Main LLM Results

The overall results of the project, deriving from the pilot validation and the scientific and usability evaluation of the LLM solution, and the important feedback from the involved stakeholders of the LLM Network of Interest, has provided to the consortium the confidence that LLM deployment is feasible and the appropriate positive influence to proceed to its business sustainability.
Consortium activities and Partners complementarity provided the opportunity to validate the LLM deployment potential in three (3) different perspectives: technological, scientific and business.
The evaluation process included a clinical intervention protocol, dedicated usability and user satisfaction questionnaires, interviews, open discussions and several small scale surveys, with the following valuable human resources of the LLM project:

• A large variety of stakeholders (private and public) that have been involved especially through the project network of interest (medical and health-care providers, investors, government bodies, insurance companies, etc).
• The older people involved in the pilots, that have very generously provided their time and commitment to use and validate LLM service.
• Care personnel involved in the pilots that have provided a large support and feedback in a daily basis, helping significantly to improve the pilot processes.

Technological

The integration of the three components, CTC, PTC and ILC and their corresponding applications was successfully accomplished. Therefore a server based infrastructure was developed which allows an easy integration of new kinds of application modules, requiring minimum adaptation efforts.
Technical large scale testing of the LLM system was conducted twice in a laboratory environment on the two versions of the overall system that was released during the project lifetime.
Additionally, the usability testing of LLM service through the pilot trials has shown that: around 84% of the participants in the evaluation process, rated the LLM as being easy to learn how to use, warm & friendly user environment, the instructions were clear and both the physical and the cognitive components were well adapting to the users’ needs.

Scientific

Affective evaluation of LLM
Training with the LLM program made 94% of the participants feel mostly positive (they felt it was fun, they liked it, they felt cheerful after training with it, they felt refreshed and calm).
95% of participants believed that exercising through LLM was beneficial for them, most felt LLM was amusing and they enjoyed their sessions with it and LLM met their expectations. The majority of participants felt quite satisfied with LLM.
It is an innovative and very enriching experience that helped them also work several emotions:

• Control of fear facing new situations / Confidence
• Helps approaching failures and successes / Enthusiasm
• Safety through training / Satisfaction
• Working with computers strengthens self-esteem

Satisfaction
There was an overall satisfaction of achievement, for being part of a flexible, rigorous and entertaining programme that offers a new way to approach their problems, that it really catches users’ attention.
78% of the participants felt LLM was amusing, they enjoyed their sessions with it and it met their expectations. The majority of participants felt quite satisfied with LLM.
All staff members believed that the participants seemed to enjoy their training with LLM, that it is beneficial for them and that LLM is useful in training elderly people cognitively as well as physically.

Independent Living
On average, users reported that:

• training with LLM made them feel they can control their health better
• they would be able to use it at home without help
• In Home installations, some agreed that LLM made them feel more autonomous
• some of them , especially when  performing physical training alone at home, felt more safe  knowing that a fall down would lead to an immediately generated alarm calling for help
• the user interface was very easy to learn and handle
• The ILC’s information features were seen as a very attractive goodie (e.g. RSS-feed, weather forecast)
• nearly all participants would like to have the system when it comes to a final product

Social Integration
The vast majority (96,5%) of the participants at Day Care Center Installations believed that training with LLM improved their social life.
Most users at Home Installations believed that LLM enriched their means of communication and it made them feel closer to their families a little more than before.
Exercising at care centers revealed competition between the elderly on their cognitive and physical exercise performance, which was an incentive for them to be engaged, reduced the drop out percentage and improved their social interaction.Cognitive and physical benefit
The overall statistical data of measuring cognitive and physical parameters has shown that this non-pharmacological intervention to improve cognitive abilities in elderly people (healthy subjects or patients with mild cognitive deficits or early stages of dementia) had impressive results both qualitatively in certain brain functions affected by aging and psychological state of participants.
Overall, we demonstrated that the full LLM training, consisting of combined physical exercise and Cognitive Training, leads to significant improvements in both episodic memory (the capacity to learn and retain new information) and working memory (the capacity to hold and cognitively manipulate new information) in elderly people.
Longer training durations and more training sessions induces stronger improvements of long-term memory function. Based on this we recommend a continuous training regimen which is associated with long-lasting memory improvements.

Figure 2: LLM intervention effects on latent cognitive functions. a) Bars represent change effect sizes (post-test minus pre-test, divided by the pre-test standard deviation of the total sample) for the Long Lasting Memories group (LLM) and the passive control group (Control). Net ES d is presented for statistical significant group × session interaction effects. b) LLM and Control group comparison of standardized pre- and post-scores of episodic memory performance. Arrows represent SE. Statistical effects are marked by asterisks: * p < .05; ** p < .01, *** p < .001What scientific data show, is that if we could delay the onset in the dementia in the population by 5 years, we would reach a 50% reduction in the cases of Dementia. In this way the improvement of cognitive abilities in the elderly people is highly welcome.

Sustainability outcomes

The diversity of the European Local Markets makes it difficult to establish a common market selection and strategy, not only due to very different sizes but also to the non-existence of some niches in those Local Markets. On the other hand, the unique selling proposition of LLM empowers LLM business opportunities beyond competitors across all Europe. To manage these issues, the LLM Consortium has proposed a new orientation to its business model, in order to achieve the needed flexibility to adequately reach the market.
Several local business models are envisaged in five (5) countries, some of them promising, some of them already proven to be valid, differ across Europe: either a collaboration agreement for selling across a country with already settled providers (case of Spain) and the creation of spin-offs coming out of the University (Cyprus, Greece and Germany) and the nonprofit research institute (Austria).
The strategy of local business plans has allowed even partners that initially felt out of the business because of their academic profile and because they were not directly involved in running a pilot in their site (e.g. UULM), to rethink their situation and find out how to make business out of the project outcomes.
In this respect, all consortium partners, private, public and non-for-profit ones, have shown their commitment for deploying the LLM services and sustain them locally, by designing their own local business plans.
Even if conditioned by a difficult financial environment, LLM exploitation shows a good potential.  Going to the market with the full or the light LLM service, seems feasible, even if it takes longer and kicks-off with a lower profit than initially foreseen. Under current circumstances of economic crisis and reduction of public spending, even the fact of attempting to intrude the market can be considered a successful challenge in itself.
Pilot evaluation has shown that:

• On average, pilot users  believed that it is worth paying for LLM, that they would wish to continue using it, while the majority of them have recommended LLM to friends/relatives
• Half of the participants of trial sites in day care centers would prefer to use it at home (to avoid mobility issues), although the other half preferred visiting the day care centres thereby enjoying socializing with other people while training with LLM.

In parallel, the overall market analysis and business plans from identifying customers, proposing marketing strategies to foreseeing sustainable business models has been communicated with the project NoI stakeholders, providing a clearer and more focused view to the consortium.
The received feedback that motivated and helped in the final decision making of the overall partners business plans, can be seen below (in a best practice recommendation format):

• Advise on replicability of LLM service to other member states
• Acquire the commitment of technology providers that will continue to support the service after the end of the project.
• Allow for as lower prices as possibly achievable to make it affordable
• Split the offering of LLM into two packages CTC+PTC and CTC+PTC+ILC
• Provide scientific consulting services when dealing with customers with cognitive deficits (subjects with Mild Cognitive Impairment or Mild Dementia)
• Improve LLM system technologically and increase support and marketing resources with the first income acquired.
• Penetrate the market by building strong relationships with the Care service organisations and public social policy organisations