In Series 2 Episode 16 of the Health Points podcast recorded in front of a live audience at the UKRI Healthy Aging Challenge Conference 2023, Ben, and guest host Julia Glenn, welcome our panellists Jon Hymus: Managing Director of Innerva, Bruce Elliott: CEO of Memory Lane Gamesand Silvia (Juan) Lin: Founder of Tycho MedLink.
John from Inerva discusses their power assisted exercise equipment that supports active and healthy aging. Bruce Elliott talks about Memory Lane Games and how they use old family photos to create games for people with dementia. Sylvia from Tycho MedLink explains how they use augmented reality and virtual reality to gamify tasks for cognitive empowerment.
The panel then discusses whether gamification is helpful or harmful in engaging older adults in health services. John believes it can be useful for marketing purposes but may not directly appeal to older users. Bruce shares his experience working with clinicians who initially had reservations but eventually saw the value of using games for engagement. Sylvia emphasizes the importance of purpose, autonomy, and competence in gamification and mentions its benefits in simulating real-life conditions and fostering social interaction.
The development of gamification for healthy aging interventions raises ethical and moral considerations, particularly regarding the use of gambling mechanics that can be highly addictive. The panel emphasizes the importance of personalized and adaptive content to engage older adults, taking into account their familiar concepts and preferences. They also highlight the need for user-centered design with easy-to-understand interfaces. The panel discusses the ethical and moral considerations of using gamification for health interventions. They emphasize the importance of obtaining informed consent from users, especially vulnerable populations like dementia patients. Privacy and data security are also highlighted as top priorities.
The panel acknowledges that gamification can be a helpful tool to encourage healthy activity but should not become overly addictive. They discuss the challenges of getting clinicians to prescribe and recommend gamified interventions, citing the need for more clinical evidence and a cultural shift in expectations. Personalization is achieved through tasks like memory games using individual photos. The effectiveness of the game depends on both individual use and social interaction with caregivers or family members. The focus of the discussion is on a game that can be played in care homes or people's homes for socialization purposes. The game allows personalization and offers various options based on individual preferences. It is intended to be a social experience rather than a solitary one. Additionally, there is mention of a premium feature that allows families to create their own personalized games using family photos and questions.
The panel also discusses the potential role of gamification and virtual reality (VR) in healthy aging care, with mentions of Apple and meta's involvement in this area. There are discussions about the need for collaboration among different organizations working towards healthy aging goals and the importance of involving research communities from an early stage in product development.
You can listen to this episode below:
Outline:
Chapter 1: Introduction and Panelists Introduction: 00:07-00:36
- Summary: The host, Julia, introduces the episode of Health Points, which is being recorded live at the Healthy Aging Conference in London. She also introduces the guest host, Julia, and invites the panelists to introduce themselves and discuss their understanding of gamification.
Chapter 2: John's Introduction and Inerva's Gamified Exercise Project: 00:42-02:44
- Summary: John Heimus, the managing director of Inerva, introduces himself and discusses his involvement in a UKri project called HRA (Assisted Gamified Exercise for All). He explains the various elements of the project and how it aims to incorporate gamification into exercise for older people.
Chapter 3: Bruce's Introduction and Memory Lane Games for Dementia: 03:19-05:20
- Summary: Bruce Elliott introduces himself and talks about Memory Lane Games, an app he developed for people with dementia. He explains how the app uses quiz-style trivia games to trigger positive memories and improve communication between individuals with dementia and their carers.
Chapter 4: Sylvia's Introduction and AR/VR for Cognitive Empowerment: 05:29-07:24
- Summary: Sylvia introduces herself and discusses her work in using augmented reality (AR) and virtual reality (VR) to empower individuals with cognitive impairments, including dementia and stroke survivors. She explains how their platform allows users to practice daily tasks and how AR/VR can enhance engagement and memory.
Chapter 5: Panel Discussion on Personalization and Engagement: 09:45-18:56
- Summary: The panel discusses the importance of personalization and engagement in gamified interventions. They explore how tailoring content and adapting to individual preferences can enhance the effectiveness of these interventions. The discussion also covers topics such as onboarding, gameplay, and the need for a variety of solutions.
Chapter 6: Panel Discussion on Fostering Conversations and Sharing Memories: 20:37-27:36
- Summary: The panel discusses how gamified interventions can foster conversations and facilitate the sharing of memories among individuals with cognitive impairments and their families. They highlight the importance of making communication easier for caregivers and emphasize the positive impact of reminiscing and storytelling.
Chapter 7: Panel Discussion on Promoting Adoption and Prescription of Gamified Intervention: 30:32-38:15
- Summary: The panel explores the challenges and changes needed to make gamified interventions commonplace in clinical practice. They discuss the need for increased personalization, the role of clinical trials, and the potential for collaboration between researchers, developers, and healthcare professionals.
Chapter 8: Audience Questions and Additional Insights: 38:18-50:59
- Summary: The panel responds to questions from the audience, covering topics such as the role of research in product development, engaging the research community, funding options, and the potential impact of gamified interventions on changing lives. The chapter concludes with a round of applause for the panel.
Episode Transcript:
Ben
Everyone, and welcome to another episode of Health Points. Today we are live at the healthy Aging conference in the Oval in London. I have my guest host, Julia.
