Scientific

Aspects of Instant Aging and Old Age Simulation

An Old Age Simulation Suit, Age Suit or Senior Suit is a jumpsuit that allows younger people to explore the living conditions of the elderly, when many of their physical abilities have gone. They are are tools for the sensitization of the public for the needs of the elderly, for the training of nurses and medical professionals, for tests of usability and barrier-free designs, and for the development of ergonomic products and environments. The following article describes the technological evolution of old age simulation and current applications.

The interest in the abilities of the elderly is increasing, as their share in western populations is getting bigger. It is expected, that the group of persons aged between 50 to 100 years will soon establish half of the population in Europe. And here, age simulation suits provide research insights less costly, faster and in a more direct way than other methods, e.g. computer models. Through self-experience age suits can create an intuitive understanding, which gives more insight than would be possible by theory alone. Therefore, age simulation suits are now used worldwide by ergonomists, architects, product designers, engineers, market researchers, politicians, trainers, human resource managers, and by many other ones.

Every once in a while a politician or a journalist thinks he could use an age simulation suit to prove that elderly should generally not be driving cars. However, the age simulation suits deliver fast and accurate results in this field of research. Age suits predict the problems of the elderly with precision, however not to exclude them from driving. The driving abilities of the elderly show very specific problems, such as a difficulty of getting into and out of a car, and turning the head when driving backwards. (This is why many automobile producers are now offering back view cameras). On the other side, power steering, power brakes and automatic transmission make it possible for many seniors to drive a distance by car (to see a doctor or to go shopping), which they could not go by foot any more. And as a matter of fact, studies show that the accident rate decreases over age until the age of 75 at least [1]. The young and learning drivers between 18 and 25 are much more accident prone.

Ergonomists, for example, are interested in the impact of aging effects on job efficiency. Nevertheless, for those having physically demanding jobs, such as roofers, tilers, bricklayers, fire-fighters and police officers, growing age leads to the perspective of reduced performance connected with specific dangers. In many areas of occupation it is therefore important to think about solutions, such as an internal job rotation to other activities in the same company. Age simulation suits can help to identify dangerous activities for the elderly at an early stage and they can help to develop an understanding for older people in younger decision makers.

The Simulation Suits also help engineers and ergonomists to assess the work line setups for older people. Companies have built production lines as wooden models and used age simulation suits to check the problematic areas. The difficulties that were found were in the field of fine assembly work, and they were changed before the final construction was persued.

Architects and also some politician are interested in understanding how age restrictions influence the design of buildings, public transport and the urban developments. For blind people and wheelchair users there are established rules as barrier-free design. But although the physical constraints of older people are largely known theoretically, as there exists a standard to their consideration, the ISO 20282, there is still a lack of corresponding reactions [2]. Several public activities with an SD&C Senior Suit have shown that there is still need of action in adapting the world for the elderly, e.g. public vending machines often are unusable for the elderly. Several studies with age simulation suits showed, that the labelling of the bells and intercom systems of a houses, the accessibility of the front doors and insufficient illumination were often problems for the test persons. With regard to the interior design of apartments and hotel rooms, some bathtubs were veritable traps for senior people. In several cases none of the test persons could turn on the television in a hotel room, because the remote control was impossible to handle for them. Floor buildings without elevator often are a proven problem for aging residents.

Mayors and town councils of several cities have explored and evaluated potential trouble spots with the age simulation suits of SD&C in order to find solutions and to prevent danger zones. They detected for example the need to extend the duration of the yellow traffic lights and to start the green flashing one second earlier to reflect the reduced reaction rate of older users [3]. Until now the implementation of appropiate measures is still missing in several countries, although some have reacted.

Although the elderly are physically weaker and less agile, they take actively part in life more than ever before, thanks to medical progress. By no means is this group only living in nursing homes. Many of them are pensioners travelling to visit their grandchildren or going out for concerts, they are often active in honorary offices and city councils, and they cultivate their gardens or perform handicraft work to embellish their homes.

