A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among communitydwelling adults. The sample included 1,204 individuals ranging in age from 18–91 years. All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety. These findings are discussed in terms of training strategies to promote technology adoption. <s> BIB001 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> In this paper, we present UbiMeds, a mobile application and architecture that aims at supporting prescription medication adherence for aging and disabled population. We review the problem of medication adherence in general and from the accessibility perspective. We describe the design process guided by the accessibility issues identified in the non-adherence phenomenon. We present a proposed comprehensive architecture (including an iPhone application) aimed at improving accessibility in the practice of medication taking from patients, and supporting the intake tracking and monitoring by physicians and family members. <s> BIB002 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> During the last decade, the challenges of an ageing society became focus for extensive scientific, public and political discussions. From discussions in scientific fora within each discipline, there is now a shift towards cross-disciplinary scientific approaches. The aim of this article is therefore, to collect and describe different scientific viewpoints in this regard and to point out research gaps to be addressed in the future. The article is based on a number of review articles and keynote lectures given by the author, and complemented with informal interviews of experts from different scientific fields engaged in the field of technology and ageing. Results show that research has emerged from being technology-focussed to scenario-based taking different scientific perspectives into account. However, the biggest challenge still is to accommodate the need for a holistic integrated service which means to provide personalised services and adapt technology and content to individual needs of different stakeholders. Further, cross-disciplinary research is needed that relates informatics and technology to different stages of the aging process and that evaluates the effects of proposed technical solutions. <s> BIB003 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> Smartphones with touchscreen-based interfaces are increasingly used by non-technical groups including the elderly. However, application developers have little understanding of how senior users interact with their products and of how to design senior-friendly interfaces. As an initial study to assess standard mobile touchscreen interfaces for the elderly, we conducted performance measurements and observational evaluations of 20 elderly participants. The tasks included performing basic gestures such as taps, drags, and pinching motions and using basic interactive components such as software keyboards and photo viewers. We found that mobile touchscreens were generally easy for the elderly to use and a week's experience generally improved their proficiency. However, careful observations identified several typical problems that should be addressed in future interfaces. We discuss the implications of our experiments, seeking to provide informal guidelines for application developers to design better interfaces for elderly people. <s> BIB004 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> Abstract Non-adherence to a drug therapy is often the reason for not achieving the therapeutic goals in patients. Measuring drug adherence is an important intervention to understand patients’ adherence patterns and behavior as well as to provide supportive measures to enhance the patient adherence to a prescribed drug therapy. A variety of different adherence measurement systems (AMS) exist that have been proven valid even though there is not one single AMS considered to be a gold standard. Some AMS allow through interactions with the physician or pharmacist and the patient to initiate corrective interventions, mainly in the form of alert and reminder systems. When applied to patients with several morbidities, co-morbidities and disabilities, appropriate AMS still remain a challenge. <s> BIB005 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> The introduction of the iPad and similar form-factor devices e.g. Samsung Galaxy Tab, Asus Eee Pad and Motorola Xoom has provided a unique opportunity for older adults to engage with mobile computing devices and platforms. Engagement with 'traditional' computing devices amongst older adults, including arguably mobile devices, such as laptop computers is low due to dexterity issues amongst this population Hertzum & Hornbaek, 2010. Whilst the iPad removes some of the traditional barriers to computer engagement, new barriers including weight and screen reflection are evident to an older user group. This paper provides an exploratory evaluation of how older adults in 11 UK care-home settings and the staff engaged in their care are using iPads to help improve communication, build physical social networks amongst residents, staff and family members, and map the most frequently used applications by an older population during a six-month pilot period. Results suggest that applications involving information searching for personally related and historical information were most valued by older adults. Further, older adults and care staff alike report mainly positive experiences of iPad use in care settings including the increased opportunities for social interaction and the enhancement of intergenerational communication. Additionally, the barriers to use e.g. device weight are often overcome by low-tech adaptations and adjustment when using the device. This paper argues that the portability and adaptive nature of the iPad combined with the increased social interaction afforded by device could increase quality of life in care settings. <s> BIB006 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> Despite the apparent popularity of touchscreens for older adults, little is known about the psychomotor performance of these devices. We compared performance between older adults and younger adults on four desktop and touchscreen tasks: pointing, dragging, crossing and steering. On the touchscreen, we also examined pinch-to-zoom. Our results show that while older adults were significantly slower than younger adults in general, the touchscreen reduced this performance gap relative to the desktop and mouse. Indeed, the touchscreen resulted in a significant movement time reduction of 35% over the mouse for older adults, compared to only 16% for younger adults. Error rates also decreased. <s> BIB007 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> Healthcare activities in private home settings that are not supervised by a healthcare professional can challenge older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are designed. However, most of these systems target a specific