Adapting a Virtual Assistant Device to Support the Interaction with
Elderly People
Manuel Bolaños
1 a
, Cesar Collazos
2 b
and Francisco Gutiérrez
3 c
1
Universidad de Nariño, Grupo Galeras.net, Pasto, Colombia
2
Universidad del Cauca, Grupo IDIS, Popayán, Colombia
3
Universidad de Granada, E.T.S. of Computer and Telecommunication Engineering, Granada, Spain
Keywords: Social Isolation, Technological Isolation, Elderly, Virtual Assistant.
Abstract: Some authors agree that the elderly suffer social and technological isolation, or even exclusion, due to their
aging condition, a situation that could worsen in the future, as the trend of higher population growth in the
world, so some studies are needed to identify the expectations of such population in terms of the usage and
adoption of technology; so, new technological developments implement specific requirements that help them
to adapt to their use. This paper presents a study developed for evaluating the technological acceptance of
smart virtual assistants by the elderly people. Such a study involves the design and the implementation of a
recreational strategy to remember the taking of medications, considering some experiences in the development
and implementation of technology for this kind of users.
1 INTRODUCTION
The elderly people face a series of prejudices that
make their integration difficult to the new challenges
that are found in a digital society, which several
studies determine how they adapt to their daily life
(Ronning & Solvberg, n.d.), aging takes place in the
social context in which the elderly people is living,
and today such a population is into a digital
environment in which they should have access to all
the possibilities that technology offers, in order to
participate with greater capacity in a society in which
new technologies are increasingly prevalent in
different areas of daily life (Loos et al., 2012), in the
same way the editors affirm. “It is essential that we
recognize the differences and the similarities between
younger and older people using new media such as
websites, but we also have to pay attention to the
various sub-populations, especially within the
broader group of senior citizens. Individual
differences increase as people age” (Loos et al.,
2012).
When reaching a certain age, the fundamental
objectives of the elderly people are to have a good
a
https://orcid.org/0000-0002-3077-415X
b
https://orcid.org/0000-0002-7099-8131
c
https://orcid.org/0000-0001-6629-7597
state of health, well-being and tranquility of life,
guaranteeing in some way to be physically and
mentally active (da Silva et al., 2009). This is
important considering that one of the main problems
of the elderly people is memory loss. Memory loss
involves dealing with problems in development and
social integration of the elderly people. Due to
changes in cognitive processes, the elderly people
show notable differences in the way they manifest
such changes. Although, there is no scientific
evidence available to indicate the relationship of
some aspects of cognitive functioning with age, there
are two general topics on cognitive aging that are still
being investigated: “the first one is that different
cognitive variables have different patterns of relations
with age, and the second one is that there is large
variation in cognitive performance across people at
any given age, such that the differences associated
with age correspond to only a small proportion of the
total variation that exists across people” (Salthouse,
2010).
Stereotypes of culture against aging have an effect
on the general well-being and quality of life of the
elderly people. Such stereotypes influence how they
Bolaños, M., Collazos, C. and Gutiérrez, F.
Adapting a Virtual Assistant Device to Support the Interaction with Elderly People.
DOI: 10.5220/0009840102910298
In Proceedings of the 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 291-298
ISBN: 978-989-758-420-6
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
291

see themselves, and how they see others, which can
affect their social integration. (Dionigi, 2015).
According to the review of 2015, there were 901
million people over 60 years of age or older, which
represents 12% of the global population. Such a
situation is growing at a rate of 3.26% per year
(United Nations, 2015). Currently in developed
countries, the number of the elderly reaches 24%
(Klimova & Poulova, 2018); in addition, people of 65
years of age or older are expected to represent at least
25% of the European population in 2020, increasing
to 40% between 2010-2030 (Shore et al., 2018).
According to the review of 2019 from the world
population outlook (United Nations, 2019), the fastest
growing group are people over 65; therefore, it is
expected that by 2050, one in six people will be over
65, representing 16% of the population. In this vein,
In North Africa and West Asia, Central and South
Asia, East and Southeast Asia, and Latin America and
the Caribbean, this population is expected to double
by 2050. At that moment in time, in Europe and North
America, one in four people would be 65 or older.
