Gerontology & Geriatrics Education

ISSN: 0270-1960 (Print) 1545-3847 (Online) Journal homepage: http://www.tandfonline.com/loi/wgge20

Walking a Mile in Another’s Shoes: The Impact of Wearing an Age Suit Martin Lavallière, Lisa D’Ambrosio, Angelina Gennis, Arielle Burstein, Kathryn M. Godfrey, Hilde Waerstad, Rozanne M. Puleo, Andreas Lauenroth & Joseph F. Coughlin To cite this article: Martin Lavallière, Lisa D’Ambrosio, Angelina Gennis, Arielle Burstein, Kathryn M. Godfrey, Hilde Waerstad, Rozanne M. Puleo, Andreas Lauenroth & Joseph F. Coughlin (2016): Walking a Mile in Another’s Shoes: The Impact of Wearing an Age Suit, Gerontology & Geriatrics Education, DOI: 10.1080/02701960.2015.1079706 To link to this article: http://dx.doi.org/10.1080/02701960.2015.1079706

Published online: 06 Jan 2016.

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Date: 30 January 2016, At: 20:27

Gerontology & Geriatrics Education, 00:1–21, 2016 Copyright © Taylor & Francis Group, LLC ISSN: 0270-1960 print/1545-3847 online DOI: 10.1080/02701960.2015.1079706

Walking a Mile in Another’s Shoes: The Impact of Wearing an Age Suit

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MARTIN LAVALLIÈRE, LISA D’AMBROSIO, ANGELINA GENNIS, ARIELLE BURSTEIN, KATHRYN M. GODFREY, HILDE WAERSTAD, ROZANNE M. PULEO, ANDREAS LAUENROTH, and JOSEPH F. COUGHLIN AgeLab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

The “Age Suit” described in this article was developed to enable future designers, business leaders, and engineers to experience navigating the world as many older adults must. Tools such as this Age Suit offer the opportunity to “walk a mile” in another’s shoes to develop empathy that can result in better design of spaces, goods, and services to meet the needs of a rapidly growing older population. This work first examined, through a series of clinical tests, whether younger adults’ physical capacities were reduced in a direction consistent with aging by wearing a suit developed by the MIT AgeLab. An experiential learning task was then completed with the suit to understand its impact on completion of an instrumental activity of daily living. Results showed that younger adults wearing the suit experienced changes in task performance consistent with expected changes associated with aging. Participants’ self-reports from the experiential learning task indicated that they were able to empathize with older adults regarding some issues they face while completing a grocery shopping task. Future research with the suit should involve a wider range of individuals from the population and examine what effect participants’ levels of fitness have on the experience of wearing the suit. KEYWORDS aging, education, empathy, evaluation, suit

Address correspondence to Martin Lavallière, AgeLab, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Room E40-278, Cambridge, MA 02142, USA. E-mail: [email protected] Color versions of one or more of the figures in the article can be found online at www. tandfonline.com/WGGE. 1

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INTRODUCTION Changes in technology, medicine, and education have resulted in a global success story: on average, people all over the world are living longer, and some nations are aging rapidly. In the United States, the percentage of the population age 65 and older in 1900 was just more than 4%; by 2000 this number had grown to 12.4%. By 2050 the share of the U.S. population age 65 and older is projected to reach over 22% (U.S. Census, 2014). These aging trends imply projected increases in the prevalence of conditions associated with old age and limited mobility. For example, the number of adults with a diagnosis of arthritis is predicted to increase by about 11 million from 2015 to 2030 (Hootman & Helmick, 2006). Prevalence of vision loss related to macular degeneration, diabetic retinopathy, and glaucoma—diseases associated with old age—is also projected to nearly double from 2005 to 2020 (National Center for Chronic Disease Prevention and Health Promotion, 2009). The growth of these conditions and others in the population suggests that for many older adults everyday environments will become increasingly complex to navigate. The need for insight into older adults’ experiences with goods, products, services, and their environments is pressing. Despite the fact the user/customer experience has been identified as an essential factor for business success (Bodine et al., 2013), many designers of tomorrow’s products and services may not be aware of the challenges older adults experience when using or accessing these environments or products. In the science and engineering fields, nearly three fourths of the labor force with a postsecondary education is younger than age 50 years (National Science Board, 2004). These younger adults move through shopping malls, grocery stores, and transit systems easily with little thought to the challenges these environments pose to an increasing number of older adults. Thus, a young workforce is faced with the task of creating accessibility across industries and environments for older adults. This gap in experience provided the impetus to develop a tool in the form of an aging simulation suit. Through wearing the suit, younger adults may learn to consider not just their own capabilities, but also to develop empathy for the challenges an aging population faces. The suit described in this article was designed to educate younger adults about the accommodations necessary for millions of older adults to navigate a range of environments safely and comfortably, from public transportation to retail space.