Julia
Hello. So I'm Julia. I'm the design innovation lead from the healthy aging challenge. Good to see some new faces and some familiar ones. Hello.
Ben
And this is the first time health Points has ever been recorded in front of a live audience. This is always exciting. I'm going to start with asking each of the panelists to say who they are, what they do, what does gamification mean to them?
John
John, do you want to. Yeah. Good afternoon, everybody. My name is John Heimus. I'm the managing director of Inerva. We are a UK based designer and manufacturer of power assisted exercise equipment that supports active and healthy aging rehabilitation and supports people with long term health conditions. We've been in existence for about 30 years. I've been involved with the company just for the last two. We produce power assisted exercise equipment. And power assisted exercise equipment is different than normal exercise equipment in so much that you can either exercise passively or actively. It works very similarly to an electric bike. So if you don't want to do anything or you can't do anything, then it will move you. But actually, if you feel more confident and you want to exercise, then effectively it creates something called isokinetic exercise.
John
So if you're recovering from a stroke and you don't have any mobility, or your mobility is limited, this equipment is excellent for that, and it's brilliant for sort of older people or people who aren't really used to or comfortable with exercise. There's a major element of what we do around the psychological and social well being part. So actually, because it attracts older people and you exercise in a circuit altogether, the equipment is designed specifically so it's got a very small console, and actually, we want to actively encourage people to chat because that's a major piece with older people around, combating social isolation and loneliness. In terms of the gamification element of it, we are involved with a UKri project called HRA, and that stands for assisted gamified exercise for all. There are a few elements to that.
John
One was a big piece around market research, but actually there's a big element around converting our dumb console into a smart console, building into that some elements of gamification within the hardware, software. So there's a whole load of things. I can sort of talk about that and then actually, then beginning that gamification journey, specifically thinking about how that works with older people on that platform and in that digital ecosystem. So in terms of what gamification means to me, really, I think it's a method of engaging users. The bits that are really important for me are the play part, the fun part, rewards, I think, lesser for this particular market. But for me, that's certainly a couple of the major pieces that are really important to us.
Ben
Brilliant. Thank you for that, John. Bruce, do you want to come in and tell us what you do, who you are, and what's gamification in your world?
Bruce
Sure. Bruce Elliott. I'm the CEO and co founder of Memory Lane Games, and we began in a pub in 2019 with a friend of mine and I talking about our mums and his mom's now 94 with vascular dementia. My mom's now 90. Sharpest attack. Back in Canada, were talking about what they both have in common, and it was love of old family photos. I wonder if we can turn those photos into games. And my friend Peter said, actually, we're turning memories into games. And we started memory lane games the next day, and we built an app that had some quiz style trivia, Jeopardy. Like games, and we really built them just for our moms to start. And then during COVID it kind of blew up. And we've had 100,000 downloads around the world, gameplayed in 134 countries last month.
Bruce
Thousands of hours of gameplay every month. With people with dementia and their carers and our trivia style, multiple choice games. It looks like you might think, oh, this is brain training, or this is those kind of activities. Not at all. What we've been able to show clinically and with our users is that our games get people talking. So we trigger a positive memory with a beautiful image, and then we foster improved communication. And we work with the Mayo Clinic and Arizona State University now. And one of the professors from Arizona state said, actually, what you're doing is social cognition. I said, what is that? So I wrote that down.
Bruce
They said, you take an image, so you've got a visual stimulus, you've got a question, a cognitive stimulus, you've got the reminiscence, emotional stimulus, and then you have fine motor skills where you're picking the answers. And he put that together and said, that is something you repeat six times in a game and six games at a time. No wonder you have therapeutic benefit. So we're using quiz style games to improve the lives of people with dementia and their carers by getting the two of them talking more. That's what we do. Amazing.
Ben
Thank you, Bruce. Sylvia, if you want to come in last, what do you do? And how does gamification work in your world?
Sylvia
Sure. Hi, my name is Sylvia. I'm the founder of Tyco Mezzlink. So what we do is we line XR both include argument reality and virtual reality to gamify the task. And regarding the armed reality, we unified the daily task and aim for help people who have cognitive empowerment, including those people living with dementia and stroke survivors, to allow them to practice the daily tasks in our platform and regarding the virtual reality. And we simulate the virtual light and providing the light therapy in our platform and allow people who have a seasonal vaccine disorder to enjoy the virtual sunlight in the VR sense. Regarding what games mean to me, so aligning with germination theory. So there are three very important elements. One is the sense of purpose, and the second one is autonomy. And the third one is competence.
Sylvia
And so that's what we implement in our product and we engage in the game elements, including the track, the patient's progress, and also to come up with actionable feedback and allowing them to do the levering up. That's how to motivate them and engaging them by simulating the real life condition. And the second one, I recall what Roses said before, which is social element, because within the community and collaboration element, moving to the game will also motivate people, the users, more involved into the game. And the third one is the quantified self digital design that will come up with a reward. So once, if a user can get some reward, like a sense of achievement from playing something, they'll be able to enjoy it.
Ben
Thank you very much, Sylvia. Right, so we're going to go into question number one now. So question one for the panel is the term gamification helpful to define a method and approach to engagement and behavior change, or harmful as it can be viewed as trivializing health services for older adults? John, I'm going to start with you.
