Abstract
Age-related decline in cognitive capacity can lead to functional restriction in everyday life. Therefore, interventions that aim to maintain and facilitate the individual cognitive capacity are becoming increasingly important. Computer-based cognitive learning is a promising approach to combat age-related loss of functional capabilities. The publicly funded project LeVer was developed especially for older adults and consisted of an online virtual cognitive training platform that enabled older adults to train on their own and in groups. Apart from investigating how older adults interacted with the platform, acceptance towards computer-based group training and audio-video communication was also analyzed. During the 20 to 30 minutes long sessions of the group training, learning units that included memory strategies as well as everyday exercises to intensify those strategies were taught. The group training was divided into four modules. The content of each session was structured using evidence-based cognitive training methods and manuals. Of the 40 older adults who used the individual online cognitive training (IOCT), half of the participants (11♀, 9♂) took part in all of the four sessions of group training. 14 participants (9♀, 5♂) aged 62–77 years (M = 69.56; SD = 3.99) answered a proprietary evaluation questionnaire after all of the group sessions. The opinion of the participants about the content and design of the group training was rated on a 4 point Likert-scale with 43 items. Group training was generally rated as a positive experience. The online video communication was new for the majority of participants and was rated as enjoyable. The answers to the open questions in the evaluation questionnaire revealed that group size, topics covered during training and the exercises were seen mostly positive. Criticism was focused almost solely on technical problems, which occurred before or during the training sessions, such as loosing audio or video or an intermittent Internet connection. In this study online-based cognitive group training (OCGT) for older adults via video communication was confirmed by the participants to be a useful and positively received method to facilitate cognitive function. Participants that did not complete the training to the end did so due to time or technical problems. Since this type of training is rather cost effective and easily accessible and can be used at home, it is a favorable alternative to conventional face-to-face training. Training to better use these devices and technical support on hand is necessary to take care of participants during the group training.
1 Introduction
1.1 Older Adults and the Use of Technology
Media plays a significant role in the daily life of older adults. Over the last decades, the Internet use of older adults has consistently increased in the United States and Europe [10, 46, 48, 49] but is nonetheless lower compared to younger Internet users. The results of the UK panel survey “Consumers and the communications market” [33] showed that age is the factor with the greatest impact on Internet use, however, other relevant factors such as technology commitment [45] or cognitive status were not included in the analysis. In addition to age, a large-scale study from Loges and colleagues also showed that education and income are the most important influencing factors on Internet usage [28].
A large proportion of the age group under 50 years are very familiar with the Internet due to experiences during their professional life [24]. If computer skills were not obligatory in earlier stages of life, the Internet is rarely used in older age [5] and the overall computer literacy is low. Many older people consider themselves too old to learn a new technology and the self-perceived computer skills are low, which can even result in fear of using the Internet [8].
The integration of various forms of communication in Internet platforms offers interesting possibilities for older adults. Like their younger counterparts, older adults use the Internet mostly for communicating with families and friends via e-mail and video communication programs, online shopping or personal banking [21]. A mini review showed that online communities are suitable for providing social support in difficult life situations and even some evidence was found for overcoming loneliness and relieving stress [27]. The different communication methods such as group chat or group discussions have not been fully adapted to suit the older adult user. The majority of the older target group is unaware of the forms of “many-to-many media” such as group chats to get in contact with multiple people and start discussions [37]. Lehtinen and colleagues defined friendship (new platforms should transfer current relationships) and similarity of conversational partners (communication is only possible with similar interests of the counterpart) as the two most important criteria that could possibly lead to more communication in Web 2.0 platforms [26]. Moreover, it seems interesting for motivational reasons, to implement elements of group interaction in regular online platforms (e. g., integration experts, chats; [36]. Studies have shown that video technologies are beneficial to enhance social presence. However, we still know very little about the use of video communication by older adults. Milliken and colleagues conducted quantitative and qualitative analyses to explore users’ motivation for video communication [31]. The authors found, that the participants do recognize the power of video conferencing to engage, inform and entertain, but would be more interested to use it if they had adequate reason and support. In Home TeleHealth Systems (HTH) two-way interactive audio – visual communication between a healthcare provider and a patient are used to assess the patients’ vital signs and televisits. Only 11 % of HTH studies are raising usability or user acceptance evaluation aspects [25]. In current studies, these technologies are used in hospitals or nursing homes not only for doctor-patient contact, but also for direct patient-to-family communication. Positive effects were measured using this technology in rural health settings, in psychiatry [3] and palliative care [6].