THE EMPATHY TRAINING SUIT CONCEPT Empathy training is an established technique that allows the trainee to understand life from another person’s perspective and to experience similar

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challenges (to receive intrinsic feedback) (Eymard, Crawford, & Keller, 2010; Farmer & Bruce, 2010). Empathy training draws from experiential learning theory, which states that knowledge is gained from transformational experiences (Kolb, 1984). Suits have been created for use in empathy training in pregnancy (Birthways Childbirth Resource Center Inc., 2011) and obesity education (Angier, Huntley, & Liebman, 2001). This approach has also been used in mental care using role-play settings (Farmer & Bruce, 2010), and with people suffering from locomotion impairments that require the use of a wheelchair (Boschetti, 1995).

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AGE SUIT CONCEPTS Although most people experience a certain degree of decline with age, physically (Joaquin & Gollapudi, 2001), visually (Haegerstrom-Portnoy, Schneck, & Brabyn, 1999), or cognitively (Atkinson et al., 2007), the concept of age suits is relatively new, and such suits have been used primarily within the automotive realm. Automobile companies have created proprietary suits to try to simulate the effects of aging to improve vehicle design for older drivers. Unfortunately, no results are available from these field studies, as manufacturers choose not to advertize their vehicles as “older people’s cars” (Coughlin, 2007). Some home nursing programs have also introduced the use of an aging suit to enable students to experience what older adults face in health care situations (Henry, Douglass, & Kostiwa, 2007; Pacala, Boult, Bland, & O’Brien, 1995). This has been successful in increasing nurses’ empathy toward, and knowledge of, older patients. Other suits designed to simulate the impact of aging have typically focused on only one part of the body (e.g., the feet, Eymard et al., 2010; the spine, Tremayne, Burdett, & Utecht, 2011; and hands, Georgia Tech Research Institute, 2007). One study examined sensory loss across four different systems (visual, auditory, olfactory, and tactile) (Pastalan, Mautz, & Merril, 1973). This study was limited, however, because each system was impaired in isolation, rather than simultaneously, and the tools were evaluated only from participants’ self-reports. None of these aging suits, however, has been tested with specific metrics to measure the extent to which they impose physical limitations on those who wear them, or how these limitations explicitly impair any performance of daily activities.

AGE SUIT DESIGN The Age Suit (AGNES: Age Gain Now Empathy System) used in this work is designed to mirror various sources of physical limitations based on changes in the body and its function with age. Different pieces of readily available equipment were assembled to reduce ranges of motion, balance, and tactile

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ability. Because many functional movements originate from the body’s core, the suit extends from the pelvic girdle up to the head and out to the extremities, engaging the user in a total body experience. The center of the suit is designed around the pelvis at the base of the spine because of the spine’s significance as a “connector” within the body and its crucial role in human mobility. A secure climbing harness forms the anchor for many of the suit’s components. Straps, braces, and bands of varying lengths allow the suit to be customized to an individual to provide consistency in the degree of physical constraint. The various components simulate spinal compression, increase the threshold of muscle fatigue, reduce postural balance, impair vision and hearing, limit joint range of motion, and hamper dexterity. Modified shoes challenge users’ balance, and a variety of gloves and goggles simulate different degrees or conditions of sensory impairment. Each component of the suit is intended to simulate some aspect of physical aging, with the effect of the whole to give wearers a sense of the net experience of an adult who has multiple functional limitations. The intended impact on the user’s function and a description of individual suit components are listed in Table 1. Figure 1 depicts an individual wearing the suit and identifies its key components. In this research, our goal was first to explore whether the impact of the suit on younger adults’ physical abilities in clinical tests was consistent with changes associated with aging. Second, we wanted to investigate the subjective reactions of younger adults through an experiential learning task involving an instrumental activity of daily living (i.e., grocery shopping), with the intention of determining if the Age Suit worked as an empathy training tool.

