**5.1 The effect of technology interventions on reducing social isolations**

Social isolation is one of the major risk factors of mental and physical health for the elderly [43]\*.

However, many authors have investigated the role of technology as a new potential intervention to prevent social isolation.

Assistive technology could contribute to improving their quality of life, living independently at home.

Assistive technology includes many devices, which support people in their independent living [44]\*.

To date, smartphone and smart applications are the most common device involved in assistive technology [45].

Using smartphone includes many advantages: Flexibility, user friendly, various built-in sensors and connectivity options.

These technological devices make possible the development of new solutions for the elderly.

Going deep under the use of technology, several studies proposed the role of video games as powerful tools for cognitive training and well-being of the old people.

In fact, during the past years, video games were not designed to support people or for specific improvements on cognitive domains, but recent research finds out that they could be a valid instrument to help people with specific cognitive training and brain exercise.

Generally, there are two types of video games: Hardcore and casual video games (CVGs).

Hardcore video games are harder to play; they are usually played for a long time period.

However, hardcore action video games were mostly used in most research during the past years to study the improvement of perceptual and cognitive abilities in the younger audience.

*The Complexity of Frailty: Psychological Mechanism and Therapeutic Interventions in Old… DOI: http://dx.doi.org/10.5772/intechopen.92630*

Furthermore, the interaction between old people and this type of video games could be very difficult.

First, learning how to play an action video game could be very difficult and challenging for the elderly, and secondly, as many authors suggested, the elderly usually dislike action video games, especially when they have violent content [46].

To sum up, all these results suggest that the elderly could be less motivated to be involved trough action video game interventions which are less attractive.

On the other side, casual video games (CVGs) have short play session and are an easy task to be played, and this is the reason why they are mainly a target for old people improving cognitive functions and emotional well-being [47].

Different CVG genres engage different perpetual and cognitive functions, and it is important to understand the logical process under these video games to improve specific cognitive abilities [48].

In order to understand better which CVGs are more suitable and enjoyed by the elderly, many authors from Switzerland have studied what older people like to play [49].

In this study, Chesham and coworkers [48] have evaluated 16 healthy older adults (5 females and 11 males) aged between 65- and 84-year olds coping with games.

All the participants have no deficit vision, and exclusion criteria were a diagnosis of dementia, mild cognitive impairment, and motor impairments leading to inability to manage a tablet computer.

Finally, all participants were informed about the procedure of the study and signed for the informed consent.

We examined casual game enjoyment and game characteristics across a range of four genres (casual action, casual puzzle, casual simulation and casual strategy games) based on different cognitive functions in healthy older adults.

The results of this study suggest that tablet-based casual games have been enjoyed by the elderly.

A possible limitation of the study was that all the subjects were healthy and well-motivated to participate in the research.

No prior game experience was considered as possible bias in the obtained results.

#### **5.2 A social virtual reality-based applications: The physical and cognitive training of the elderly**

Virtual reality is an interactive and immersive experience that can be used to transport patients to a place beyond the clinical setting.

Patients can experience realistic, three-dimensional worlds that aim to not just reduce the stress and anxiety of a clinic visit but also teach patients' and the clinicians' new skills [50].

Generally, virtual reality is usually used to enhance many cognitive abilities (attention) in clinical disease.

Because virtual reality is an interactive method, it is mostly involved in rehabilitation and education in children [51].

It leads the opportunity to work on creating a new virtual world.

There have been several numbers of software created to deflect the minds of patients and focus more on virtual reality worlds that can help them to relieve stress and to stimulate cognitive functions.

Virtual reality-based cognitive stimulation can also be used to improve cognitive functions in critically ill patients, and most research involved the elderly population [52]\*.

This tool could be a valid instrument to prevent the patients from the overload of disturbing extra-stimuli, especially during the hospitalization period.

Furthermore, thanks to virtual reality, it is possible to select natural restorative environments with neutral content.

Generally, there is a distinction between virtual environments (VE) and virtual world (VW).

In virtual environments, people could see characters and objects interacting with them in a realist way in real time.

On the other hand, virtual worlds consist of a social world that is more stable, where people could interact with other users using an artificial avatar [53].

One challenge in using VR stimulation in old people especially in a critical situation is to engage their attention in a suitable and relaxing scenario [54].

Many authors suggested that visual exposure to the natural environment (e.g. landscapes, vegetation and water) has a protective role against stress, restoring physiological, emotional and attention functions [55].

The attention restoration theory suggests that exposure to natural environments combined with sounds has a relaxing effect.

The attention request from the clinical setting is lower, and this promotes a sense of being away, stimulating less cognitive domains.

This has a crucial role in cognitive abilities because it allows the attention capacity to be restored [56].

Chirico et al. focused on the level of immersion given by this experience.

They found out that exposure of VR nature environment stimuli can trigger a parasympathetic activation, inducing strong emotion and a vivid sense of scene [57].

Gerber and colleagues [58] conducted an interesting study in order to investigate how virtual reality could help to relax in the intensive care unit.

In this study, three different nature VR videos (landscape, water worlds and animals) were presented.

To measure the visual exploration behavior (e.g. where the patient "looks at" and whether the eyes are open), the video-oculography was used.

Furthermore, to measure participant's reactions to the virtual reality stimuli, many vital parameters (heart rate, blood pressure, etc.) were recorded while the videos were presented to the patients.

The results suggest that in line with previous studies, the exposure to virtual nature environments produced a relaxing effect.

In fact, all vital sign measurements (heart frequency, respiratory frequency) significantly decreased during the session of virtual reality.

This could show a positive link between VR and the reduction of psychological stress.

In addition, no fatigue in visual exploration task and target stimulus has affected the visual exploration behavior.

Finally, the VR scenario was accepted by all the participants of the study and the possibility to be adapted for use in frailty patients.

## **6. Future perspective of research and the potential benefit of the use of the proposed model in the clinical setting**

The aging population is increasing, making a critical impact on social care. Therefore, from our point of view, it is necessary to consider new potential solutions as a therapeutic instrument to help frailty people.

A potential benefit solution comes from positive technology.

#### *The Complexity of Frailty: Psychological Mechanism and Therapeutic Interventions in Old… DOI: http://dx.doi.org/10.5772/intechopen.92630*

The aim of this approach is contributing to the development of well-being for the elderly and allows them to maintain their autonomy in their activities of daily living.

It is necessary to consider that positive technology could have a positive effect on the psychological well-being of the elderly in an alternative way from the classical therapeutic intervention which has already been used.

Also, taking together the main geriatrics models and deep comprehension of the cognitive and emotional functions of the older gives the clinicians an opportunity to embrace multiple disciplines.

It is crucial to consider many different aspects of the aging process from a different point of view (medical, psychological and engineering).

This multidisciplinary approach gives the clinicians the opportunity to develop and implement an innovative cognitive rehabilitation program providing to the elderly strategies to increase motivation and social relationship in every clinical setting.

In conclusion, future research should be focused on the importance of technology as an instrument that could be used by the clinicians, the elderly patients and especially their family to reduce the distance between them.

It has to be considered that most of the frailty elderly are in critical conditions and live in nursing homes away from their family.

Positive technology could represent a bridge of hope between them and their families, contributing to keeping alive a sense of community and the joy of sharing their emotions.

## **7. Conclusion**

The basic objective of this book chapter is to briefly describe the complexity of aging, the impact of cognitive representation on emotions and life events, and the role of new technology's solution and physical activity as therapeutic interventions.

These results confirm the importance of considering multidimensional aspects of the aging process (psychological mechanism and physical structures).

Taking together there are really good changes that in the near future will be possible to help many humans to live healthy aging.