In addition, market researchers found that most luxury vacations are booked by elderly and that older people are also those, who buy the most expensive cars and the products with the highest quality. Meanwhile also touristical operators and aircraft manufacturers have tested their products with age simulation suits. For the automotive industry for example, the quality of the Age Simulation Suit is a decisive factor for progress, because age simulation is showing where innovations are still necessary. Tests lead by SD&C in cooperation with the automotive industry pointed out various problem areas of both cars and trucks that still need a solution.

Siemens found out, that older people do not buy household appliances, if they are not sure how to handle them. Therefore the company made great efforts to develop products that are easy to operate, including the help of age simulation. Through years of research, manuals and guidelines have been created on how products should be designed to be better usable by the elderly. The usability of Siemens household appliances for older people has been raised to a high level, as international consumer associations confirmed. SD&C now treasures and applies these guidelines.

Not surprising, the idea of ergonomical age simulation has its beginnings in the ergonomics department of Siemens. From 1999 on ergonomists at Siemens were starting to research the problems of the elderly. The simulation suits have proven to be excellent tools for research, and also to convince executive managers, when it could be demonstrated, that they themselves were not able to use their own products while wearing an age simulation suit. Many new product improvements nowadays are due to age simulation suits.

Another big field of interest for age simulation can be found in the training of medical students and (geriatric) nurses. Meanwhile, the self-experience of being old in a Simulation Suit is part of the education in many good training centres. After having dressed on a Simulation Suit, the students lie down on a bed and try to grab the tools around, press the emergency button, then get up and walk with rollators, manage stairs or unpack and sort drugs. Reading theof the drug packaging and opening the boxes still is a big problem for the older ones. Although some pharmaceutical companies have made tests with Age Simulation Suits, the regular label, describing the drugs, is still very small and the need for age-appropriate design continues.

The application spectrum of the Senior Suits in the training sector is a very large one. Some first class Hotels train their employees with the Suits to let them better understand the needs of the elderly. Finally insurance companies and banks discovered the use of Age Simulation as a unique way to convince younger people to also save some money for old age.

Categories of Age Simulation

After a first international meeting concerning Age Simulation in the Siemens design department in 1999, a Japanese patent on an Age Simulation Suit came up (see fig. 3). And after a first public appearance in Munich in 2004, a German patent has been applied for (see fig. 2). Both patents were attempts to conquer a new field of research that then still lacked experience. Both patents were found to be impractical and had no success on the market. Today there are at least twenty different Age Simulation Suits in the world, several of them in Germany, but many are just copies of the first attempts. The basic ideas seem to be easy to implement: eyeglasses provided with a sheet of plastic inside for decreased vision, weight vests from sports equipment to simulate the loss of force, and orthopaedic collars to reduce mobility. However, while it seemes to be easy to build a first Simulation Suit, producing a good simulation that follows the real curves of functional loss, turned out to be very difficult. When ordering the existing Simulation Suits along a scale to measure to what amount they create a realistic age simulation, the SD&C Senior Suit Delta could be placed as the most advanced Simulation Suit on the market. At least this is what a dissertation at the university of Dresden found out in 2007.

Today SD&C distinguishes three different performance classes, requiring different positions on the realism scale.: 1) Raising awareness (Alpha), 2) Training (Beta) and 3) Design (Delta).

The Senior Suit Alpha by SD&C is simply used to raise public awareness to interested persons and to explain the physical constraints that elderly people are facing. In this case, the quantitative accuracy of the simulation is not that important if the scope and the direction are right. SD&C makes sure that the intensity is limited. This means that only the healthy and natural aging process is simulated without exaggeration, so that no one is shocked or traumatized by the experience. Blindness, Parkinson tremors, completely numb fingers or a clubfoot for example are diseases that not everybody gets while getting older.

It is therefore important to distinguish between diseases and the normal aging process. In the context of medical education it can be very useful to simulate the mentioned diseases. That is why there are corresponding supplementary deals. With the Simulation Suit Beta by SD&C the vision and the hearing is simulated more accurately. The visual blurring is simulated with a flip-up visor with two different aging steps of twenty and forty years. The hearing impairment is linearly adjustable by a Tinnitus that is variable in the volume. Removable weights in the vest allow nine graduations of loss of power and the pressure sleeves for the joints can be variably applied.