1.2 Usability for Older Adults (with Cognitive Impairment)
As mentioned above, the most significant barriers of using the Internet and e-learning platforms are still usability problems with internet-based technology. There is still a lack of knowledge in usability research on e-learning platform use by older adults. Only some usability studies [9, 19] give important insights into design considerations for the GUI of Internet pages or interface considerations for the older target group. Mead, Lamson and Rogers showed some evidence that a variety of cognitive impairments can have an impact on web performance [30]. Especially older adults with mild cognitive impairment who would benefit the most from online cognitive training therefore have problems to deal with these new technologies. This target group differs significantly in comparison to older adults without cognitive deficits in performance of web platforms. Older adults with mild cognitive impairment (MCI) need more time and are more likely to make mistakes when using a web platform [18].
1.3 E-learning and Cognitive Training
Internet platforms are increasingly used to promote learning. E-learning platforms are developed for taking university classes, learning languages or discussions about political and social topics. In the field of Gerontology, researchers are dealing with a growing number of e-learning platforms for the promotion of lifelong learning of older adults with and without cognitive impairment. Studies show that learning success in older years is still possible [22, 47]. Studies of older people who attend computer classes show a positive impact on learning in general. In a qualitative study by Warren-Peace, older participants mentioned the fun of using the computer in addition to the computer-based learning. Participants who used computer-based learning applications seemed to be more open even to not-computerized learning tasks [35]. Internet platforms are becoming an essential instrument of information and education and are able to integrate e-learning elements, which opens the possibility of learning remotely [42]. However, there are still very few commercial e-learning fferings for this specific target group [14] and considering the potential opportunities of this medium for older adults, the few existing platforms are rarely used by the target group [32]. The majority of platforms for older adults aim at learning about the internet and acquiring computer skills. The combination of real and virtual learning opportunities seems promising. Very little is known about older adults’ acceptance of e-learning platforms and media educational concepts that take the perspective of older people into consideration are still in their infancy [1].
The individual training of cognitive resources represents a special feature for learning with internet platforms. Studies show that cognitive training can achieve sustainable improvements in memory performance. Especially older adults with cognitive impairment may benefit from neuropsychological training [2]. There are various computer-based cognitive training programs, with good acceptance values [23], which are used in the clinic for therapeutic training. However, these are exclusively software solutions. In the field of cognitive science, there are currently a number of approaches that deal with the development of science and internet-based training programs. So far, however, most of these approaches are not ready to be implemented in the commercial market. Intervention studies with these new programs (e. g. Cogito study [39] or IMPACT [44]) show very promising results. Schmiedek et al. criticized the fact that these studies have been carried out almost exclusively on cognitive training platforms in laboratory situations [39]. Using computer-based cognitive training platforms in a domestic environment could contribute to a reduction of age associated cognitive capacity loss and increase independence and quality of life in older adults [20, 40]. It seems that not only the training with cognitive exercises can lead to an improvement in cognition, but also internet usage itself can be a positive factor for improvement in several cognitive domains [11, 43]. There are only few studies in which older adults autonomously use such newly developed training programs in their home environment for an extended period of time [15]. Only one study is focusing on OCGT. Cho and colleagues developed a cognitive enhancement group training program and applied it in a nursing home with 22 demented older adults in Korea [7]. The authors found positive effects in cognition and daily living activities.
The cited literature show the demand for and the acceptance of cognitive training by the older target group, but there is still lack of senior-friendly and scientifically evaluated products on the market. Reducing web usability barriers for older adults was the main purpose of the German funded project LeVer (Lernen gegen das Vergessen), in which a training platform for cognitive training was developed. Moreover, many platforms used in pilot studies or clinical trials have not undergone any initial and systematic feasibility testing. There is evident need for evaluating user behavior in home environments of older adults. Currently, there are no usability or acceptance studies evaluating OCGT.
1.4 Aim of the Study
In the present study, we aimed to understand more about the feasibility and acceptance of video-based online platforms for older adults. The presented pilot study was embedded in a field test with 40 older adults, who conducted an individual online cognitive training over 8 weeks. The goal was to assess older adults’ subjective ratings of an OCGT. Further, we investigated the possibility of older adults implementing and independently using such a training platform in their homes. We also aimed to gain important insights concerning specific technical barriers in this field. The final aim was to analyze the usage behavior (changes) over the intervention period of four weeks and the acceptance of older adults.