John
I think it depends on your market, really, and whether you're being over or covert in terms of your approach. I think probably for older users, let's say our end market, for the people that we work with, I think if we talked about it overtly, I think it would probably put a lot of people off, because you only have to look at certain statistics to see there's not that high level of engagement or interest. It's probably not in their comfort zone. You look around the room here, it's probably a slightly younger demographic than the conference that we've seen. I think for older people, it probably wouldn't work, but for commissioners, for operators, for the people that we sell to actually, I think it's really helpful. And the reason for that, I'm going to be a little bit controversial.
John
Working with older people is not an exciting, interesting, sexy thing, whereas gamification is a new, exciting kind of thing that people will give some attendance to attention to. So I think, actually, it's a really useful tool. There are benefits, there are real proper benefits attached to gamification, but there's also a marketing based kind of benefit in which you're getting people interested. And that's maybe a cynical view, but I listened to a podcast recently where there was a guy who was a bit of an expert on the NHS, and he was talking about some of the problems that they face in the NHS, one of the major ones being GP services. We all probably experience that in our day to day lives. If you look at the investment and innovation that's gone into GP services, there's hardly any.
John
If you look at the innovation and excitement and interest that's gone into AI, robotics and health service, it's huge. And so I think, actually, gamification for me is a real useful tool that can be used to attract attention from a b to b perspective. But from my market, it's probably less useful directly talking about it from a b to c perspective. Now, as I referenced, there are lots and lots of benefits, sort of little things that I'm sure we'll touch on that actually are really real world benefits that's attached to the gamification. But we just got to be careful, in my opinion, about how we actually surface.
Ben
Those good points indeed. Bruce, do you want to come in on top of that?
Bruce
Sure. In working with the Mayo Clinic, were fortunate enough to be invited to the Mayo and AsU medtech accelerator in March. Somehow we won. We're thrilled to. And they called us something really simple but scalable. And I think that's the essence, is that we like the term games. Not all clinicians do. They say, are you serious? Games? We're just casual games, but we're not focused on brain training, where a lot of people automatically assume that's what it's all about. So for us, the perception of games drives engagement. So when you sit down beside someone, say, would you like to play a game on the town you grew up in? That's an easy engagement. And all of a sudden, then you've got cognitive stimulation, and then you've got visual stimulation, you've got emotion and reminiscence.
Bruce
But if you sit down and it's setting up something complex in front of you, it can be hard. So for us, we love that. But at the Mayo Clinic and ASU, we had 31 one sessions with the leading clinicians for the Mayo Clinic and ASU. And when we sat down with them at the beginning, they look at us and they're shaking their heads. Games, like, really? But by the time we left those 30 minutes meetings, they're going, I get it. You can personalize this content. So my dad's town he grew up in, or his favorite hobby, or his favorite sports team, he'll talk about those things. And that's where we see the magic. But it's been hard, because people expect we position ourselves as games, as medicine.
Bruce
And I thought the Mayo clinic might throw us out of the room for that, but they ended up loving it. So I think there's a bit of we don't mind, I guess, the challenge. We love wood games, and we're casual games, not serious games.
Ben
And what you've just echoed is affected a lot of previous guests, in that when they put forward gamification interventions, it can also be viewed by the general medical professionals and health system as a trivial activity. And how could a game result in a health outcome? And I think what we're getting now is the amount of publications coming through, the amount of case studies that exists, the fact that now there are FDA approved gamification interventions that exist now that weren't there three, five years ago. I think that shift is then supporting these conversations, too.
Bruce
Some of the people in this room may have played the games, Star wars games or Medal of Honor. I don't know if anybody's played those games. The fellow at Lucasfilms games who, you know, from Achille Interactive, they moved from building those video games, some of the most popular in the world. Now they're building video games for ADHD with amazing clinical results, and out of Boston, they're incredible company. So it's happening. It really is happening.
Ben
Thanks, Bruce. Same question to you, Sylvia. Is gamification helpful, or is it trivializing our work?
Sylvia
It depends on the audience, because there's a term of a serious game, and also because sometimes for the medical professional, when we first introduce our game intervention, and they will start to think of how dust game can actually be effective and how to implement in their system, and we can't like to be put into the serious game side, because if we said, oh, if wear a casual game, and they're going to be quite reserved at the first point and not really willing to try it on, and like we said, we simulated the daily life and help people to practice the daily task in our platform and by multiple and for example the tea task, making a cup of tea and then they will start to for the medical professionals that are willing to start to have the conversation and then we can actually.
Sylvia
Yeah, that's how we do. Because I think regarding for the helpful side is something that I've mentioned before. Because we can simulate the real life condition. That's what we do. And by the same time if we don't put as serious game it will be minimized the impact. I think currently they are in the middle ways. It's kind of like the medical professionals starting aware of how game can be used on the rehabilitation route, but they still require a lot of proof or evidence to make it as effective to be used in their centers.
Julia
Great. So I move on to question number two. So we'll start at this end this time. So burning question, is gamification a gimmick? Is it just points and leaderboards or does it make a difference?