Furthermore the Delta model allows also adjusting the weights on the extremities. For each side of the arms and legs nine levels are adjustable. The weights on arms and legs as well as the pressure sleeves for the joints can be placed very accurately and stay in the intended position due to additional velcro strips in this model. Even with skidding movements, as they occur in some activities, the weights and pressure sleeves don’t fall off. Measuring devices for medical and ergonomic studies can be attached in the pockets of the suit. Openings for cables are available as well.

In addition to the distinction between Age Simulation Suits along a specialization axis, there exists the distinction between Modular and Integral Simulation Suits. With Modular Age Suits the simulation elements can be individually placed on the body, with Integral Simulators the strength- and mobility reducing elements are incorporated in one single body suit (overall). The disadvantage of Integral Suits is the fact that the simulation elements are likely to be in the wrong places, because of different body proportions. The SD&C Senior Suit Delta 2 combines the advantages of the Modular and the Integral Suit. On one hand, the simulation elements can be placed directly at the right place on the body. On the other hand, the body suit represents a fastening system that allows attaching the elements as it is not possible with Modular Suits. In addition to that, stiffening elements are incorporated in the jumpsuit.

Genetic aging and ergonomic performance curves

The human body consists of 220 different types of cells that create organs like the muscles, eyes and ears. Their ergonomically-related performance can be measured. The cells and organs are subject to different aging processes. Some cells are replaced every few days whereas some organs grow older slowly and can only partly be replaced. Cellular aging depends on human genetic setup, whereas the performance of an organs depends not only on the age but also on wear and tear. The average performance of the eyes, ears and muscles during the aging process has been researched, and age simulation can be based on the known curves of performance over age, as they are referenced in ISO 20282 [2].

Age simulation with the suits of SD&C leads from one point of the performance curve, from the actual age, to another, which is 20 or 40 years away. To ergonomically solve design problems it is often sufficient to estimate the range of fluctuation in the target population to make a problem visible. In cases with interactive displays, the solution to a problem often is to automate a function, so that accurate values are not necessary any longer. But in cases, such as in determining the maximum shelf heights for the elderly, it is necessary to know exactly what percentage of the population at a certain age can reach up to a specific height. With the help of Age Simulation it is possible to distinguish the necessary from unnecessary data collection and thus to save costs through preliminary tests. High quality age simulation neither trivializes problems nor exaggerates them. It is particularly advantageous that Simulation Suits allow the testing of combined performance effects in the old age, e.g. that of vision and movability when gripping something high up or low down. Using age simulation, we get significant results for conditions that are not fully explored yet. The Simulation Suit by SD&C realizes an artificial aging of about 40 years, which means that 20 to 40 years old engineers and designers can simulate on themselves being 60 to 80 years old.

The simulation of aged visual abilities

The aging of vision is a very complex process and involves a number of ergonomically related functions.

The main function is 1) the change in visual acuity, which becomes in most cases presbyopia. Most elderly need glasses for reading and recognizing details at close range. Already at a young age the process can be advanced and glasses are required. At the age of 50 years nearly every adult needs reading glasses. Other aging factors of vision are 2) altered colour vision, 3) an increased need for illumination, 4) restricted peripheral vision and 5) in many cases there is a slight macular degeneration.

The simulation of reduced hearing and tactile ability

Roughly similar to eyesight, the hearing and the sense of touch change with age. The SD&C Senior Suit Delta simulates the limited sense of touch with gloves and the reduction of hearing with electronic ear capsules. As one third of older people suffer from tinnitus, the sound of tinnitus is simulated in the ear capsules of the Senior Suit. The simulation of hearing is widely variable over the whole range of understanding to total deafness. This sound can be changed in the volume or turned off. With the tinnitus sound fully turned up it is nearly impossible to follow discussions in the surroundings. The speech intelligibility in certain situations can now be measured and directly compared.

The simulation of reduced muscular force

The muscular force of takes a different course over the years than the function of the sensory organs. Muscular force has it’s maximum at the age of about 30 years, and from then on the average value decreases continuously. At the age of 70 people have only about half as much power available as with 30 years. Some Simulation Suits tried to simulate the lost power by elastic elements (see Fig. 2 and 3), but the correct positioning of the elements on different bodies proved very difficult. Under tension the elastic elements tended to snatch from the provided positions and the free belts often got caught on door handles, which was quite dangerous for the test persons. Therefore most of the Simulation Suits simulate the reduced power by fitting additional weights to the body. With SD&C Senior Suit Delta 2 the elements can be positioned correctly and stable to the individual body positions.