THE IMPACT OF THE AGING SUIT Method PARTICIPANTS Twenty-two study participants were recruited via a combination of posters in the local area and online advertising. Participants had to be between ages 20 and 29 (on average 24 ± 2.6 years old, 14 female and eight male), in self-reported good health, and able to walk for 5 minutes without stopping. Exclusion criteria included hospitalization within 6 months prior to the study; neurological problems; using a cane, walker, or wheelchair; having fallen within the year prior to the study; and any current experience of dizziness or numbness in their limbs. All participants understood and spoke English. The recruitment materials and study were approved by the Massachusetts Institute of Technology Committee on the Use of Humans as Experimental Subjects (#905003267). All participants signed an informed consent form and received $30 as compensation. Descriptive characteristics of the study sample by sex are displayed in Table 2.

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Hearing

Sight

Changes in senses Touch

Hip

Knee

Cervical spine

Shoulder

Elbow

Restricted range of motion Wrist

Balance

Changed Function

Suit Component

The user wears latex gloves to reduce dexterity and tactile sensations. This is consistent with the description of surgeons wearing gloves (Phillips, Birch, & Ribbans, 1997; Wilson, Sellu, Uy, & Jaffer, 1996). The suit employs yellow glasses to simulate vision change (Hennelly, Barbur, Edgar, & Woodward, 1998; Pokorny et al., 1987). Standard foam earplugs reduce hearing by 30 decibels, consistent with a clinical diagnosis of moderate hearing loss in the human ear (Cruickshanks et al., 1998; Strawbridge, Wallhagen, Shema, & Kaplan, 2000).

Braces are used to restrict the motion of the wrist. Grommeted holes in the sleeve cuffs of the coveralls serve as attachment points for the arm bands to the harness (Contreras-Vidal, Teulings, & Stelmach, 1998). Neoprene braces are pulled up over the sleeves of the coveralls onto the elbows to secure the sleeves in place and to reduce elbow flexion. Theraband straps connect the harness to the coverall cuffs, reducing mobility of the shoulder girdle. This component limits flexion, abduction, extension, and abducted external rotation of the joint. The user wears a plastic safety helmet attached to the harness using adjustable Velcro loops and flexible bungee cords to replicate the reduced extension and rotation of the cervical spine. A foam neck collar reduces mobility of the cervical spine further (Barry et al., 2003; Staudte & Duhr, 1994). Neoprene braces are pulled up over the pant legs of the coveralls to secure the pant legs in place and to reduce knee flexion. Theraband straps are connected from the harness to the back of the shoes to reduce hip flexion, reducing stride length while walking (Maki, 1997).

The suit includes shoes that reduce the ability to balance by creating an unstable platform upon which to stand (Woollacott, 1993). One-inch-thick soft foam core padding glued to the bottom of the wide base sandals provides an unsteady sensation while standing. The rear strap of the shoes also serves as an attachment point for leg straps.

TABLE 1 Suit Components and Intended Impact on Function

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FIGURE 1 Suited up in the suit.

PROCEDURE Each participant visited the lab individually for a single visit that lasted up to 2 hours. Upon entering the lab, participants were given an overview of the study and signed consent forms. The research staff then measured participants’ height, torso length, arm length, and leg length (see Table 2 for results). Participant weight was not relevant to calibration of the suit; consistency of effects was instead dependent on height and limb length rather than waist or wrist circumference. Participants were assisted by the researcher in putting on the suit to ensure a proper fit and placement of suit components.

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Age Gain Now Empathy System TABLE 2 Sample Characteristics

Age (in years) Height (meters) Hip to head lengtha (meters) Arm lengthb (meters) Leg lengthc (meters)

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Suit harness size worn Suit shoe size Number of cases

Male

Female

Total

t Value

p

23.38 (3.46) 1.75 (0.16) 0.73 (0.1) 0.6 (0.07) 1.04 (0.06) Medium Men’s 10 8

24.79 (1.85) 1.66 (0.06) 0.69 (0.05) 0.56 (0.03) 1.00 (0.04) Small Women’s 8 14

24.00 (2.57) 1.71 (0.11) 0.71 (0.07) 0.58 (0.05) 1.02 (0.05) N.A. N.A.

1.257

0.223

1.923

0.070

1.304

0.207

1.971

0.063

1.824

0.083

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Notes: Table entries are means with standard deviations in parentheses. a Measured from greater trochanter to top of skull. b Measured from acromion to ulnar styloid. c Measured by outseam.