Sylvia
I do think it will make difference because although there's a lot of barriers that we need to crack on, because for us we're targeting with people who have live with dementia and stroke survivors, which is in order for the age, it's quite aging population. So the usability and accessibility is something that we need to taking care of it. Other than that we will be able to enhance their engagement by providing dynamic and interactive environment because that will encourage the users to participant as many times as possible. And so usually people, I was still taking the tea task as an example. So usually people will just making maybe maximally, I can think or I can imagine around three or four or five maximum to making five cups of teas in a day.
Sylvia
But if they will be able to practice as many as times in our platform, I think that is one thing. How would they be engaging and enhance their memory from one side and the second one is with personalization and adaptively because the individual they might have their own preference of their own content. Some people might prefer the orientation and problem solving tasks. Some people might prefer the memory tasks.
Julia
So Bruce, same question for you. Gimmick or does it make a difference?
Bruce
We hear this a lot. So we love games and the simple gamification because that drives engagement. And once you've got engagement, then it gives you the right to do a whole bunch of other things. So for us, we track seven clinical data points behind the activity. But really people are just playing our games on their favorite cities or their hobbies. But we're tracking accuracy frequency, duration, number of games played, mood liked games. Did you like the game or not? All of those things are signals for us. One of our care home groups, Bupa, who uses us, say, if someone likes the same pudding every day for 30 days and then doesn't like the pudding the next day, it's not that they don't like the pudding. Something else is going on and we can see the same trends in data. If you play the same.
Bruce
People with dementia often play the same games over and over, so we can see patterns and then we can see changes. And I think that's where it gets really exciting for us. But it starts with games, and if you don't have that engagement, then you don't get the right to really process the wonderful data behind it.
Julia
Brilliant, John. Does it make a difference?
John
I think it's fairly obvious that it's not a gimmick. And what I mean by that is there wouldn't be a multi billion dollar industry in terms of gaming. So there's got to be something in this, right, I think for us and how. We've got to think about how it's presented, how we use it. The big thing for me is application is key. I'm sure everybody's heard of nudge theory. This doesn't have to be about leaderboard and the ultimate end of sort of gaming. It can be about sort of little dopamine hits and little rewards and little smiley faces. And certainly that's some of the stuff we're trying to build into. The hardware element of it is these little unnoticed kind of pieces that are cleverly used in sort of mainstream games to encourage engagement. Exactly as Bruce said.
John
It's about actually encouraging people to take part in whatever activity is that you're trying to sort of have. And part of that is absolutely understanding your market. You need to understand who the end user is and what they're going to be doing and what's going to motivate them. I've had experiences in a previous organization where there was a big push because it was all fit people and this was a fitness based kind of app, but actually the majority of the users weren't fit people. They were all going crazy. But we've got to have leaderboards, we've got to have this, we've got to have that. And actually, there was barely any engagement. I think it was like 1% of the app usage was based around these leaderboards.
John
And that's because it was the person who was designing its interest rather than the actual sort of end market. So absolutely. It's not a gimmick.
Bruce
We get exactly the same feedback when people look at us or in game and they always say, how come there's no leaderboard? How come I don't see scoring? We say, well, it's not for you. That's right, it's for your mom. And then they get it.
Ben
Completely agree. In terms of the size of the sector. You may not know this in the audience, but the games industry is bigger than the movie industry and the music industry combined. If you think how big blockbuster is and the top of the pops and the charts, it's bigger than both those industry combined. This is a huge industry. Now. I think leaderboards get put down a lot in gamification because they've seen this really simplistic way to do gamification, but ultimately they do work. Really simple game mechanics makes a huge difference. And that's why it's become such a big industry, because it creates this level of motivational engagement. I think what you've highlighted in the talk so far is that there isn't a one size solution.
Ben
If any of you do play games, I bet you only play that game for maybe a couple of months before you find a new game that you like more on. The reality is, if our gamified interventions exist in there, they're not going to last forever. In the same way, people will find a new game every couple of months, every couple of years, or play it infrequently. And just because someone gets bored with a game doesn't mean that it was a failure as a game or as an intervention too. I mean, to see that it is that. So what I want to talk about now is the fact that our focus group is older adults, but the vast majority of older adults don't play video games. And for every decade, over 60, the number of people who engage with games is getting smaller.
Ben
Now people know, fastest growing demographic for people starting to use games and engaging with them. But worse, start to introduce games to a demographic that doesn't traditionally play games. Is that the right way around it? Should we be doing that?
John
That was an interesting statement you made then. Older demographics don't play games. They may not play electronic games, but they play lots of other games. And I think we've got to be a little bit careful we don't go down that rabbit hole of it all being about it and actually matching activity to market. So the guys in Nerva laugh at me because one of the things that we will do on our platform when it's sort of built is we're going to have Inrva bingo, because actually, there's a massive group there that are really interested in that. And that's a game, it's not an electronic game. Well, actually it is. It's a massive multimillion pound gambling thing, actually. But that's one side. Older people have played games throughout their lives, haven't they, really? They've just perhaps forgotten about them.
John
And so again, it comes back to what were talking about earlier, about trying to match activity to the sort of market. You'd asked us to do a bit of research on some statistics. The only statistics I could find about games use was the Internet use of games. And the ONS did a study back in 2020, and only 17 and a half percent of people aged over 65 do online gaming. Then that cohort, as you go down, the age group seems to double each time. Now, that's going to work its way through. But I'd argue there to some degree, it's probably the wrong sorts of activities and the wrong sorts of games.
