The CAREUP project investigates how to implement the “inclusive health & care approach (health prevention, preservation of physical & mental health, social participation)” of the AAL Call 2021 ”by taking into account the specific needs of end-users. To reach its goals, the CAREUP project will develop an ICT-based solution to continuously enhance the quality of life of older adults following a life-course framework and using the guidance offered by the “Positive Health” concept and the WHO “Healthy Ageing” recommendations. The CAREUP solution allows older adults to adhere to these two guidelines thorough self-monitoring of two key elements: Functional Ability and Intrinsic Capacity.
Gamification is introduced in CAREUP as an incentive to self-monitoring adherence but not only. The CAREUP system requires the design of games which shall aid in both diagnosing and improving the physical and mental health of the primary users. We will develop and implement an innovative gamification strategy based on a shared topic for the games to provide homogeneity and usability along with an attractive and motivating platform. The selected topics (social skills, cognitive skills, and mindfulness) will be the basis for sets of minigames with various aims. The aims will be two: help with diagnosis and mitigation. The diagnosis part will mostly entail gamified tests (a core innovation of the project) while the mitigation part will focus on long term adherence, the main challenge that many platforms for seniors struggle nowadays, and one that AAL calls have intensively insisted on. To cope with this challenge, co-creation will be given a lot of relevance to have games that users feel engaged with. The games will extract data: scores, reaction times, usage time, participation of other people, cognitive, social parameters.
Phase 1
Act 1.1 CAREUP platform specification and architecture: The CAREUP project proposes an ICT-based solution to enable older people to adhere to Healthy Ageing (HA) by monitoring its key elements, i.e. functional ability and intrinsic capacity. The monitoring will be based on data collection from different sensors such as health parameters (e.g., blood pressure, glucose levels, weight, pulse, etc), from digital questionnaires and through interaction with gamification elements. The data collected using different technologies will be processed using artificial intelligence algorithms to asses the intrinsec capcacity of the elderly user. The CAREUP platform builds on previous results and therefore the architecture development has started from the architecture of the IONIS and NITICS projects. We have presented here the main physical components (e.g. subsystems, devices, networks, software modules) of the platform as well as how these are interconnected.
Act 1.2 Analysis of usage scenarios based on the identified functionalities: In this activity we started from a central scenario developed at the beginning of the CAREUP project. Based on this scenario and the architecture developed in Act 1.1, we have developed scenarios for the use of the various components of the platform. We focused mainly on gamification which is the main contribution of the CITST partner in CAREUP platform but we also included a scenario on the positive health component. The following scenarios were developed: Gamification scenario - patient perspective; Gamification scenario - informal caregiver perspective; Gamification scenario - family doctor perspective; Health scenario - family doctor introduces recommendations in AIHAP; Health scenario - informal caregiver and attending physician. These were presented both descriptively and through UML diagrams.
Act 1.3 Studies on existing gamification elements on the market or in the literature that address the CAREUP target aspects: In order to develop new solutions for gamification elements, an analysis of existing serious games for older people was carried out. We focused on games that address the maintenance and improvement of physical and cognitive skills. For this purpose, a number of existing cognitive games were analysed, such as SynapseToLife, Rhythm, MemoreBox, FallSensing game suite, Mimic Instruments, A-go!, MobileQuiz, ElderGames, HitIt and Reach, Out in Nature, VIRTRA-EL web platform 3D game, Harvest and Cook.
Act 1.4 Development of new solutions for existing CITST gamification elements: In order to develop games which, address the intrinsic capability of the users, we will be developed gamification elements that build on the Cogstate (Brain Health for All) principles. For example, starting from the Match Game developed in INCARE AAL, new games will be developed that will involve selecting images which contain elements from a predefined domain (e.g. selecting all images containing flowers). Starting from the Collect Objects game, a new version will be developed (based on Cogstate - Visual Learning) which: will require the collection of all objects that have already appeared in the environment; each level will have a fixed time - the user will have to collect the objects as correctly and as quickly as possible; the score will be calculated based on the number of correctly collected objects and the time they have been collected. An important part of the user experience in interacting with gamification are the characters in the game and their personality, i.e. the way they react to the story that is unfolding (how they animate). This aspect will be taken into account in the development of gamification elements. Algorithms will also be included that link the games to the rest of the CAREUP platform.