treatment or a specific condition. In this paper, we discuss experiences from designing the tablet-based application MediFrame. MediFrame is a personal medication management system to support older adults in non-clinical settings such as the home. The paper describes the user-centered design process and the resulting tablet application. We show how MediFrame can be used to support adherence in medical treatments through fieldwork informed use scenarios. Based on early qualitative feedback, we also discuss lessons learned and how designers can support a holistic medication experience for an older adult's everyday life. <s> BIB008 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> Abstract Several aspects of older adults’ life can benefit from recent technological developments, but success in harnessing this potential depends on careful design and accessible, easy to use products. Design and development must be centered on the elderly and adequately consider interaction. In this paper we follow this design approach and put it to the test in developing a concrete application, aimed to contribute to lower the high levels of non-adherence to medication in the elderly population. The “Medication Assistant” application was developed following an iterative method centered, from the start, on the elderly and interaction design. The method repeats short-time development cycles integrating definition of scenarios and goals, requirements engineering, design, prototyping and evaluation. Evaluation, by end-users, of the increasingly refined prototypes, is a key characteristic of the method. The evaluation results provide information related to strengths and weaknesses of the application and yield suggestions regarding changes and improvements, valuable support further development. Results regarding evaluation of the second prototype of “Medication Assistant” are presented. <s> BIB009 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> Despite the fact that a third of all cases of unintentional medication non-adherence are caused by simple forgetfulness, the majority of interventions neglect this issue. Even though patients have access to smartphone applications ("apps") designed to help them remember medication, neither their quality nor effectiveness has been evaluated yet. We report the findings of a functionality review of 229 medication reminder apps and a thematic analysis of their 1,012 user reviews. Our research highlights the gap between the theory and practice: while the literature shows that many medication regimens are habitual in nature and the presence of daily routines supports remembering, existing apps rely on timer-based reminders. To address this disparity, we present design requirements for building medication reminders that support the routine aspect of medication-taking and its individual nature, and demonstrate how they could be implemented to move from passive alerts to a smarter memory and routine assistant. <s> BIB010 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> Physical activities can improve the physical and emotional well being of the elderly [3]. However, a variety of barriers make it hard for them to maintain or increase their physical activity level (e.g., lack of facilities, communities poorly designed and low self-efficacy). Previous studies reveal the power of persuasion strategies in home based interventions (e.g., [1] & [5]), with [5] pointing to the social persuasion (e.g., social support, competition and collaboration) as the dominant strategy to prolong the interest of the elderly in following a long-term physical training plan. <s> BIB011 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> A. LIMITATIONS AND OPPORTUNITIES <s> BACKGROUND ::: Older persons following a prolonged complex drug regimen often make mistakes when taking their medication. Currently, the widespread use of tablets and smartphones has encouraged the development of applications to support self-management of medication. ::: ::: ::: OBJECTIVE ::: The aim of this study was to design, develop and assess an app that transforms medication-associated ean-13 (barcodes) and Quick Response codes (QR) into verbal instructions, to enable safer use of medication by the elderly patients taking multiple medications. ::: ::: ::: METHODS ::: Meetings were held in which participated a total of 61 patients. ::: ::: ::: RESULTS ::: The results showed that patients appreciated the application and found it useful for safer use of medicines. ::: ::: ::: CONCLUSIONS ::: The study results support the use of such technology to increase patient safety taking multiple medications safety. <s> BIB012
All the studies evaluating tablet usability among older adults  , BIB006 ,  ,  were conducted around the same time (2012-2013), with the same tablet technology (iPad) and similar age groups. However, the studies were conducted in different settings (laboratory, home, home-care and work) and with different sample sizes. Qualitative usability measures (observations, focus groups and interviews) were used for evaluating the usability of these tablets. Future research can benefit from objective usability metrics: task completion time, number of errors committed, and number of successful tasks. Research has been conducted to evaluate specific tasks (dragging, pointing, pinching) on a touchscreen using these quantitative measures BIB007 , BIB004 . However, these studies were conducted with applications designed specifically for performing study tasks. The existing studies were conducted with earlier versions of iPads  , BIB006 ,  ,  . The tablets have drastically evolved since the time these studies were conducted. These imply that the disadvantages regarding tablet adoption (heavy weight and screen resolution) could probably be already outdated. Tablets have become lighter and slimmer, suggesting the weight issue identified in BIB006 may have been already resolved. Tablets have become cheaper due to advances in technology and increase in tablet popularity  . The price of a tablet has been reported to be a challenge in tablet adoption among older adults BIB006 ,  . Further, the memory/storage of a tablet can now be extended with external storage cards (SD cards) countering the storage limitation. However, we might need to address new challenges due to differences in tablet specifications [weight, resolution, size], including impact on touch sensitivity, font size and various other aspects of usability. Stronger and effective conclusions about the usability of new releases of tablets could be reached by using larger sample, by evaluating performance using quantitative metrics available for usability evaluation and by comparing tablets with different specifications [operating systems (Apple, Android and Windows)]. The results should be further analyzed with respect to demographic variables (age, gender, years of education) and experience using tablet/technology because computer knowledge, computer anxiety, and learning