MEASURES A comprehensive literature review was used to identify measures to test physical performance and functional changes anticipated while wearing the suit. The tasks were organized into four categories: postural balance, neck and shoulder range of motion, low back and hamstring flexibility, and gait. Participants were asked to complete a series of these tasks twice, once with the suit on, and once without wearing the suit. Participants were randomly assigned to wear the suit either the first time or the second time performing the clinical tests. An exercise physiologist and research associates she trained collected the measures of physical function. Postural balance. Postural balance was assessed through the use of two tasks: (1) balancing on one leg with eyes open and (2) balancing on one leg with eyes closed. Participants received one opportunity to practice balancing on one leg with their eyes open. After the practice, they were instructed to stand on only their right leg with eyes open for two trials. The same procedure was repeated on the left side. Using a standard stopwatch, participants were timed from the moment they lifted a foot off the ground to the moment they lost their balance, assessed by tapping their other foot to the ground or flailing arms for support. If participants were able to maintain their balance for 30 seconds, they were allowed to stop and “30 s” was recorded in the data sheet. Following this, participants repeated the same balance sequence with their eyes closed (Bohannon, Larkin, Cook, Gear, & Singer, 1984; Duncan, Weiner, Chandler, & Studenski, 1990). Neck and shoulder range of motion. Four tasks were used to measure neck and shoulder range of motion: (1) shoulder abduction, (2) cervical spine extension, (3) lateral neck flexion, and (4) neck rotation. A goniometer

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and an inclinometer were used to measure range of motion in degrees for these tasks. For shoulder abduction, participants were asked to raise each arm to full abduction (arms extended above the head, pointing straight up), and the angle was recorded. Cervical spine extension was measured by having participants tilt their heads straight back as far as possible for two trials. An inclinometer was placed on the left ear of each participant to measure lateral flexion to the right. Participants were then asked to tilt their heads to the right as far as possible. The angle measured was then recorded by the inclinometer. The same procedure was conducted for lateral flexion to the left. Following this task, neck rotation was measured using a goniometer (Boone & Azen, 1979). Low back and hamstring flexibility. The sit-and-reach task using a sit and reach box (Novel Products, Inc.) measured participants’ low back and hamstring flexibility in centimeters. Participants sat on the ground for this procedure and began the task by placing their feet against the box with their legs fully extended, then extended their arms as far as possible per the American College of Sports Medicine (ACSM; 2006) protocol. Our protocol deviated from the ACSM’s protocol, which requires individuals to remove their shoes. As a control measure, all participants wore the same brand and model of shoes that were specifically modified for the suit when completing all of the sit- and-reach tests. In each condition (wearing or not wearing the suit), participants repeated the sit-and-reach task 3 times, with the best of the three measurements recorded (Fitzgerald, Wynveen, Rheault, & Rothschild, 1983). Gait. Participants walked a marked 10-meter distance to assess gait. An acceleration and deceleration space was included on either side of the marked distance. Participants’ time to complete this task was recorded with a standard stopwatch. The number of steps required to complete this task was visually observed and recorded by the researcher. Walking velocity and step frequency were calculated from time and number of steps recorded (Gabell & Nayak, 1984; Oberg, Karsznia, & Oberg, 1993; Ostrosky, Van Swearingen, Burdett, & Gee, 1994). ANALYSIS Statistica 12 (StatSoft, Inc., USA) was used to conduct all analyses. Descriptive statistics and t tests were used to compare sample characteristics and oneway ANOVAs were used to compare task performance results while wearing the suit and without the suit.

RESULTS FROM THE EXPERIENTIAL LEARNING TASK Preliminary statistical analysis revealed no differences between groups’ performance based on whether participants wore the suit for the first time

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FIGURE 2 The impact of the suit on task performance. Note: Bars represent the percentage of participants in each category with the number of cases noted above each bar. Study N = 22.

or the second time through the clinical tasks. A Group (suit first vs. second) × Condition (suit vs. no suit) ANOVA was run and did not show any effect of assigning suit first or second. As a result of this consistency, further analysis draws a simple comparison of participants’ scores with and without suit. Figure 2 displays the different tasks participants completed and how their performance on the tasks was affected by wearing the suit. The majority of participants experienced a decline in performance while wearing the suit (see Figure 2). Most participants showed decreased performance in neck (86%) and shoulder range of motion (86%) and lower back and hamstring flexibility (95%), suggesting that the impact of wearing the suit may be felt more acutely around reductions in range of motion and abilities to stretch and reach. Balance was the one set of tasks where there was an exception to the trend of decreased performance while wearing the suit; the majority of people saw no change in performance while balancing with their eyes open when they wore the suit. A decline in performance occurred for a majority of participants while balancing with eyes closed while wearing the suit. Gait was also negatively affected, but for a smaller number of participants. Figure 2 indicates that participants experienced performance declines while wearing the suit, but it does not show whether these differences were large and consistent enough to be statistically meaningful. Table 3, however, shows that, with the exceptions of balancing with eyes open and step frequency, participants experienced a statistically significant decline in performance while wearing the suit.