2 Methods
2.1 Apparatus
The OCGT was embedded in the age-friendly concept of the Internet-based cognitive training platform LeVer.
The platform was divided into four categories: (1) general settings, (2) communication functions (messaging and video call), (3) cognitive training and (4) information section on healthy aging, nutrition and cognition. A style guide was used to develop this platform for both a standard PC and a Samsung Galaxy II© tablet to ensure consistent visual appearance and user interfaces. Aspects that were specified in this style guide included text, color, target size, interaction patterns such as a three step volume control or a progress bar, additionally multimodal interactions including gestures, speech and navigation widgets. Several studies have recently been conducted to ensure a good usability of the platform and to diminish age-related barriers [16, 17].
2.2 Measures and Procedures
After formal inclusion in the study, assessments and training sessions were conducted in subgroups of eight to ten participants. Each participant received questionnaires, e. g. regarding socio-demographic data and computer and tablet usage. In addition, several tests assessing cognition like the computer-based Letter Updating Test (episodic memory), Multi-Source Interference Test (executive function), Object Location Memory (working memory), which were also conducted within the Berlin Aging Study II [4] and the Mini-Mental State Examination (MMSE, [13]) were conducted. Finally a self-efficacy questionnaire [41] was filled out by the participants. All participants received a senior-friendly handbook and obtained a technical support phone number. In total 40 participants conducted an individual online cognitive training (IOCT) with the LeVer platform for eight weeks. They used either study-provided tablets or their personal computers.
Participating in the group training sessions was optional for the users during the study. Therefore, participants could choose several scheduling possibilities for each session available via the platform (Figure 2).
Within the video-based group training the responsible psychologist conveyed cognitive strategies including their theoretical background to the participants, as well as exercises, that should apply the learned strategies in an everyday environment (Figure 3). The content of each session was structured using evidence-based cognitive training methods and manuals [12, 34, 38]. The group training was divided into four modules. A maximum of four participants and one instructor could take part in a session (Figure 1). Each of the sessions took 20 to 30 minutes. Within the first session a cognitive strategy of repeating information was covered. After all technical problems were resolved and a short introduction about the organization of the course was provided, the participants were asked to introduce themselves shortly. In the following the participants were informed about the storage of information. In this part of the session three questions were asked and answered by the participants and the trainer: How will information be stored? Where will this information be stored in the brain? Why will the information be stored in networks? After answering the questions the participants practiced the learning strategy with short exercises. For example the trainer showed a colour and the participants had to write down their first association with the colour. After an exercise each participant had the possibility to present a term. The second session was about structuring information. Specific knowledge about the structure of the memory was conveyed. At the beginning of the second session two more questions were asked: How is the memory structured? How will the information be stored in our long-term-memory? Within the practical exercise the participants should find categories for individual terms. For example the trainer showed four terms: horse, dog, cat, cow and the participants should find a suitable general term like animals or mammal. The third session was about connecting logical information with pictures and meanings. A first introduction was given by explaining the meaning of the term stimuli to the participants. In a subsequent practical exercise the participants should combine numbers with pictures (e. g. 0 = egg; 24 = hours per day). The fourth module was used to repeat the learned information and to practice all learned strategies. In this session the participants had to detect countries with jumbled letters (e. g. NSIPA, NEERTHNDLA). In another exercise the participants should associate terms with colours and justify their choice (e. g. chimney sweep = black; doctor = white, figure 3). Each session had the same structure: introduction, theoretical background, link to everyday life, exercises to practice, homework.
Group training session with four participants and a therapist.
Registration for OCGT.
Practical exercises within the four OCGT sessions: (1) Red: name an associated term; (2) carrot, potato, pepper, kohlrabi, red cabbage: find a suitable general term; (3) Combine numbers with figures; (4) ITALY: bring the letters in the right order.
All participants of the four group training sessions were asked to answer an anonymous online evaluation questionnaire, which could be answered in 5 to 10 minutes. We developed a usability questionnaire for the study based on the validated USE Questionnaire by Lund [29]. All sessions were evaluated with the same seven statements (e. g. the content of the session was easy to understand). Subjective opinions of the participants concerning the content and design of the group training with a total of 43 statements on a 4 point Likert-scale were rated.