John
And I think we just maybe need to take a more holistic approach, which is what the panel has sort of said, really look at the elements of gamification that you can use in products and services that you're designing. Perhaps make them less competitive, make them more holistic, make them more sort of engaged and working together. But actually, I think for me, it's absolutely something that needs to be built into everything that we do.
Ben
Bruce, your thoughts for us?
Bruce
We went with something familiar. So my parents love to watch jeopardy. On television and play trivial pursuit or who wants to be a millionaire? Those kind of questions. They're familiar with those just like bingo as well. And so we focused our format, gaming, around that familiar concept. We just had to make the content personalized. So it was really interesting to that one individual and adaptive so that it can be easier or harder for those individuals. So that's where we focus. So we think it's important. But again, it was for our audience, people with dementia, where it needed to be really personalized to get that engagement level because it's so easy, just say no. Would you like to engage in this activity? Would you want to come to the next room? And often in care homes, as we see people just say no.
Bruce
And no matter what the game is or the activity. But if you sit down and say, would you like to play a game on your hometown? I know that's how we've approached it.
Ben
And Sylvia?
Sylvia
Yeah, I think old people, they do play game, but it's just not like an online game that we offer refer to. And they do play as single. Or when I did the testing in the church, they do gather together and play card game. So when we design our product, that's something that we consider as well. Because we just need to make sure that to apply is easy and simple interface. And all the traditional games that we can think now is some online game, a very popular one. They come with a quite difficult to understanding or like quite comprehensive interface, which there are many buttons or many elements involved. I understand one side, it can make that game really interesting and engaging. But another term means it's difficult to understand for them.
Sylvia
And usually for now, the old generation doesn't really grow up with the technology. So it will be quite challenging. And it takes time to educate them to know from the very basic level, which is like how to tap a button on the screen. So I think that is something needs to consider is applying the user centered design and also get something that they familiar as accountant. And the third one is going to be making really easy to understand and simple interface. And then once they get used to it, and once they get educated, and then we can move on.
Ben
I think as a panel, you've kind of highlighted that from your previous answer, John. The individual who made the fitness app for the workplace, it was based on their view as what was said. What you've all done collectively is look at what are the motivating factors that older adults are engaging with in terms of analog or digital games already? And how do you build that into onboarding, how do you build that into gameplay? Exactly as you said, sylvia, around human centered design. Thank you very much.
Julia
Okay, so next question. Sylvia, I'll start with you again. So are there ethical and moral considerations for development of the use of gamification, especially when applied to healthy aging interventions. So, gambling mechanics, highly addictive. So right or wrong, and what are the ethical and moral considerations?
Sylvia
That's very interesting question. And I think when it comes to this one, it's really important to get informed consent from user. Because, for example, because for us, we are looking for people live with dementia or stroke survivors. We will need to get consent or either from them or from their care or from the clinicians. We'll let them to aware the features and also make them understand the game. Because the least thing that we want to do is bring additional harm to them. So that's something that we will definitely want to prevent it. And because we aware that they are really vulnerable and they already had some horrible things happen. So another thing is that I want to mention is the privacy and the data security because patients data is something that should be in top priority as well.
Julia
I agree.
Bruce
I think it's a complicated question, but it's an excellent one for us. We've kept it very simple and so the user isn't exposed to anything complicated. It's just playing some trivia games behind the scenes. Our data privacy consents or clinical models are very strong because they need to because we're handling data. But I'll give you some examples. Where were challenged, a number of people said, you know what, you should be recording those reminiscences. So when someone starts talking about the photo from their dad's hometown, he's telling a story and that'd be wonderful to share with the families. And my dementia clinician said that's interesting except two things. One, sometimes people with dementia hallucinate, they may not remember that and sometimes they bring up stories that they don't want to share.
Bruce
It might have been a kid that no one talked about, or there are some other things that do come up in some of these discussions. So we've not gone down that route because we're really worried about, we just want to maintain that integrity of the conversation. But it'd be interesting, everybody AI looking at turning these scripts into natural language models. But for us it's again just about fostering those conversations, making it just a little easier for the caregiver and the family. We've avoided those, but I think there's some real tricks there and we have to be really careful.
Julia
Thank you. So John, your view, I mean, clearly.
John
There are data concerns, GDPR concerns. Those things are a given, though to a large degree. I'd argue that a lot of that is dealt with via legislation. I think the interesting piece for me is theoretically, yes, there are of course considerations that you sort of need to undertake and think about for this, to sort of use these kinds of principles. But practically probably not so much, because in the majority of cases, some of the health interventions are going to be the reason that people are not undertaking some of these health interventions more from like a fitness perspective, is because for most people they're not very nice. So actually some of this gamification I'd see almost as being a spoonful of sugar for the nasty medicine. That sort of goes alongside that.
John
And actually you're also competing in a market where people like McDonald's are using monopoly to gamify the sale of fast food. So these guys have got no moral considerations as far as I can see, other fast food companies can be talked about as well. But I'm not just picking on McDonald's. So why should we be limiting ourselves around that? Why should we being overly worried? And I think it's because health, medical, that's always been that kind of like the proper kind of process to take. But I don't think we should allow it to necessarily shackle ourselves and be overly worried about that kind of stuff.