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TABLE 3 The Impact of Wearing the Suit on Task Performance

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Tasks

Average Without Suit

Balance Balance, eyes open 29.68 (seconds) (1.08) Balance, eyes closed 18.63 (seconds) (8.05) Neck and shoulder range of motion Shoulder abduction (◦ ) 169.2 (15.7) Cervical extension (◦ ) 83.9 (12.0) Lateral neck flexion (◦ ) 39.9 (8.5) Neck rotation (◦ )a 71.8 (13.2) Low back and hamstring flexibility Sit and reach test (cm) 25.84 (13.54) Gait parameters Gait (seconds) 7.13 (0.85) Velocity (m/s) 1.42 (0.17) Number of steps/10 m 14.25 (1.38)

Average With Suit

Average Change

28.63 (2.40) 11.30 (6.69)

−1.05 (1.32) −7.3 (1.36)

156.5 (20.0) 69.5 (15.0) 27.7 (9.0) 54.8 (11.5) 21.79 (12.5) 7.87 (1.22) 1.31 (.024) 15.09 (1.69)

Average Percentage Change (%) −3.5

Partial EtaSquared 0.129

−39.2

0.468∗∗

−7.5

0.513∗∗

−17.2

0.613∗∗

−30.6

0.675∗∗

−23.7

0.545∗∗

−4.05 (1.04)

−15.7

0.488∗∗

+0.75 (1.32) −0.11 (0.07) +0.884 (0.31)

+10.5

0.409∗

−7.7

0.364∗

+6.2

0.316∗

−12.7 (4.5) −14.4 (3.1) −12.2 (0.5) −17.0 (1.7)

Notes: N = 22. Table entries in the first three columns are means, with standard deviations in parentheses. a Neck rotations were tested for both sides (left and right). Because no differences appeared between left and right neck rotations, overall means are presented by conditions. ∗ p < .01, ∗∗ p < .001.

Performance declines while wearing the suit were most pronounced in the areas of flexibility and balance. Specifically, young adults wearing the suit on average had a 30.6% reduction in lateral flexion (27.7 vs. 39.9), a 23.7% reduction in neck rotation (54.8 vs. 71.8), and a 17.2% reduction in cervical extension (69.5 vs. 83.9). For the shoulder abduction, a 7.5% decline in range of motion was observed (156.5 vs. 169.2). The low back and hamstring flexibility was reduced by 15.7% while wearing the suit versus not (25.84 vs. 21.79, respectively). The changes in balance with eyes closed were also large; participants on average balanced for 39.2% less time while wearing the suit (18.63 vs. 11.30, respectively). The balance time with eyes open remained unchanged between wearing or not wearing the suit (28.63 vs. 29.68, respectively). For the gait parameters, velocity showed a reduction of 7.7%, while the time taken to complete the distance and the number of steps required increased when wearing the suit (5.6% and 9.4%, respectively).

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These results indicate how wearing the suit affected younger adults’ physical performance and function. Although physical changes in older adults vary in form and severity, wearing the suit resulted in a simulation of overall reduction in mobility that was consistent with the literature on aging bodies. To explore the impact of the suit on physical capacity and mobility, an experiential learning task was developed. Younger adults wore the suit while completing a grocery shopping task to evaluate how the suit affected their ability to navigate the supermarket environment.

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PARTICIPANTS Participants in the experiential learning task were affiliates of the laboratory, two undergraduate engineering students, and two research staff members. The participants read and signed an approved waiver for participation in the experiential learning task by the Massachusetts Institute of Technology Committee on the Use of Humans as Experimental Subjects (#905003267). The two student participants were age 19 years, and the staff participants were age 23 and 35 years. All were in good health. The two students were familiar with the grocery store used in the study, but the staff members were not. No compensation was provided for their participation. PROCEDURE The four participants donned the suit at the MIT AgeLab. Wearing the suits, they were driven to a local grocery store, given shopping lists, pen and clipboard, and asked to collect and purchase the items on their shopping list while completing a questionnaire about their experiences. Each shopping list consisted of 17 items, varying slightly from list to list, located throughout various sections of the grocery store. Participants searched for specific items, such as low-sodium products, and item selection sometimes required interacting with the product (e.g., comparing brands and prices and reading nutritional information). Some items on the lists were chosen because retrieving them required reaching to higher shelves, bending to lower shelves, and/or loading the cart with heavier items, thus involving physical exertion to feel the limits imposed by the suit. MEASURES A questionnaire captured difficulties associated with the shopping experience, gathering quantitative and qualitative self-reported data. Participants assessed how difficult it was to perform 20 different actions withing six broader activities: (1) entering/exiting the store, (2) navigating the store,

