Increasing life expectancy and consistently low birth rates have led to a larger aging popula-tion, more individuals requiring care, and related phenomena such as dementia. Information and communications technology (ICT) may contribute to a better quality of life for older adults when enabling their health, safety, care, and social participation. Exergames are gener-ally video games that involve different physical and cognitive exercises to encourage physical activity. Furthermore, aspects of gamification often support these exergames to foster new ways of engaging and stimulating individuals in interactive fitness. Indeed, studies have indi-cated that using exergames can result in improvements in individuals’ fitness, adherence, and balance, irrespective of their ages. The goal of this thesis is to explore whether appropriately designed exergames could improve the social interaction, collaboration, and well-being of people with dementia (PwD) and their caregivers.
The thesis followed a practice-based design approach to develop a suite of exergames based on long-term engagement with PwD in different care settings and considered the rele-vant stakeholders’ diverse levels of needs and demands, designed a tailorable suite of exer-games, and investigated its appropriation. Throughout the research phase, we assessed the appropriation, individual and social experiences, and integration of the exergames into daily life across the different care settings; the system of games was continuously redesigned, re-fined, and extended to reflect the insights that arose from our observations of its use, as well as feedback from the PwD and their caregivers. This thesis thus addresses the following re-search questions: (1) What are the long-term impacts on the activities of daily living (ADL) for individuals living with dementia? (2) What are the social, institutional, and emotional ex-periences for their relatives and caregivers? (3) How are systems individually and socially ap-propriated and contextualized? Finally, (4) how should exergame-based activities be designed to positively affect individual resources while considering the social environment in dementia care?
Our results illustrate that besides the observed and reported impacts on physical activi-ty and especially social interaction during and after exergame use, strengthened relationships and increased engagement were observed among PwD. These socio-emotional aspects were reported to encourage PwD in the long-term use of the system and motivate them to appropri-ate and engage with it. We noted that the grandchildren of PwD began to develop an interest in the exergames and played them together regularly. People with dementia and their grand-children also played the games together, and opportunities for relatives to follow the activities in their own social lives, such as reading books, meeting friends, and going out for walks, were thus created.
The findings indicate further specific advantages for the relevant stakeholders, which the system initiates within the social environments of PwD. In fact, the system was confirmed to destroy barriers and facilitate social connections for some participants. Particularly in day-care centers, participants were observed to develop a certain group dynamic and sense of in-terpersonal relationships while playing the games, which strengthened their collaboration, as well as their motivation to interact with and support one another. The social collaboration dur-ing group sessions often encouraged and helped them all and thus generated a cooperative, respectful, and motivating atmosphere. Relatives and professional caregivers reported having noticed the positive emotions, collaboration, and expressions that the PwD exhibited while using the system and that the games were a starting point for further discussions, even after the sessions. In addition, the studies conducted reveal that the appropriation and integration of the system depend only partly on the physical and cognitive benefits for PwD but especial-ly on the social impacts and added value that their social care networks perceive. However, certain challenging aspects of using the exergames disclose some interesting insights for the community regarding how to improve the design in this area, covering matters such as mal-functions when interacting with the exergames, personal misapprehensions, and interpersonal frustrations.
This thesis analyzes and discusses the results of the underlying studies by focusing on the need for a design in dementia care that conceives more socially embedded innovations that can address the social actors and diverse experiences involved. We argue that these ef-fects are fundamental to successfully integrating technologies in the complex environment of dementia care. This thesis therefore contributes to expanding the current discourse on Human-Computer Interaction (HCI) and dementia care by examining the impact of a suite of exer-games that was designed to support the ADL of PwD and their caregivers.