John
Because to be honest, if we can get people far fitter and healthier by using gamification, I'm pretty sure that we're not going to get loads and loads of people addicted to these kinds of things, because know, it's quite hard work and this is why we're talking about this kind of stuff, to solve the problem.
Ben
So just to expand from that, in your view, John, there is no limit to how addictive health gamification should be aiming?
John
I think you've got to be careful. There's always going to be limits. Of course there are. There's always going to be extremes. And you see in gyms, people addicted to exercise, another form of psychological problem that's attached to that. So you can never work on extremes. What I'm kind of saying really is that let's not allow ourselves to be limited in terms of using it. We should be thinking about using these kinds of things to encourage healthy activity. Because actually, I think in the real world, it's probably going to be really difficult to do.
Bruce
The ADHD app I mentioned earlier, Achille, they limit 25 minutes a day for children using the app, so it only works for Latin, it shuts itself off till the next day. And I think that's a useful mechanism, for example.
Ben
But I think fast food limit how many burgers you can have a day, though. So we're fighting an uphill battle. Just a final question for the panel then, is these interventions exist. What influence needs to happen, what change needs to happen, so that it becomes commonplace for clinicians and gps to be able to prescribe and recommend these gamified interventions. John, I'll start with you.
John
Having worked or tried to engage with the NHS across my career, it's a really tough thing to kind of do, so we should be using all of the tools available to us. And I think Bruce sort of referenced earlier about the difficulty that they found around those initial engagements. Working with clinicians is really tough because they've got lots and lots of demands on them. And I think if you can use this as a tool to sort of get them to actively encourage, to prescribe these kind of things, then good luck, because it will be a bit of an uphill struggle. I think the fact that this is seen as an exciting kind of thing, balanced, of course, against the skepticism that you may find, I think will be a helpful tool, but it will be hard to do.
John
Certainly in the UK and certainly with the NHS, it's really tough to engage with the four and a half thousand different organizations. That's without the individual clinicians that you're talking to, plus all the change, plus all the demands that are on them. And I think we should be using whatever tools in our bag that we can do to try and encourage healthy outcomes.
Ben
Bruce, your experiences.
Bruce
I'm intrigued. So we've had with a free app that went all around the world, 100,000 downloads and 134 countries. The games were played in the last month as we moved to commercialize, working with some care home groups, Bupa, and a number in the US and Canada. But across the NHS, we've been hard to adopt. They just haven't quite got their head around us. One group, I said, we'll give it to you for free for a year. And they said, well, we can't do an ROI on thought, okay? But it takes more clinical evidence. We ran a clinical pilot here in the UK that showed some interesting results and some of those results that if you play our games three times a week with your dad, that we can maintain the severity of dementia over six months, which was unbelievable.
Bruce
So now we're going to run that trial over a year in the US with Arizona State University backing us. I think once we get that level of clinical support evidence, then I think more doors open for us. But I worry that digital health in our case, has so little downside. In our clinical trial, we had to identify the risks. And that was, number one, dropping that iPad on your toe. And the second was triggering a negative memory, which never happened for us, which was wonderful. But we need to find faster pathways to interventions that will have wonderful results but don't, and that have almost zero negative impact. Social prescriptions was a great vision, but we've never seen a social prescription yet. In our view, prescription apps have been perceived as a wonderful way where formal prescriptions are written.
Bruce
But in Germany, Diga, the leading global prescription app market, it's not taken off, really. The doctors still don't quite know how to prescribe them. And in the US, a number of the largest digital health apps companies are shifting away from making prescription apps and going direct to consumers. So that adoption cycle, I think is interesting.
John
There's a really interesting challenge there, isn't there? Because I think, let's say in GPS, the expectation is people will go along and there'll be a tablet for something. And so actually to go along and not get a tablet and be given, I don't know, an app as that.
Bruce
As another tablet, you're absolutely right, of course.
John
But I'm sort of thinking in terms of there's a cultural customer expectation, or expectation there that somebody will go along and get something physical. And that's a real challenge, I think, in our society.
Sylvia
Yeah, definitely. Another thing is going to be the patient's expectation, because they're expecting for some physical thing instead of some software or not really tangible things, immediately they will start to question the effectiveness. But regarding the benefit that we can see is because it can be a cost effectiveness solution, and at the same time it can be personalized intervention based on the individual's desire. Because, for example, one task in our product is as a memory task, we allow users to taking their own photos, because each user going to taking their own photo, many photos, and then we put into the card and allow them to match it together. So this is how we personalize the different tasks. So it could bring the personalization to them.
Ben
I think one of the challenges within digital health and within gamification is that for things like pharmaceutical interventions, when the active therapeutic agent changes, the chemistry changes within the tablet, well, that's a different intervention. You need to go back through all the different phases of the trial, have it evaluated before it can go back onto the market. Now, the great thing about digital health and gamification is that you can tweak those game mechanics pretty quickly by comparison. And there isn't currently the framework existed that I've seen that acknowledges and accepts that even though there might be some tweaks within a game mechanic, it doesn't change therapeutic intervention or therapeutic agent. But at the moment, what you put for a clinical trial is what the intervention needs to be for it to be potentially commissioned or prescribed.