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(3) locating items, (4) handling items, (5) comparing items, and (6) paying for items. Participants rated each action with a difficulty score on a 5-point scale, with 1 (very easy)” and 5 (very difficult). Participants were encouraged to write open-ended comments about each task and to provide overall feedback about the experience of shopping while wearing the suit. ANALYSIS Results were compiled from the questionnaires participants completed.

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RESULTS FROM THE EXPERIENTIAL LEARNING TASK Tables 4 presents participants’ difficulty ratings and comments about each task, grouped by activity type (entering/exiting the store, navigating the store, locating items, handling items, comparing items, and paying for items). Participants noted in their written comments various challenges the suit added to the shopping process. They reported that reduced range of motion, flexibility, strength, endurance, and visual capacity made tasks more difficult to complete. These comments are summarized by activity type below:

Entering/Exiting the Store Participants commented that shopping carts were difficult to locate, aisle signs were not highly visible upon entering the store, and that aisles were too narrow.

Navigating the Store Physical and visual limitations combined with the layout of the store made the shopping experience more frustrating for participants. Distances seemed longer as gait was restricted. Reduced gait and balance made the stairs at the entrance to the supermarket harder to climb.

Locating Items The location of signage posed a challenge to participants, as did differentiating among an array of products. Visual impairment caused by the yellow glasses made it difficult to read the information necessary to locate desired products, consistent with previous research (Pokorny, Smith, & Lutze, 1987). Viewing higher shelves strained the neck because of the suit’s straps simulating spinal compression and reducing cervical rotation.

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Locating items

Handling items

Pushing shopping carts full of items Read signs

Access frozen foods in aisle freezers

Use fresh food displays

Reach products from high and low shelves

Sort through product shelf and clutter

Find appropriate aisles

Maneuver carts through aisles

Navigate the store

Load the car with groceries

Enter the store

Task

Navigating the store

Entering/exiting the store

Activity type

Comments Escalator broken, hard to use stairs, hard to get out of car. Hard to find carts. Had to reach up and bend over, not easy. The car’s trunk is low enough that it doesn’t pose a huge challenge. Bottles are hard to grab and lift. Carts hidden—had to walk a long way to get them. Hard to find carriages, glossy signs hard to read, store was in confusing sections. Narrow aisles, the store wasn’t crowded so I’m sure it’ll be harder when it is full of people, cart wheels sticky and hard to unjam sometimes. Contradicting signs made things difficult. Elbow pads added stiffness. Turning was difficult. Cart was helpful for support. Tiring after a while. Moving carts was easier than walking around with items. Signs were too high. Signs are glazed so it’s hard to read them from certain perspectives. Challenging to look up. Hard to move neck to see. Didn’t want to do it. Signs were in the middle of the store so when you walk in you only see signs for half of the store. Very hard to locate produce section. There should be signs as the path to produce was very strange. When I was looking for low sodium tomato soup, it was overwhelming so I almost didn’t bother. I found it, but it took me a longer time than expected. Low shelves easy, high shelves harder. I found weight would most likely be the toughest issue. I could bend knees rather than stretch spine because bungees restricted movement. Hard to find bags, hard to tie bags, hard to see if fruit was ripe, couldn’t reach back of stand. Signs were clear in this section, it was easy to find the location I wanted, I didn’t have to reach deep into the freezer.

TABLE 4 Comments Reported by Type of Activity for the Experiential Learning Task

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(Continued)

2,2,-,3

4,4,4,3

5,4,5,3

4,4,4,4

4,4,4,5

4,4,4,5

4,3,2,4

4,2,3,4

5,4,4,4

4,3,3,2

4,3,3,2

Scores

14

Had to reach over the bar and bend down into the cart, very hard movement, especially with heavy items. It wasn’t difficult, but I did find myself moving slower. Hard to lift over side of cart. The large soda bottles kept rolling back and forth as I pushed the cart, one fell out as I was stopping the cart, it was very awkward and difficult to get down and put items there. The knee restraints made this difficult. Small section of store, hard to balance on one hand and open. Overlooked them on my grocery list. Contrast wasn’t great on labels, writing was too small, it was overwhelming to look at so many small words. Labeling was confusing. I didn’t even bother. Didn’t refer to price as much. Pricing signs were bunched together, number prices were in larger text but it is unclear what the prices are for (which products). Had to put bags into cart myself, not sure when exactly to pay (swipe credit card). The store clerks were nice and friendly, but the experience was not easy, I felt rushed. The screen was too small, I wasn’t paying enough attention, I was too focused on getting items into cart quickly to not hold up the line. I didn’t bother to check. Price was small on register screen. No time to do it! Change hard to handle. There were too many options in some locations, which made things confusing and overwhelming. Very long, tiring, eyes were tired.