Act 1.5 Dissemination of results (web page, Linkedin, etc.): The project page is maintained by the CITST partner in English and Romanian at: http://www.citst.ro/projects/careup/. The Linkedin page is maintained with contributions from all partners at: https://www.linkedin.com/in/careup-project-890156243/. Other dissemination events include promoting the project at BeHEALTH 2022 and the AAL Forum during the European Week of Active and Healthy Ageing.
Phase 2
Act 2.1 Development of the CAREUP solution with integrated gamification elements: a number of gamification elements have been proposed to support the concept of intrinsic capability, such as estimation of: cognitive decline, mobility, auditory acuity, visual acuity, depression symptoms.
Act 2.2 Development of new solutions for the gamification elements existing at CITST: in this phase two new games were created (based on existing games), as follows: 1) the Puzzle game allows solving a puzzle, without receiving indications of correct/incorrect placement of pieces and 2) the Find Path game involves walking a specified path in a maze (with or without the existence of enemies), in a predefined time.
Act 2.3 Development of new gamification solutions for the CAREUP users: in this phase new games were designed and implemented that require attention, memorizing and speed of reaction: detection of certain specified objects, selection of an object of a certain color in a certain time or selection of an object when its color becomes a specified color, speed of performing simple mathematical calculations (addition / subtraction / multiplication) in a fixed time.
Act 2.4 Widespread dissemination of the results: The project page is maintained by the CITST partner in English and Romanian at: http://www.citst.ro/projects/careup/. The Linkedin page is maintained with contributions from all partners at: https://www.linkedin.com/in/careup-project-890156243/, publication of 5 articles (1 Q2 journal article with impact factor and 4 conference papers with proceedings indexed BDI and undergoing ISI indexing). Other dissemination events presented the project at the COST Network on Privacy-Aware Audio- and Video-Based Applications for Active and Assisted Living (COST Action CA19121 GoodBrother) Summer School, 13-16 June 2023.
Publications
- Velciu, Magdalen, Luiza Spiru, Mircea Dan Marzan, Eva Reithner, Simona Geli, Barbara Borgogni, Oana Cramariuc, Irina G. Mocanu, Jerzy Kołakowski, Jaouhar Ayadi, and et al. 2023. "How Technology-Based Interventions Can Sustain Ageing Well in the New Decade through the User-Driven Approach" Sustainability 15, no. 13: 10330. https://doi.org/10.3390/su151310330 (IF: 3.9, jurnal Q2), under ISI indexing process.
- Stanciu, I. D., Cramariuc, O. T., & Mocanu, I. G. (2023, July 15). Types of affordances and their role in quantitative and qualitative UX/UI research. A scoping review of affordances-focused literature. 17th International Conference on E-Learning and Digital Learning, https://www.elearning-conf.org.
- Irina Mocanu, Oana Cramariuc, Dorin Ionut Stanciu. An Intelligent Application for Improving Health Conditions through Gamification. 24th International Conference on Control Systems and Computer Science – CSCS24, 24-26 may 2023, in press.
- Irina Mocanu, Alex Imad Awada, Oana Cramariuc. A System for Engaging Older Adults in Maintaining an Active and Healthy Life Through Games. 19th eLearning and Software for Education - eLSE Conference, 27-28 april 2023, in press.
- Roxana Elena Stiuca, Irina Mocanu. Character Animation using LSTM Networks. 46th International Conference on Telecomunications and Signal Processing, TSP 2023, 12-14 july 2023, in press.