3 Results
3.1 Sample
In total 40 participants used the LeVer platform within the study. Participants were recruited from classes at the Senior University, Berlin, announcements on the Internet, and former contacts of user studies of the Geriatrics Research Group. Half of them also joined all group training sessions of the OCGT. The main reasons for not joining OCGT were difficulties in scheduling and instability of internet connection. The participants who joined the group training were 69.5 years old on average and more women (55.5 %) than men took part (Table 1). Over half of the participants were married and lived in a two-person-household. The number of people, who used a tablet or a computer for the training sessions was the same (n = 10). Most of the older adults were married and well educated (65 % university degree). Both participants with and without mild cognitive deficits took part in the study, but there were no significant differences between the two groups regarding MMSE (range: 25–30). Also, no significant differences in demographic data were found between the participants, who joined the OCGT and the participants, who conducted only the IOCT – except education (Table 1). In comparison to the other users, the participants who joined the group training were better educated.
Characteristics of participants who joined or did not join the group training.
| Only IOCT (n = 20) | Additional OCGT (n = 20) | p | ||
|---|---|---|---|---|
| Age [years] | 69.9 | 69.5 | n. s. | |
| Gender [%] | Female | 50.0 | 55.0 | n. s. |
| MMSE | 28.2 | 28.6 | n. s. | |
| [0–30 points] | ||||
| Education [%] | Low education | 60.0 | 30.0 | |
| Mid-level | 5.0 | 5.0 | ||
| education | 35.0 | 65.0 | p < .05 | |
| High education* | ||||
| Family | Single | 5.0 | 5.0 | |
| situation [%] | Married | 40.0 | 55.0 | |
| Widowed | 30.0 | 35.0 | ||
| Divorced | 25.0 | 5.0 | n. s. | |
| Self-efficacy | 31.1 | 32.0 | n. s. | |
| [0–40 points] | ||||
| Device [%] | Tablet | 50.0 | 50.0 | n. s. |
The questionnaire for evaluation the group training was answered by only 14 participants. The online survey was sent after the last study visit. Another reason for the low response rate could be that some participants had a lack of computer experience and were maybe not able to answer the online questionnaire. The participants, who answered the questionnaire were 69.4 years old on average, more than 60 % were female and 57.1 % used a tablet.
3.2 Usage of the OCGT
20 participants joined all four session of the OGCT. The number of participants who took part in the computer based cognitive group training slightly decreased with each training session from 24 participants in the first session to 20 participants in the fourth session (Figure 4). There were no differences in gender or age between people who used the group training and people who did not use it. However, there was a significant correlation between the participation in group training and the level of education (r (38) = .312; p < .05).
Number of participants in each session.
People who took part in the group training, generally used the training platform more frequently than participants who did not. The participants of the group training visited the platform on 36.5 of 50 days in comparison to the average of 23.7 days in those who did only the individual training (t (35) = –3.425, p < .01). Within the 50 days of usage participants who took part in the group training visited the LeVer platform 54.1 times; all of the other participants visited the website only 36 times (t (33) = –3.094; p < .01).
3.3 Acceptance of the Group Training in General
The users were asked to rate the group training in general. Almost all participants (n = 13) stated that they thought that the audio video communication was integrated seamlessly in the LeVer platform. The same number of participants (n = 13) also agreed to the statement that participating was manageable concerning the time necessary. Instructions were rated equally positively (n = 13). Communicating via an audio video communication was a new experience for three participants. The video communication was rated as comfortable by 10 participants. Only three participants felt encouraged to communicate with other participants of the study, 6 participants were encouraged to try out new forms of communication. All of the participants agreed to the statement, that open questions were sufficiently answered during the group training sessions.
Nine participants strongly agreed to the statement, that the group training was interesting (Table 2). The group training was not at all informative for two participants. 11 participants would recommend the group training and 12 would also take part in a group training in the future. In total, almost all participants (n = 13) felt like the group training was a positive experience. Additional feedback that was received included one participant requesting more exercises (♂, 70 years old), four participants criticized technical problems in the internet based audio video communication. Of those three participated in the group training using a tablet. Another participant (♀, 67 years old), mentioned feeling uncomfortable being seen by all participants. An additional positive comment was that the group training was fun (n = 2) and that the group size was adequate.