Loading shopping carts (the top portion)

Count change/read receipt at checkout Overall shopping experience

Read the display of price/product at checkout

Go through checkout and pay

Reading pricing to determine price per item

Read product packaging

Check the eggs

Loading shopping carts (the bottom portion)

Comments

Task

Notes: N = 4. In Scores column, “-” indicates that that the participant did not rate that experience.

Paying

Comparing items

Activity type

TABLE 4 (continued)

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4,4,4,4

3,2,4,2

5,3,4,2

4,2,3,2

4,-,4,1

4,3,4,1

4,-,-,1

4,4,4,4

4,3,4,4

Scores

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Handling Items The physical limitations the suit imposed made handling products a balancing act, particularly large bottles or products on high shelves. Reaching products on high shelves was challenging because of resistance from simulated spinal compression and reduced range of shoulder motion. The depth of the shopping carts added difficulty to lifting products over the side and placing them at the bottom of the cart. One person noted, “Had to reach over the bar and bend down into the cart, very hard movement, especially with heavy items.”

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Comparing Items The suit negatively affected fine motor skills required for opening cartons to check eggs, tying plastic produce bags, and comparing products. Participants described the entire process as more exhausting because wearing the suit resulted in slower and restricted movements and required greater concentration to complete shopping tasks. Participants identified glossy signs that reflected glare as problematic, as well as words on products and labels that used poorly contrasting colors. Impaired vision combined with an array of product choices on shelves made finding specific items challenging. One participant commented, “When I was looking for low sodium tomato soup, it was overwhelming . . . I found it, but it took me a longer time than expected.” This led to reduced awareness of product information before purchase, “Labeling was confusing. I didn’t even bother. Didn’t refer to price as much.”

Paying for Items Overall, participants felt rushed during the process of paying because information was difficult to collect quickly (e.g., reading the information was made difficult by the yellow glasses) and money was hard to handle. Participants were also sensitive to the reactions of those waiting in line behind them. One participant wrote, “The screen was too small, I wasn’t paying enough attention, I was too focused on getting items into cart quickly to not hold up the line. I didn’t bother to check.”

Summary A majority of the comments throughout the experience reflected participants’ acceptance of the suit as a new “normal.” In other words, participants identified the source of their difficulties in completing the tasks as due to the supermarket’s layout, rather than due to wearing the suit. A typical comment was one such as, “Signs were in the middle of the store so when you walk in

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you only see signs for half of the store. Very hard to locate produce section.” Only three of the 35 comments referred to the suit itself, two mentioning the knee restraints and one mentioning the neck restraint. Otherwise, the language participants used did not focus on the physical abilities or limitations imposed by the suit. This suggests that the suit created a transformational learning experience. The suit became integrated into younger adults’ reality, and the challenges they identified while grocery shopping were attributed to the environment rather than to the suit. Overall, participants found grocery shopping while wearing the suit to be frustrating and fatiguing. They were overwhelmed by product options, the demands on their impaired vision, and the physical strain added to each task, particularly around reductions in range of motion and flexibility. Participants rated their overall experience with a score of “4”: Difficult.

DISCUSSION This research demonstrated that young adults who wore the suit experienced changes in task performance consistent with those expected and associated with aging. The impact of the suit was most pronounced in indicators of flexibility and range of motion, followed by changes in gait and in postural stability with eyes closed. It is worth noting, however, that for each task at least one person improved his or her performance while wearing the suit relative to performing the task without it. There are several possible explanations for this result. First, there may be some learning effect such that performance of the task a second time, even while wearing the suit, was improved. Alternatively, people may be less fatigued at the start of the study and, among those wearing the suit for the first trial of tasks, perform better. Finally, individuals’ fitness levels may assist wearers in resisting the constraints imposed by the suit, therefore overcoming the restrictive components. Although each of these explanations is possible, the number of participants who improved on some task while wearing the suit was small, offering little support for the first or second explanation. Future research, however, should measure individuals’ fitness levels prior to putting on the suit to better control for any effect. The experiential learning task took a different approach focused on how the suit might offer younger adults insight into older adults’ experiences. Asking participants to complete an instrumental activity of daily living in context, rather than repeat an isolated action in a laboratory, enabled them to empathize with older adults around some of the issues they face navigating in their everyday environments. Real life often demands the performance of multiple tasks simultaneously or in some other coordinated fashion. Although the experiential learning task is not a perfect replica of an older adult’s actual experiences, the results promote awareness of how some changes associated

