SPEECH AND AGING, September 2009, notes.

Speakers:

· Tessa Ten Tusscher, CEO and Founder,Living Well at Home

· Deborah Dahl (by phone), head of Conversational Technologies. She has been exploring speech and language technology for seniorsrecently made a presentation at SpeechTek on the topic of Designing Speechand Multimodal Applications for Senior Users

Discussants:
- Jared Bernstein, founder Ordinate Corporation and Consulting Scientist at Pearson Knowledge Technologies.
- Dilek Hakkan-Tur, Senior Researcher at ICSI
- Mary Constance Parks, Senior Voice User Interface Designer at Nuance, Inc.
- Horacio Franco, Chief Scientist, Speech Technology and Research Lab, SRI International
- Marikka Rypa,an Instructional Design Professional
- Mike Cohen, Manager, Speech Technology, Google
- Patti Price, consultant in speech and language technology.  Recent article for Speech Strategy News on Speech-Enabled Memory Assistants

Not able to attend but with useful information on this topic to share:

 - Francois Andry,Software ArchitectatIntercomponentWare Inc.blogs on technology in health care

 - Michael, a social worker from the New York City area, who also made a SpeechTek presentation onSenior Friendly Design

NOTES:
Tessa Ten Tusscher's talk:
Tessa's background is as a geriatric psychologist. The old are often divided into the old old (>85) and the younger old (>65). Her company's goal is to help people age the way they want to age, and 89% of them would like to stay in their own homes. Usually there is some triggering event that causes them to move into assisted living. The home environment can be made more supportive for older people, even after these triggering events. The current population of seniors is not on average very comfortable with technology, so the focus has been providing high touch solutions rather than high tech solutions.However, technology is of interest in that it can help to bring down costs. The approach is holistic, considering the individual capacities, recent changes, desires and current living situation.The brain goes through a number of sensory changes as we age. And many technology experts who design user interfaces do not pay sufficient attention to these.However:
. a significant number of people over age 80 start to have signs of some dementia.
. hearing degrades (there is both loss in higher frequencies, as well as difficulties in hearing and understanding faster speech and speech in background noise).

 . cognition (it becomes harder to think about more complex things) and reaction time degrades
. vision degrades
. aphasia may also result from a stroke

On the other hand, the younger old who have grown up with technology may be suddenly surprised to find that things they were used to finding online are no longer available once they turn 65,since many institutions have decided that the elderly do not use the internet, particularly with Medicare.  Young and old tend to give up in the face of consistent failure, and as we age, things do get harder (since hearing, vision, reaction time, etc. are degrading -- and there may also be arthritis, tremors and other factors that make things more difficult).

LivingWelllAtHome visits each potential client, in their home to perform a series of cognitive tests, measure attention, short term memory, etc.Depending on general health there may be more sophisticated testing. Compare to any recent tests, diagnoses, medical history, medications, recent events (e.g., stroke --- these are usually precipitators for considering assisted living).What are strengths and weaknesses. How to accommodate.Check for depression (which sometimes masquerades as mental loss).There is a tension between too much accommodation (which could lead to further degradation of function) and too little (which is frustrating and limiting).But the attempt is to try to figure out what is possible from a functional point of view and to try to build up to that point, while accommodating function loss that is not recoverable.(analogously, a lost leg may require a crutch, while a sprained ankle needs rest and then rehabilitation to bring back function).

The technology currently being used by LivingWellAtHome is largely industrial technology (e.g., site monitoring technology) adapted to a home environment.The solution is a combination of modifying the home and service provision. Clearly costs are reduced if there is a good technology solution to service costs.

Deborah Dahl's Talk:
1. Why design for seniors (variety of social reasons... and we all tend to aspire to become old).
2. How can speech technology help?
a. Some are applications that anyone can use, but accommodate the senior demographic
b. Assistive applications, that help seniors in daily life
 c. Rehabilitative applications that help improve function (e.g., aphasia therapy -- which can help the young as well as the older aphasics).
3. Changes that occur with aging: physical, psychological, motor, etc., but physical (hearing, seeing, dexterity...) and cognitive (memory, attention, language processing... ) are the most noticeable.All of these changes should affect how we design applications.