Ben
But we're always trying to make better projects, better products, better services, and they're a continual, iterative process. And at the moment, I don't see a solution to that. And I think in order for adoption to truly happen, the framework needs to be created because the traditional pharmaceutical framework isn't as applicable for gamification the same way before. That's all my question, thank you very much.
Bruce
Sorry, point. I think what we found is that the FDA told us we're a general well being app and we should just stay there. Okay. So even if we run these clinical trials and all these magical things, we may just choose to stay as a general well being app so that we don't have to go through every time we change from multiple choice with four questions to three questions, do we have to do another trial? Those kind of things. So there are some ways to handle it, but yeah, it's a challenge.
Sylvia
And another thing is regarding, usually the clinical trial can take up to a couple of four years as well, but in order for technology development, it's really rapid and irritative very quickly. So sometimes this might happen when we do the clinical trial at the first place, but when the results come out even, it's positive. But our technology has been already overcome to the next stage. So does that mean that we need to come back and to do another clinical trial again, or sometimes challenging?
Bruce
No.
Ben
Thank you very much, panel. I'm going to open to the floor for questions. First of all, thank you to the panel for coming along. I'd like to open to the floor for any additional questions. David.
Ben
I'm David Wally. I was the founding director of the Sirius Games Institute, and I started gamifying my own health eleven years ago. So I'm a big fan of the process. I'm also very interested in the role of memory supporting dementia.
Bruce
That's a different story.
Ben
Bruce, the question I have for you really is there's a couple of questions. One is I'm fascinated to know how you personalize the game. Someone coming to it the first time, you won't know anything about them. So how do you personalize the game? I understand, I think how you crack the metrics that can be used in clinical validation. And the second part is, does the effectiveness of your game, is it based on an individual's use or is there a social element like Ben has in his good boost?
Bruce
Sure. So because we're not brain training, our game is meant to be played with an individual with dementia and their caregiver, or a family member or a nurse or clinician. And so in care homes or in people's homes, that's our focus has been. So it's not just playing it by yourself, because we're all about socialization, not square. How we personalize is on entry into the game you set up, you choose some familiar places, you choose some familiar hobies, and then we have 3000 games in our app that we use our AI to give you some games on what you like. So if you like hobies, or if you like woodworking tools, got a really great game on woodworking tools. And then we give you a game on what wood is this? Which is really popular. What wood? It's a piece of wood.
Bruce
What wood is this? People love arguing about that, but again, socialization, not scoring. So it's meant to be played with someone, and so everyone looks at it and they think it's just a solo play kind of thing, but it is genuinely intended to be a social experience because that's where we see the benefit is the socialization. Increase personalization. We have another feature that's a premium feature for us, but families can upload their own family photos and questions and create their own game of who's standing next to Uncle Jim, who used to live in this house? What was the name of this dog? Those kind of things as well. And they're very popular.
Ben
Thank you very much.
Jamie
Hi, Jamie Sheridan from business called life's liberated, involved innovation, technology development, particularly interested in healthy aging rehabilitation. Two questions. One from Julia's question about the is gamification the right thing? Is gamification part of you mentioned tools, John, but are they weapons in the armory? And we're here at this conference, and if you go around the posters and things like, there's an awful lot of different weapons that are there to work on healthy aging. I have an issue with commodes, not that I have an issue with commodes, because I do a lot of preventative health. So if as soon as I'm dealing with healthy aging. Oh, commodes and Sterlis. Well, no, I'm actually trying to be preventative, proactive. So that was the first question is about is it weapon, the armory? Can we all work together?
Jamie
Good boost and nervous everyone else as a nascent industry coming together. And second, if you look at, again, a different type of innovation, technology development and virtual reality VR, you see meta. They're doing a lot of advertising around meta in terms of the VR and bringing things together in terms of productivity enhancements and whatever else. Do we see meta, Google looking at driving that movement forward in longevity and healthy aging care. Is there something there, or is there again, are we all very disparate and is there a banner we can rally under?
Bruce
There you go.
Ben
Sylvie, do you want to take the VR question to begin with?
Sylvia
Definitely. So, regarding the VR, I think both NaTA and Apple is going to be released the vision pro earlier next year. And I do believe they are trying to get into the house aging in this area, and because they do see the potential in this area. And as we are also moving into aging in society now and regarding how VR can be helpful, and so just for us, what we do is we simulate the real life condition and also at the same time, allow them to see the remote monitoring through progress, through the clinicians. That's how we support the patients. And I hope that answered the question.
John
I think there might be with organizations like Apple and meta, they're in this for the long term, aren't they? If you look at what they've done over the years, especially Apple, they sort of join very late on and sort of with a created solution effectively that's then very effectively embedded. And I think that's probably the approach they're looking to take. They're probably not looking to help this current generation of older people. They're looking at sort of people probably my age and sort of slightly below, and how they can get ahead of the curve with that. For me, VR is a really interesting one in terms of its adoption with older people. Whether that's the right solution, whether it's a good solution. I've heard really mixed things.