Ratings of the Group Training in General (n = 14).
| Strongly disagree | Disagree | Agree | Strongly agree | |
|---|---|---|---|---|
| Interesting | 0 | 2 | 3 | 9 |
| Useful | 1 | 2 | 5 | 5 |
| Exciting | 1 | 3 | 4 | 6 |
| Informative | 2 | 2 | 4 | 6 |
3.4 Evaluation of the Sessions
The participants answered seven questions to rate the OCGT in general (Figure 5). All participants stated that the sessions and the structure of the sessions were comprehensible and easy to understand. The conveyed strategies in the sessions to train memory were new for only half of the participants (57.1 %) but 71.5 % of the older adults stated that they learned something new in the session. Almost the same number of participants (71.4 %) said that the conveyed strategies seemed applicable in daily life. The applicability of the second session was rated best, while the applicability of the third session was rated worst. Over half of the participants’ interests to learn something about cognition was aroused within the group training.
Ratings for Each Session Regarding Comprehensibility, Applicability, Novelty and Arousing Interest.
3.5 Training Results
The participants, who joined the OCGT performed on average significantly better in one of the tests on cognition, than participants, who conducted only the individual training (Table 3). Within the computer based Letter Updating Test participants, who joined the OCGT scored significantly better (+7 %) than the ICOT group (+5 %), under almost identical initial values (T(37) = –4.220; p < .05). There were no significant differences within the Object Location Memory Test and the Multi-Source Interference Test.
Results of the Computer-based Tests on Cognition, success rate in %.
| ICOT | OCGT | Difference | |||||
|---|---|---|---|---|---|---|---|
| Pre | Post | Diff | Pre | Post | Diff | ||
| Object Location Memory | 48 | 49 | +1 | 45 | 48 | +3 | p = .347 |
| Letter Updating | 60 | 65 | +5 | 61 | 68 | +7 | p < .05 |
| Multi-Source Interference | 89 | 90 | +1 | 90 | 89 | –1 | p = .191 |
Another significant difference was found regarding fun: Participants, who conducted additionally the OCGT had more fun using the LeVer platform than participants, who only conducted the individual training (T (36) = 2.083; p < .05).
3.6 Technical and Performance Issues
Even though all participants received a Wi-Fi hotspot for the duration of the study, which had to be returned afterwards, some of them experienced difficulties with the internet connection. The connection was individually tested with each participant beforehand, but some lived outside of Berlin without access to high speed Internet. This resulted in audio and video connection issues and therefore those participants were not able to take part in the online-based training sessions. Some participants forgot how to register for the group sessions, although every participant was instructed beforehand how to use the platform. In addition, older adults using the LeVer platform from a PC needed to install a webcam prior to the group session, which also caused problems. Some participants using the tablet computers forgot how to set the volume, which resulted in them not hearing everything correctly. One participant (♂, 74 years old) used up all of the high speed data (7.5 GB per month) prior to the study ending, causing long delays when using the platform. These technical difficulties could be resolved in part over the phone, e. g. by installing the webcam with the users. In more complex situations or when the participant requested it, home visits were necessary.
In addition to technical difficulties, fixed dates for the group training limited older adults as they could not easily integrate them into their daily routine like the individual training. This resulted in some older adults not being able to take part, even though each training session was available on multiple dates.
3.7 Recommendations for the Implementation of OCGT
Exercises should not be too simple, but to a certain degree challenging for seniors and also be based on scientific evidence
The group training should always be guided by an expert
To guarantee consistent training high usability should be ensured
Technical conditions like high-speed internet are essential, barriers like setting up microphones or speakers have to be minimized
OCGT should be combined with detailed user guidelines and continuous support services to avoid frustration and refusal
4 Discussion
As Cho et al. [7] stated, cognitive group training interventions can improve the cognitive functions of older adults. The feasibility of an OCGT concept could be shown in the presented study data. In addition to the measured intensive usage after short training and with additional support, the video-based communication received positive acceptance ratings. The psychologist who conducted the training and used the platform during the study as well as the users rated the training platform very positively. In summary, the advantages of an online training such as location flexibility were seen as part of an interesting approach of participating in group training. Memory clinics, outpatient centers or residential homes can easily offer training concepts to older adults who suffer from impaired mobility or live in rural areas where access to cognitive training is difficult. The presented data show, that participants, who joined the additional OGCT also used the IOCT more frequent. OGCT seems suitable to motivate older adults to use an online cognitive training more intensive.