Phase 3
Act 3.1 Analysis of Data Processing Algorithms: In this activity, we studied frameworks that can be used to collect and analyze user data in order to analyze user behavior. Using such analytics, developers gain a deep understanding of how players interact with games, allowing them to make informed design decisions, optimize game experiences and improve monetization strategies. Existing studies have also been reviewed to determine the recommended frequency of playing (number of times/week), as well as the time limits used in games (such as the duration of a level in Moving Object or Reaction Time games).
Act 3.2 Experimentation with gamification elements and adaptation based on user requirements from the pilot studies with platform components: the games developed in the previous steps: Reaction Time, Puzzle, Moving Objects, Math and Find Path were evaluated in the lab. Based on the feedback received, the games were updated. Additionally, we also tested another CITST-developed game for identifying identical images (Match Game).
Act 3.3 Development of new gamification solutions for the CAREUP users: in this phase a new game was developed in which the user has to choose pairs of images from the same domain (domain selected by the user at the beginning of the game - e.g. images of animals). In the current version, the images from which the selection has to be made are visible to the user.
Act 3.4 Study and analysis of the methodology required for the economic analysis of the CAREUP platform: In this activity various methodologies used for economic analysis were investigated. The PEST (political, economic, social and technological) analysis takes into account major external factors influencing economic competitiveness. One such factor is the political factor which is dictated by governmental provisions that define for example taxation policy. We also examined the VRIO (value, scarcity, inimitability and organization) analysis framework which is a strategic planning tool designed to help organizations discover and protect the resources and capabilities that give them a long-term competitive advantage. SWOT analysis (strengths, weaknesses, opportunities and threats) is a framework used to assess a company's competitive position and to develop strategic planning. SWOT analysis assesses internal and external factors as well as current and future potential. It is the most popular model of organizational analysis.
Act 3.5 Scientific dissemination and large-scale dissemination: The project page is maintained by CITST in English and Romanian at: http://www.citst.ro/projects/careup/. The Linkedin page is maintained with contribution from all partners at: https://www.linkedin.com/in/careup-project-890156243/. Other dissemination events included: the presentation of the project at the Vitalitas Centre for elderly care, July 2023; the second national conference on long-term care services organized by the Association of Directors of Institutions for the Elderly, November 20-21, 2023.
Phase 4
Act 4.1 Experimenting with new gamification solutions with users from integrated pilot studies: In this activity, we tested the gamification elements integrated in the CAREUP platform. A total of 9 seniors participated in the CAREUP test, their ages ranging from 61 to 85 years, with an average age of 69. The gender distribution was relatively unbalanced, with 2 women for every man involved; the residential environment was exclusively urban. Respondents rated the interface of the CAREUP game application as fairly easy to navigate or very easy to navigate. The games application contains both commercial games, popular among the elderly population, such as Sudoku, Solitaire, Mahjong, Chess, Tetris, etc., as well as the games developed within the CAREUP project, which are 5 in number: Shape Matching Game, Puzzle , Moving Objects, Reaction Time and Mathematical Calculations. Among the 5 games developed within the project, the easiest to play was considered the Match game, which involves the player turning over some cards with pictures and matching the picture with a similar one. This game was rated very easy to play by 5 out of 9 participants, with the rest finding it fairly easy to play. The next easiest to play was considered Mathematical Calculations (Math), which involves calculating some mathematical operations in a given time; this game was rated fairly easy to play by 5 participants, and very easy to play by 4 participants.
Act 4.2 Implementation of the gamification solution model by optimizing the CAREUP games following the integrated pilot studies: In this activity we have optimized the games developed within the CAREUP platform as a result of the end-user feedback. Thus, the following functionalities were added following the observations received during the platform testing: 1) "Settings" menu in which a) you can view the current version of the games, b) you can choose the way of feedback offered to the user after performing a correct action or incorrect (visual or auditory), 2) the possibility of selecting the number of pieces for the Puzzle game, 3) the addition of the "Hint" button in the Puzzle game to indicate to the user the correct way of placing the current piece, 4) the implementation of a reward mechanism through which users can obtain medals: bronze, silver and gold based on the scores obtained in the games developed within the CAREUP platform.
