms of the goals for introducing audio-enhanced photos and the older adult′s involvement in content creation. We examine the ways in which emotional information is embedded in and triggered by this media form, and discuss considerations for
Conclusion
This article presents pen-based authoring software that enables caregivers to create custom audio-enhanced paper photos to support the emotional and social needs of the older adults for whom they are caring. We analyze the design and use of audio-enhanced paper photos in two contexts, and through this analysis provide insight into the ways in which this media form carries and evokes emotion. Printed photos on paper are familiar to older adults and allow caregivers to flexibly incorporate a
Acknowledgments
We thank our study participants, and we thank Livescribe for donating digital pens.
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