The remarkable population growth of the elderly
people requires that technology developers pay more
attention on these types of population. Every day it is
more common that people use different technological
devices, either as work items, distraction or for health.
Fortunately, the increase in the development of
technological assistance devices for the elderly
people allows researchers to understand more about
how such a population can improve the quality of life
for that type of user. In this way, understanding the
different forms of adoption and non-adoption of
technology, as well as their social impact is important
in this historical time. (Neves & Vetere, 2019). Thus,
the development of new technologies is necessary, in
order to guarantee in some way that older adults will
have something that motivates them to use them.
2 TECHNOLOGY FOR THE
ELDERLY
Like other technological devices, virtual assistants
have become an element of great help to integrate and
keep people active, in addition to facilitating the
different tasks that are performed day by day
(Gutierrez et al., 2017). Intelligent Virtual Assistants
such as Alexa's Echo Dot developed by Amazon, Siri
from Apple, Google Assistant from Google, Cortana
from Microsoft, and Bixby from Samsung, among
others, are commercially available with great
acceptance in the consumer market (McLaughlin,
2020). Such a technology. It is becoming necessary
elements to facilitate the tasks of people's daily lives.
However, considering that aging is recognized as a
period in which the person experiences numerous
changes -due to lifestyle, and social and family
system-, continuously influence the various areas of
operation (Palloni & McEniry, 2007). Technology
and its rapid progress should be used as a tool to
reduce the social isolation of the elderly people, and
the “digital divide” -as a sort of differences that exist
between the societies- closely related with unequal
exploitation of ICT must be minimized. Countries of
the world do not have the same technological
capabilities that allow their inhabitants to use them
and keep up with other countries. The main idea is to
provide friendly and easy-to-use devices and
applications (Syeda & Kwon, 2017).
The elderly has some drawbacks with the use of
technology. That is why today people find and are
generating diversity of systems and applications
adapted to such a type of users, in order to facilitate
communication with their social environment, and
serve as support for their daily tasks.
With the purpose of knowing the singularities of
the design and implementation of technology for the
elderly people, some experiences were reviewed,
among which are:
Photo Alive, a Web design application, which
uses simple and intelligent interfaces that allows
family members to connect through different devices
and technological means (Syeda & Kwon, 2017).
Figure 1: Photo Alive, Interface and interaction techniques.
SocialConnector, it is an ubiquitous system that
allows the elderly to interact with other members
within their social network using regular social
networking services (Gutierrez et al., 2017).
Voice Assistant to Remind Pharmacologic
Treatment in Elders, it is a voice assistant that
remembers the daily pharmacological dose using an
autonomous system that functions without an Internet
connection. However, there are some important
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Figure 2: (a) Main user interface of SocialConnector for
tablets; (b) interaction scenarios between the users and the
system.
Figure 3: System overview, voice assistant.
restrictions derived from the context that limit the
possible options (Jesús-Azabal et al., 2020).
The Social Message Translator System, such a
system translates social media messages in both
directions and adapts the process, mediating the
communication supported by social interaction
applications and media such as Gmail, WhatsApp and
Telegram (Rodríguez et al., 2018).
Figure 4: Structure of Social Message Translator.
As you can see, the design of systems for older
adults needs special specifications, which allow
maximizing its usefulness and ease of use, so it is
important to conduct studies to identify what are the
expectations of this type of users in terms of use and
technology adoption, so that they become the starting
point for the design of new devices, applications,
systems and in the particular case of this virtual
assistants project, in which the implementation of
features and specificities that help the older adults to
easily adapt to their use (Ordonez-Ordonez et al.,
2017).
Precisely, in order to verify the probability of use
of some of the most common virtual assistants in the
market -such as Google Assistant, Siri, Cortana,
among others-, a study was carried out to evaluate
their functionalities and how these could be used to
help the elderly people to strengthen their social ties
with groups. from family and friends (Reis et al.,
2017). One of the important conclusions of such study
is the set of relevant activities to interact with a
greater number of people, for instance: making a
basic and pleasant greeting, managing email,
managing events on social networks, and playing
games for elderly people.