Act 4.3 Selection and integration of suitable commercial games in the CAREUP solution: In this activity, commercial / existing games were integrated into the CAREUP platform. Initially a number of existing web-based games were selected. The selection of existing games was made following the votes made by the users who tested this platform. Thus the games that got the most votes are: 1) Solitaire, 2) Sudoku, 3) Mahjong, 4) Chess, 5) Black sudoku, 6) Sweet world 7) Find differences, 8) Tetris and 9) Wordle. When starting the game application, the user has the possibility to select a game developed within the CAREUP project or one of the commercial games. Since there is no possibility of direct integration of code related to existing games, the score obtained by the user must be entered manually by him. Thus, after completing the game, in the CAREUP platform, users must enter the score obtained manually.
Act 4.4 Development of algorithms for processing information acquired through gamification: : In this activity, the scores obtained by each user during the testing of games developed within the CAREUP platform were analyzed to establish the threshold for awarding medals. A series of care plan guidelines were also created for the use of games in stimulating cognitive aspects.
Act 4.5 Development of the economic analysis documentation for the CAREUP platform: In this activity, a business plan was created for the CAREUP platform as well as one dedicated to the separate commercial exploitation of the gamification elements. The business plan presents the opportunity and the targeted market segment, the competitors, the canvas model, the marketing strategy as well as the acceptance and legislative barriers.
Act 4.6 Wide scale dissemination of the project results: The dissemination activities included the following:
Online dissemination
- The project page was maintained by the CITST partner in English and Romanian at: http://www.citst.ro/projects/careup/.
- The Linkedin page wad maintained with contributions from all partners at: https://www.linkedin.com/in/careup-project-890156243/.
- CITST contributed regularly to the blogs maintained on the project coordinator's page at: https://www.careup.care/blogs.
Scientific articles and presentations at conferences
- M. Kolakowski1, A. Lupica, S.B. Bader, V. Djaja-Josko, J. Kolakowski, J. Cichocki, J. Ayadi, L. Gilardi, A. Consoli, I.G. Mocanu, O. Cramariuc, L. Ferrazzini, E. Reithner, M. Velciu, B. Borgoni, S. Rivaira, S. Leonzi, G. Cucchieri, V. Stara, CAREUP: Integrated Care Platform with Intrinsic Capacity Monitoring and Prediction Capabilities, submitted to Sensors (ISI, IF=3.3).
- A. Mocanu, C. Ciobanu, M. Georgescu, T. Ciobanu, Gamification as a way to reduce tech exclusion and improve digital education for seniors, submitted to the 19th annual International Technology, Education and Development Conference.
Other events
- Dissemination of the project at the forum organized by the National Association of Patient National with Noncommunicable Diseases COPAC (23-24 May 2024).
Within the CAREUP project, financed by UEFISCDI through the European AAL program, an e-health platform was created that directly supports the promotion of a healthy lifestyle, addressing the specific problems of aging and digital skills, with the aim of improving intrinsic capacity. At the same time, the requirements imposed by the concept of intrinsic capacity were analyzed. The concept of intrinsic capacity was introduced by the World Health Organization (WHO) and includes all aspects related to the physical and mental capacity of an individual. The platform has a modular and flexible design and was developed starting from the user's requirements (user-centered design) to eliminate the risk of the user being overloaded with (actional) goals and information. The acceptance of the platform as well as its usefulness were confirmed through pilot studies, in real operating conditions, which revealed that the use of the platform and the exploitation of gamification will have a positive impact on the elderly, addressing both physical and mental health challenges. The platform and related services as well as the component elements will be commercially exploited by the CAREUP transnational consortium. The suite of gamification elements developed by the IT Center for Science and Technology will be offered to the market in 2025.
Gamification elements integrated in the CAREUP platform
Schematic representation of the CAREUP platform
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