John
You can see some organizations that are clearly making some impact, but then I've had some feedback from sort of care providers who pretty much said, if anybody ever asked me to put another blooming VR headset on an older person, I'm going to go mad kind of thing. So I think actually there's possibly a piece there, and I'm working on another project with a UKRI project where they're looking at sort of the adaption of existing technologies because they're much more familiar with sort of older people, I think. So in terms of the point around the coalescing, I think. Sorry, coalescing as a group, but there's definitely something there, isn't there?
John
There's becoming a bit of a movement, and I'm not quite sure what needs to be created to have that, but I think there is something that needs to be created that effectively all these different organizations can sort of come together to form, to sort of work towards this kind of common goal. It's such a massive untapped market from a commercial perspective, let alone the moral kind of perspective, that something needs to happen. What that is, I haven't got a clue. Somebody else needs to do it. Maybe it's in the too difficult kind of thing for certainly the size of organization that I am, but there definitely needs to be a thing, maybe from a governmental perspective.
Bruce
What I'm seeing is Silicon Valley is pouring tons of money into early detection and for dementia. Okay, your mom has dementia. Okay, now what? So it doesn't help the. I think there needs to be more investment into healthy aging for those who have been diagnosed or mild cognitive impairment. It's important work to do preventative. But I'm not seeing enough innovation happening for those who have the condition. I think to me, that's the message for Silicon Valley. It's not just about technology for early detection. It's got to be care as well.
Sylvia
And I think another thing regarding the technology is to the AR and a VR. It used to be as a separating. So augmented reality stands for AR, which means to overlay the virtual model into the real world. Usually they can see through the mobile device like Pokemon go and the virtual reality, it will be done for putting the headset on and bringing you to a totally virtual scenario. And that's two things has been separate. But currently I can see the trend that, including Apple and meta, they are trying to bring two things together and to stay as a mixed reality, which is you can put the headset on, but at the same time you can see through from the headset with the real world. I think that's how they are currently doing.
Ben
I think to add on that for your question. I know that the community of practice exists for healthy aging. That's not going to stop anytime soon. I don't think. But I think it's going back to center March 24, but I think it's going back to center for aging better and saying that we don't want the community of practice to end. But also, is there a subgroup on gamification for healthy aging? And is that just a quarterly check in meetups? Who knows what grows into. But happy to, as one of my.
John
Actions about Amazon, the data that they're collecting, it's all that, they're very scary, particularly if you're trying to sell product and against them. So it's all coming together.
John
It's the movement one high level.
John
Big data, big business, but then everything we're doing and startup businesses together, how.
John
We can work together.
Ben
I've got time for one last question.
Julia
Hello there.
Alison
Alison Dawson from the University of Sterling. Thank you, panellists. It's been really interesting, what I'd like to ask you, and I'm sorry, it's a bit self centered as a question, but can you tell me, all of you, at what point in the development of your products did you first engage the research community? And with the benefit of hindsight and imagining for a moment that money was no issue, what would you have involved them in. Had you got the chance to go back and do it again?
Sylvia
Yeah, I can start literally, because we are part of the UCL incubator, we literally start with the support from University College London. So, regarding with your question, we're literally involving the research organization at the very beginning, and then we start to involve the patients. So before we have everything, before we actually start with the development process, we had the research and also with the patients involved first, and then that is.
Bruce
How our route for us, we started again making games for our own mums. And then we made a presentation at a small event in Manchester, and afterwards a woman came up to us and said, boys, you have no idea what you have here. This app can change lives and we can prove that in clinical trials. We're just making game for our mums. So Helen joined as our director of clinical. She had run eight dementia trials in her career for Big Pharma and R D for NHS Trust. So she designed our first trial that we did. We funded ourselves. We're still paying it off. It was painful because we know games and everything else. We weren't connected into the research world. So in hindsight, I wish we had more support at that point so we could make a bigger trial.
Bruce
But we learned a lot and we took a stubborn approach of trying to be really. We didn't care about the result, were really just trying to learn, weren't trying to fix a result, so it was positive. Now we're doing a much bigger trial in Arizona. State university is going to fund that for the most part, but we're looking at two or three other options and we have no clue how to plug into research in the UK. We were successful in the UKRI's longitude prize for dementia, partly because someone coached us that we needed some academic partners. So we partnered with City University, London, which has proved to be really helpful for us, our business, as well as the prize, but we really want to run some bigger trials in the UK, but we just don't have the roadmap.
John
So our HRA project is part of a consortium and there are two academic partners that are part of that. The consortium is ourselves an operator, a leisure operator partner called Everyone Active, a digital partner called Pixamill, who are a digital studio based up in Manchester. The academic partner in the consortium is the AWRC, the advanced well being Research centre, Sheffield Hallam University, and then we have a subcontractor who is an academic partner, and that's Manchester Metropolitan University. In terms of the research, everything has been based it started with that. So AWRC did all of the co design and user research for a variety of different methods, which, as a non scientist or non academic, I have no idea what they're involved with. It sounded great and gave us some great results, so that's great.
John
And then from an MMU perspective, they did the sort of operator market research and provided some brilliant information. So were quite fortunate that the whole thing's been designed around it, and I'd absolutely recommend that's been really beneficial.
Ben
Thank you very much for the questions. A huge thank you again to our first ever live audience. A huge round of applause for the panel for joining us today.
Bruce
It.
Ben
Thank you all very much.