General Discussion

WHAT DEGRADES AS WE AGE? WHAT MIGHT IMPROVE?
Although seniors have degrading cognition, sensory input, etc., some things may get better.Perhaps they have learned to be more patient?Although it seems that patience may be in some areas but not necessarily all. Ability to focus and to find things (on a computer screen for example) seems to degrade. Seniors today tend to have older, smaller screens with lower resolution and larger fonts, so less fits there and things ARE harder to find. There is a tendency to focus on developing NEW technology to assist seniors in various ways.But we must also remember to adapt current technology to make it easier to use as people age.

WHY MULTIMODALITY?
Multimodality is important for many reasons (for seniors in particular, but for general population as well):
. One modality can be substituted for another (e.g., spoken outputs for low vision individuals, and visual information displays for those hard of hearing)
. More often both vision and hearing are a bit impaired, and the two together allow comprehension.
. Having the information presented in more than one modality seems to aid memory and understanding generally

WHY CONVERSATIONAL SYSTEMS?
Although many of today's seniors prefer high touch to high tech, this may not be as true of tomorrow's seniors as it is of today's cohort of seniors.And it is not entirely true of seniors today. Some older people seem to prefer the high tech to the high touch, if they feel it works well and gets their job done without bothering or annoying anyone.But, perhaps because of the degradation of various physical and cognitive skills, it may be useful for seniors to break down interaction into smaller steps, so that there are many simple steps rather than a few more complex ones.This, too, may be true of the more general population.For example, Wallace Chafe's work at UCSB shows that intonational units tend to have 1 new idea and last about 1.2 seconds.  Wallace Chafe, Discourse, Consciousness, and Time.

The function of interactivity in conversational interfaces therefore goes beyond just making them more human-like and chatty.A crucial aspect of both human-human and human-machine interactions is to break a task into small, easily confirmable components. Many seniors may be highly motivated to avoid 'bothering' a human for information, and are perfectly capable of finding information themselves on the web.However, if the information goes against their expectations, they may prefer to have a human being say it, to be sure of it. The simple rule of many small one-piece-of-information units may be broken if for any reason the interaction is very slow (e.g., talking via teletype or via an interpreter).In this case, if there are 5 - 10 second delays, the preference for smaller units changes to longer, more complex ones.

HOW IS TECHNOLOGY CURRENTLY USED WITH CARE FOR SENIORS?HOW MIGHT IT BE USED?
Since most seniors say they would prefer to stay in their own homes as they age and since this often is a lot less costly than alternatives to individuals and to society, we should be motivated to find ways to enable that outcome.One way to keep down costs is to use technology where it is as effective as humans but less costly. Here are some ways technology is currently used:
- Medication management: primitive medication reminders, and request to input information about having taken medication. However, hearing an alarm at 3 pm may not be sufficient to let the person know to 'take that long blue pill'.
- Home security: use voice activation to open a door.Using biometrics such as voice identification for the senior as well as caretakers would be very useful, to help control who enters the home.Most seniors do not want to wear those pendants that help alert others to their distress. But a more general system that could, e.g., recognize screams would be useful.
- GPS might also help track who is where (for the senior and for care givers).
- There are some photo frames with a prerecorded message from, e.g., a granddaughter that are not so useful for most seniors, however, a device that could do this as well as other easy messaging tasks might be useful.
- Reminder systems often seem more appreciated by family members who feel they are doing something but they don't seem to get a lot of use by seniors.
- Small RFID tags on, e.g., glasses, medicines, etc. could be able to alert someone if the medecines have been touched, and make them easier to find.
- There are some wireless heart monitors in common use now, and many other systems for monitoring body functions in clinical trials.
- Wii and other games are used a lot in senior centers and can help with physical fitness and reaction time and coordination.
- Posit Science has a program for brain fitness but it focuses on a very narrow set of skills and is so boring that most people do not do them (just as they don't usually keep up gym membership).More generally --- to keep your brain fit: just do new things that are hard for you, trying to get better.(this is also how you keep your body fit).

WHAT DATA DO WE HAVE?
There is not a lot of data on voices as we age.SRI and ICSI have collected some data from seniors, from elderly care centers, and in their homes.The database consists of conversations between the elderly and another person, assessing activities, cognitive status (e.g., read a story and ask them to retell).There are also some older papers on the voices of seniors, particularly from ATT and Dragon. These data seem to indicate that speech recognition does degrade significantly for older speakers -- even when test and training are both using only older speakers. There are issues with false teeth, more variability (perhaps related to motor control), and lower amplitude levels -- sometimes their voices are very hard for humans to understand.