The SD&C Senior Suit Delta 2 with the variable weights in the vest and extremities allows adapting to weaker test persons and their individual constitution. That is why it is also possible for teenagers to try on the Senior Suit; the simulation can be adapted to the non-linear curve of the force in the aging process. For a fifteen year old teenager for example, the aging of 20 years would not mean a loss of power, but a power increase and only at an advanced age his strength will then be again fallen to the age of a fifteen year old.

The simulation of movement restrictions

The increasing restrictions on the gripping areas while standing or sitting due to the lower mobility are the most impressive results in the studies with elderly and have already led to many adjustments in everyday life. Age Simulation Suits can give a very detailed and intuitive picture of the limitations in old age to the test person. The first Simulation Suits simulated the movement restrictions of the joints with orthotics that limited the opening angle. Studies on seniors however showed that the reduction of the opening angle in the arm and leg joints is rather insignificant and that an evenly limitation over the entire range of motion can rather be reached by arteriosclerotic changes. The SD&C Senior Suits simulate therefore an appropriate articulation change with cuffs that make it more difficult to move. In addition to that, the jumpsuit is designed to make it difficult to lift the arms.

The simulation optics of the SD&C Senior Suit Delta 2 is currently the only simulation able to simulate the aged visual acuity with special glasses. A visor allows to choose between two different stages i.e. twenty and forty years. Most age simulation goggles on the market simulate the aging with a plastic layer only. These conditions correspond rather to the symptoms of the so-called “cataract” (corneal opacity) than to a normal aging process. The simulation of optics by SD&C creates very realistic results for the test person.

The option to choose between the aging of 20 and 40 years has a practical necessity. The immediate aging of vision can lead to dizziness and nausea. The two stages allow test persons to adapt slowly, and after a few minutes most will tolerate the change. In addition, the lower level with the change of 20 years only is a realistic experience for older people taking on the simulation.

Cognitive factors

Ergonomically relevant are also the cognitive changes during the aging process. It is important to distinguish between the so called “liquid” and the ” crystalline” intelligence. The liquid intelligence manifests itself in the speed of problem solving, and speed and reaction time decrease when becoming older. In situations where twenty years old people need 200 msec to react, some elderly need up to 800 msec. On average women react more slowly than men, thus when women age, the chance of slow reaction is very high. The picture looks better regarding the crystalline intelligence. Crystalline intelligence is the result of life-long experience and can still increase when getting older. If elderly persons, especially artists and writers, stay mentally trained, they can continue to be brilliant at higher age and to become even better. If appliance manufacturers took into account the fact that older people may think in an “old-fashioned way,” the participation of older people in everyday life would be no problem [5].

Wearing the simulation components results in secondary cognitive effects such as reduced balance and coordination or more prudence. Since the crystalline intelligence can be maintained in old age, a healthy aging process that is positive for everyone is simulated by the Age Simulation Suit. The fact that everyone wants to grow older in the way that is represented with the Simulation Suit may be one factor to explain it’s great popularity.

Footnotes

[1] B. Kraus und H.J. Kaiser: Weniger Unfälle bei älteren Autofahrern. Institut für Psychogerontologie der Universität Erlangen, 2008.
[2] ISO 20282: Ease of Operation of Everyday Products. ISO Genf, 2007.
[3] R. Schoeffel: Ampel-Gelbphasen zu kurz für ältere PKW-Fahrer. Fachzeitschrift für Polizei- und Verkehrsmanagement, 01/2012.
[4] Patent von Fr. Dr. Brieden aus Hilden 2004. 
[5] R. Schoeffel: Human-friendly products. ISO Focus Magazin, ISO Genf, Volume 4, No 9, 2007.

Author

Dr. Roland Schoeffel 
SD&C GmbH
Swidmutstr. 5
85301 Schweitenkirchen
E-Mail: info@sdxc.de