Still, many technical problems occurred when using the AV communication. This can lead to frustration of older adults with low computer literacy when problems occur and cannot be solved promptly or easily. Due to poor network reception (in the area surrounding Berlin), connection problems were the most frequent problems occurring during the study period. Problems with camera and microphone were reported frequently and had to be resolved before almost every training session. In the future, systems with an integrated microphone and camera, such as tablets and laptops have lower usage barriers and could be used more easily. There is still a need for good training and technical support concepts to guide participants through the course.
When developing the training concept and its exercises, the division of theoretical background and exercises to practice was evaluated very positively. The seriousness of the training was emphasized by the participants: Almost all seniors prepared themselves before the training. The participants were not disturbed during the training and the participants were punctual on all training sessions. It also became apparent that although the training was conducted from their home environment, the clothing was not casual and appearance seemed to be important (e. g. placing flowers in the picture, adjusting the camera towards a nice area of the apartment). Furthermore, the willingness to do exercises after the training at home was measured. The conducted exercises in OCGT were seen as being too easy by the participants. We recommend more demanding and complex exercises. Therefore, it would be necessary to build homogenous groups regarding their cognitive abilities.
These specific usability results are important for software developers who are developing technologies for an older target group. It is crucial to know more about barriers caused by cognitive and fine motoric deficits of older adults when using online platforms. In contrast to the results of [30] and [18], older adults with cognitive did not report essential usability problems. The usability and design was rated very well by all participants.
A limitation of our study was the relatively short usage period of OCGT. Therefore, we do not know, if our participants would continue using the online cognitive training after the study. Moreover, we recruited a small, urban, well-educated sample. It is unclear, how seniors with low education could be motivated for a long-term usage of OCGT. There is a need for more evaluation studies for OCGT with older adults to learn more about long-term user behavior, ordinary use and potential barriers of these new systems.
Online based therapy could be applied in other forms of individual therapy such as music therapy or occupational therapy. Here, additional training materials could be used and be seen via video. Not only older adults, but also other target groups could benefit from group or 1-on-1 online training. For example, the doctor-patient interaction via audio-video communication is a novel e-health approach. The results regarding usage behavior of the presented work could help understand more about the acceptance and usage behavior of older adults using Home TeleHealth Systems. There is still a need for more interventional training, learning more about long-term motivation and specific cognitive improvements caused by cognitive online audio-video based group training. Here, a comparison to regular offline training would be interesting.
About the authors
Marten Haesner is a social scientist and research fellow at the Geriatrics Research Group. He is conducting several usability trials with AAL technology and software designed for older adults. Currently he is working in several public funded projects developing assistive technologies for older adults. Since 2014, he also leads the working group “Technology & Ageing” at the Geriatrics Research Group.
Anika Steinert has studied Health Sciences at the University of Applied Sciences in Zwickau. Since 2012 she is working as a researcher at the Geriatrics Research Group. Here, she is working in several public funded projects regarding aging and technology like smartphone apps for patients with typ II diabetes or technologies assisting older adults with mild cognitive impairment.
Dipl.-Psych. Julie O’Sullivan is a cognitive psychologist and a research and teaching assistant at the Institute of Medical Sociology and Rehabilitation Science of the Charité Berlin. Her main research interests include non-pharmalogical interventions for dementia and MCI, quality of life across the lifespan, and healthy ageing. Since 2015, she is a part of the publicly funded research project PflegeTab, with the aim of developing and evaluating a tablet-based intervention for nursing home residents suffering from dementia. Previously (2012–2014), she was a staff member of the Geriatrics Research Group of the Charité and mainly involved in the research project LeVer.
Elisabeth Steinhagen-Thiessen is a medical professor who held the Chair in Internal Medicine / Geriatrics at the Charité – Universitätsmedizin Berlin. She is the head of the Geriatrics Research Group of the Charité as well as the Outpatient Lipid Management and Apheresis group. Elisabeth Steinhagen-Thiessen has been leader of the medical part of the Berlin Ageing Study (BASE), working closely with Paul Baltes, and also heads the medical team in the second part of BASE (BASE II), which is currently being carried out. Her research interests are focused on improving the situation of elderly people, both in clinical settings and at home. Research projects under her lead comprise AAL-initiatives (SmartSenior, ALFRED, LeVer), dementia studies (ELIAD), basic research (BASE & BASE II) and lipidology (NICOLa).
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