3 CASE STUDY
There are different reasons for the elderly to use
technological devices, but some of the main ones are
the interaction with other people in their social
environment and the ability to store and remember
information. Devices such as Alexa and Google
Home are very helpful and allow users to use
countless voice commands that can not only make
their lives easier, but also remove them from the
social isolation they are often subjected to. However,
although those intelligent devices learn as they
interact with humans, such devices already come with
a predefined design in their operation and interaction
interface, which means that many elder people do not
adopt these technologies for their daily activities.
That is why this research was carried out with the
purpose of studying a case to determine the level of
acceptance of Intelligent Virtual Assistants by the
elderly in the city of Pasto -Nariño, Colombia-. In the
research, focus groups were worked, which were a
space of opinion to capture the feeling, thinking and
living of individuals, causing self-explanations to
obtain qualitative data (Kitzinger, 1995), focus group
are a good tool to obtain information for their
sensitivity to investigate knowledge, norms and
values of certain groups (Barry et al., 2009).
3.1 The Focus Groups Experience
According to the characteristics of the research, the
units of analysis are finite and intentional, so the units
of work with respect to the elderly are of a non-
probabilistic type with voluntary subjects, and with
the purpose of having a diverse population sample, it
was determined to select four different groups,
conformed within each one by adults with similar
characteristics in terms of their life habits.
- Group of elder people who remain in contact
through some type of association.
Adapting a Virtual Assistant Device to Support the Interaction with Elderly People
293

- Group of elder people who practice sports and
maintain daily routines.
- Group of elderly intellectuals (teachers,
researchers).
- Group of people of different levels of education
who belong to a nursing home.
The diversity of the groups is due to the fact that
we want to find a horizon of common points and one
of specificity points in various aspects.
The work plan to test the degree of acceptance of
the virtual assistant with older adults corresponded to
the following activities:
- A sample of older adults was selected (six for
each group). Perform the installation and test of the
system.
- A personal assistance profile was installed and
designed using Amazon Alexa® for each group of
older adults. Each profile with its access account and
the appropriate agenda settings such as calendars,
important date reminders, alarm reminders for taking
medications and various activities, hobbies among
others.
- The test was carried out with the different
functionalities that the virtual assistant has
implemented.
- After the system tests, the group responded to a
semi-structured interview to determine the degree of
acceptance of the virtual assistant.
- The test results were analyzed.
The type of instrument used was a semi-structured
interview (the individuals knew in advance what they
were going to ask and the consent was requested to be
recorded in said interview), in which the members of
the group were invited to answer questions such as:
How comfortable did you feel when interacting with
the personal assistant during the test? How do you
consider the interaction with the device? Describe
your experience highlighting the positive aspects,
Describe your experience highlighting the aspects
that you believe should be improved, among others.
In figures 5,6,7 and 8 the groups are observed in
their work with the device.
The results obtained were satisfactory in terms of
acceptance of the virtual assistant, the members of the
four groups were impressed by the different things
and functionalities offered by the device, and the most
important thing for most is that they can interact with
the voice, without needing of writing commands.
In Table 1, the most relevant positive aspects and
some recommendations made by each of the groups
to improve the device are recorded.
Figure 5: Group 1.
Figure 6: Group 2.
Figure 7: Group 3.
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Figure 8: Group 4.
Table 1: Positive aspects and recommendations.
POSITIVE RECOMMENDATIONS
1 It is a device that can
help older people a lot
to remember things
that should be done
like medical
appointments,
meetings.
The device should be
wireless for added
portability.
2 Alexa is very useful
especially for
reminding adults of
things, since we are
very prone to forget
things, and also serves
as a company.
The device is very useful
when you are at home, but
it would be much more
useful if it were portable,
not dependent on the
electric current.
It would be nice to be able
to customize it, to have a
more friendly way.