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with aging, such as in eyesight and the yellowing of the lens (Pokorny et al., 1987), affect tasks younger adults take for granted, such as easily locating products or reading product information in small print. The outcomes from the experiential learning task emphasize that, however artificial or limited the constraints imposed by the suit, in practice they created challenges for younger adults wearing it in terms of reaching items and traveling through the store. In addition to any actual changes people must contend with, and may need to compensate for, younger adults reported an overall fatigue associated with wearing the suit as they attempted to complete the grocery shopping tasks.

Limitations Due to variances in genetics, physiology, and fitness among individuals, it is impossible to simulate exactly what an individual’s experience of aging entails. The results here suggest, however, that wearing the suit provides a generalized experience of aging, and that the suit may offer wearers new insights into the challenges and impacts of aging. Further, although the suit is intended to represent some of the physical changes that occur with aging, it is not comprehensive. This suit makes no attempt to simulate cognitive changes (e.g., dementia) or to simulate the sensation of pain (e.g., peripheral neuropathy). Such conditions are known to occur with aging, however, and could be implemented in future versions. Another possibility would be to use kinematic analysis to evaluate if participants wearing the suit develop different movement patterns over time due to fatigue (Corbeil, Blouin, Bégin, Nougier, & Teasdale, 2003; Forestier, Teasdale, & Nougier, 2002). The sample sizes and ages in this work were also limited. Older individuals, or individuals with preexisting conditions, who wear the suit may have a different experience than the younger, healthy users in this study. In addition, underlying fitness levels were not controlled when measuring the effect of the suit on participants. Future research should include pretesting of participants’ fitness levels to determine the effect this may have on overall experience. Finally, a larger community sample would provide a more comprehensive perspective on the impact of the suit and on potential modifications to it to simulate better older adults’ experiences.

CONCLUSION Wearing the suit described here does not guarantee that an individual “ages” to a specific biological year. As a result of lifestyle, environment, and genetics, older adults are a physically and functionally heterogeneous population (Bassey, Morgan, Dallosso, & Ebrahim, 1989; Bohannon et al., 1984b; Boone

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& Azen, 1979; Brown & Miller, 1998; Chandler et al., 1990; Fitzgerald et al., 1983; Isles et al., 2004; Oberg et al., 1993; Ostrosky et al., 1994; Roach & Miles, 1991; Wall, Bell, Campbell, & Davis, 2000; Woollacott, 1993). Although the ideal effect of an aging empathy suit might be that wearing it instantly transforms one to a specific age and health condition, this result is unlikely, in large part because of high variability in the health and fitness of older adults. The suit was created as a tool to gain insight into the changing needs of an aging population. Those who wear it can directly experience some of the physical challenges and limitations that some older adults face. To explore the impact of wearing the suit, research was first conducted with younger adults to examine whether wearing the suit was associated with declines in physical task performance consistent with those associated with aging; the results suggested that it did. An experiential learning exercise focused on young adults’ experiences wearing the suit while completing an instrumental activity of daily living—grocery shopping. Participants’ self-reports indicated that they encountered obstacles navigating the supermarket environment, frustrations reaching for products and handling money, and feelings of overall fatigue while shopping. As the population ages, improved insights into older adults’ experiences may contribute to the improved and enhanced design of homes, retail stores, and other environments. Tools, such as the Age Suit described here, offer future engineers, designers, policy makers, and industry leaders the opportunity to walk a mile—or more—in another’s shoes.

FUNDING Martin Lavallière was supported by a postdoctoral research grant - Recherche en sécurité routière: Fonds de recherche du Québec - Société et culture (FRQSC), Société de l’assurance automobile du Québec (SAAQ), Fonds de recherche du Québec - Santé (FRQS).

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Walking a mile in another's shoes: The impact of wearing an Age Suit.

The "Age Suit" described in this article was developed to enable future designers, business leaders, and engineers to experience navigating the world ...
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