ability are found to be influenced by these factors BIB001 . Moreover, longitudinal tablet studies could be conducted for capturing any fatigue arising from prolonged usage and for studying the effect of chronic conditions that affect mobility, visual senses, and bones (finger movements). The tasks used for evaluation were predefined for the studies. In longitudinal studies, we can install an application for capturing application usage (application name, and duration of usage for the application) to identify application usage frequency and popular categories among older adults. Though one of the present studies  identified the popular application categories, it was only based on the qualitative data (interviews and observations). A combination of qualitative and quantitative analysis can help us better understand tablet use among older adults. The majority of these applications provide no connectivity with the care providers/clinicians BIB008 , BIB009 . This communication is very important to gather reasons for nonadherence. Moreover, this communication is becoming particularly crucial with the increase in older adults BIB003 and continual decrease in the number of care providers  ,  . Only ALICE reports the number of missed doses and medications taken to the clinician and the care provider, listed by the user using 3G service at the end of the day  . However, it does not provide any reason for the missed doses or medications. Moreover, these applications do not provide alternate functionality for providing responses to a medication reminder, in case this reminder is overridden BIB010 . The majority of these applications require the medication list to be entered by the older adults themselves BIB008 ,  . However, the participants in the study for evaluating ALICE had their prescription information preloaded in the application at the beginning of the study. S4S Medical Assistant BIB009 created a third party service for allowing care providers to enter this list. This medication entry is a complex and cumbersome process, given the complex medical regimen for older adults. This process could demotivate the older adults from using the application. These medication management applications do not provide offline usage functionality, which could become an important limitation when deploying these applications in a low socioeconomic group. The majority of the studies evaluate the usability of the applications BIB002 , BIB008 ,  , BIB012 . However, there is only one study that evaluated the effectiveness of the application in improving medication adherence using experimental and control groups  . The study demonstrated a potential for using tablet-based applications for medication management. There was an improvement in treatment adherence and reduction in medication errors at the conclusion of the study. However, the study only measured unintentional medication errors. As there is no gold standard for measuring adherence BIB005 , a combination of different methods should be used for measuring this adherence. Moreover, people, sometimes, do not take the prescribed medications purposefully, even when they do remember to take the medication. The power of technology (scanning barcodes or QR codes) or even submitting pictures of the intake could be employed as secondary measures for measuring adherence. In addition, physiological measures could be used for evaluating the effectiveness of these applications in improving/maintaining medication adherence. Few such measures including cholesterol and blood pressure were used in the evaluation of ALICE. However, these measures cannot be generalized because they depend on an individual's chronic conditions. The majority of the studies were short term studies and employing small sample sizes. Though studies with a small sample size are important for feasibility analysis, it can be challenging to draw statistically significant conclusions about the effectiveness of the applications. These studies also do not take into account the effect of gender, age, mood, weather and chronic conditions in the analysis. Furthermore, the majority of these studies have a selection bias: non-random selection of participants having technology experience, no severe chronic conditions and no cognitive impairment. These studies do not take into account the effect of the applications installed in the tablet that can provide further motivation and improve social engagement. Virtual Social Gym BIB011 , a tablet-based application currently under development, has a web-based Coach App that allows the older adults to connect virtually with the trainers, aided by Kinect and sensor devices. Research shows that tablet-based applications can improve basic cognitive functions of older adults. However, the impact of these applications on complex behaviors such as prospective memory or goal attainment and their transfer effects to other domains of Successful Aging has not been studied. Important questions (such as, ''is improvement in prospective memory associated with medication adherence?'') still need to be explored. Moreover, user interface design requirements seem to change from one cognitive domain to the next. To develop truly effective cognitive health applications, interdisciplinary efforts are needed to integrate innovations from other fields (e.g. linguistics) as well as different areas of informatics (e.g. data science). This complicates the implementation of applications for promoting cognitive health. Another limitation is that the majority of these studies are concerned with measuring the impact of tablet applications using a rigid training regimen conducted in controlled settings. We did not find studies on effectiveness of casual games or autonomous training -two methods that might be more acceptable by older adults due to their simplistic nature. Finally, the results of the existing studies need to be confirmed with larger sample sizes and in longitudinal studies lasting over longer time periods. The major limitation of the existing studies is that they suffer from the lack of specificity when defining and measuring social support elements. This makes it harder for technologists to drive innovation and providers to prescribe technology for maintenance of socio-emotional health in older adults. Questions like ''how often email or Skype calls should be made with family or friends to reduce depression or loneliness?'' or ''how many people in the network are necessary for achieving feelings of support?'' and ''what kind of media sharing create feelings of connectedness?'' still need to be explored. A comparative evaluation of different ICT tools for their effectiveness in improving socio-emotional health of individuals and their privacy implications is needed. In general, we need to validate findings with larger sample sizes to ensure that we have the evidence base to drive policy changes and to encourage adoption of technology as a prescription for socio-emotional health of older adults.