3 It is very useful for
people who have
memory problems, as
it can remind them of
different things such
as taking medications,
or simply that they
require company to
keep their cognitive
skills active.
It would be important that
the device could be taken
everywhere, because
adults are not going to stay
at home all the time.
4 It would be very
helpful to remember
things such as where a
receipt was left, or
when it should be
paid, it serves as a
company and also
serves to make some
activities easier.
It must always be
connected to the electric
current. It would be good
if it had a rechargeable
battery to be able to take it
to activities such as going
out to exercise.
It could be used as a
decorative element if it
had another shape.
Source: this research.
3.2 Adapting the Device: CuyAlexa
One of the important recommendations made by the
members of the four groups, and which was evident
in the development of research activities, is that the
device, despite having an oral interface, requires that
the interaction start with a specific protocol, in this
case, the initiation word “Alexa”, and many times the
device does not understand what it is said, and it is
very automatic, for example, in reminders and in the
creation of task lists such as storing market purchases.
It was also suggested that it would be good to be able
to customize it with the purpose of making it a more
friendly and even decorative element.
Based on the recommendations and the evidence
in the field work, it was proposed to design
“CuyAlexa” (Figure 9), which is the figure of a native
rodent from this region and is known as “Cuy”. It was
designed in such a way that it could house the
Amazon Alexa® device and thus look more friendly
for adults in this region.
Figure 9: CuyAlexa, the physical device as a virtual
assistant based on Amazon’s Alexa Echo Dot.
3.3 A Medical Reminder: MediCuy
To approve the design of "CuyAlexa" a Skill was
implemented which was given the name of
"MediCuy" which can be used by older adults in a
playful way, through a game that allows you to
schedule your shot of medications, remind you to take
them, and, in addition, somehow a few minutes later
check if you really took the scheduled medication
asking for a known saying, so that the virtual assistant
tells you the first part of the saying and asks the user
If you remember the end. Regardless of the user's
response, the virtual assistant congratulates people for
taking the medication and remembering the saying or
invites you to immediately take your medication.
To implement the game, one of the
recommendations made by the participating elderly
people was considered. The recommendation was
related to how to interact with the device. Every time
the user wants to interact with the device, the user
must pronounce the activation word "Alexa". In this
Adapting a Virtual Assistant Device to Support the Interaction with Elderly People
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Table 2: MEDICUY “Medication Programmer”.
VIRTUAL ASSISTANT USER
Opens Medicuy | Open Medicuy
Hello, I'm Medicuy, the drug-taking programming system designed for you. Do you
want to schedule the taking of your medications?
Yes | Ok | It's ok | Ok | Of course |
Forward | Continues |
All right, let's get started. First I need to know how many medications you want to
schedule.
I want{cantidad} medicamento(s) |
I want {cantidad} | I want to
schedule {cantidad} |They are
{cantidad}
VALIDATE AMOUNT IN INCORRECT CASE
I'm sorry, I need a number of medications to be able to program.
IN CASE CORRECT
(CYCLE: i =1 to n)
Excellent, let's go with the drug number i. What custom name do you want to place
on this medicine?
{nombre_medicamento}
REQUEST CONFIRMATION
Let's schedule the drug nombre_medicamento, Please confirm!
Yes | Ok | It's ok | De acuerdo |Of
course | Forward | Continues |
TO CONFIRM
what time you want to take the first dose of {nombre_medicamento}
{Hora_inicio} | I want to take the
first dose at {Hora_inicio} | I'm
going to take the first doses at
{Hora_inicio}
VALIDATE HORA_INICIO IN INCORRECT CASE
I'm sorry, I don't understand the time of the first dose o
{nombre_medicamento}
IN CASE CORRECT
Thank you, now I need to know how often you need to take a dose of
{nombre_medicamento}
{cantidad} {medida_de_tiempo}
VALIDATE AMOUNT AND MEDIDA_DE_TIEMPO IN INCORRECT
CASE
I'm sorry, I need clarity as to the time of taking doses. I hope you'll tell me
the number of hours or minutes to schedule your
{nombre_medicamento}
IN CASE CORRECT
Thank you, your {nombre_medicamento} has been programmed
MEDICUY “playful reminder”
VIRTUAL ASSISTANT USER
2 MINUTES BEFORE…
Hello, I remind you that in 2 minutes you should take your
{nombre_medicamento}
Good | Ok | Thank you
AL MOMENTO
It's time to take your {nombre_medicamento} Good | Ok | Thank you
2 MINUTES AFTER (PLAYFUL INTERACTION)
I need your help, I don't remember this saying very well:
{refran_parte_inicial}
{refran_parte_final}
VERIFI VALIDATION IN BOTH CASE
That's good| All right | Very close| Nada mal. Not bad. By the way, 2
minutes ago you took your{nombre_medicamento}?
Yes | No | I forgot it | I did not
remember
VERIFY ANSWER IF AFFIMATIVE
excellent!
IF NEGATIVE
You must take your{nombre_medicamento} right now!
Source: this research.
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way, the user calls the device only when he/she is
going to program the taking of medications, and once
the device is finished, it activates automatically
according to the programmed schedule. The game can
also help strengthen memory, stimulating
imagination, activating attention, developing
concentration, and generating positive emotions in
the elderly people. The game was intentionally
programmed to improve mood and receptivity to new
technological environments. Table 2 shows the user
interaction with the "MediCuy" system through the
Virtual Assistant.
To evaluate the degree of acceptance of
"CuyAlexa" and "MediCuy", each of the elderly
people who were part of the focus groups will test
their operation for several days, and one of the
existing Technological Acceptance Models will be
used, after analyzing each one of them to define and
adapt the most suitable for the purpose of the
research.
4 FUTURE WORK
The design of “CuyAlexa” and the implementation of
the recreational strategy for medication programming
“MediCuy” were developed based on some of the
suggestions and comments of the elderly people who
participated in the facus group. However, it is
necessary to evaluate the level of technological
acceptance of the design of "CuyAlexa", as well as
the operation of "MediCuy"; in this vein, a test phase
will be developed soon with such a population. In this
way, the elderly people in the focus group will
interact with the device and the strategy playfully,
scheduling their medication and testing how the
strategy works. The results obtained will be analyzed,
and then, a re-design stage will be developed,
allowing older adults to participate to refine the
requirements they consider should be implemented in
"MediCuy". Thus, such activities allow identifying
new play strategies that somehow facilitate the
development of their daily activities and allow them
to interact with other people.
5 CONCLUSIONS
Elderly people who were part of the focus groups
consider the different functionalities of the virtual
assistant very useful and interesting since it can
facilitate some of their daily activities. However, they
claim that it would be better if the interaction was a
little more friendly.
The recommendations made by the elderly people
served as the basis for the physical design of
"CuyAlexa", and for proposing, designing and
implementing a recreational strategy to remember the
taking of "MediCuy" medications.
The evaluation process must be developed to
determine the level of acceptability of both
“CuyAlexa” and “MediCuy”, and then carry out a co-
design stage that allows older adults to directly
propose the specific characteristics that they would
like to be implemented
Technology is becoming a fundamental pillar of
help in the different contexts of the daily life of the
elderly people, so it is necessary to identify the
specific requirements that must be implemented in the
systems for this type of users.
Smart virtual assistants facilitate the development
of work, recreational and even health-related
activities for elderly by reducing human-machine
interaction thanks to its oral interface.
Like any technological system, those designed for
the elderly people must also meet specific
requirements that facilitate their use and acceptance
by this type of users.
Technological acceptance models must be created
that adapt to elderly people, and focus on the tasks in
which they use it, and thus, be able to measure with
greater certainly the intention of use and the need they
have of the technology.
ACKNOWLEDGEMENTS
Work funded by the Spanish Science, Innovation and
University Ministry (MCIU), the National Research
Agency (AEI) and the EU (FEDER) through the
contract PERGAMEX-ACTIVE (RTI2018-096986-
B-C32).
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