Visualization approaches to support healthy aging: A systematic review

Uba Backonja, Nai-Ching Chi, Yong Choi, Amanda K Hall, Thai Le, Youjeong Kang, George Demiris


Background: Health technologies have the potential to support the growing number of older adults who are aging in place. Many tools include visualizations (data visualizations, visualizations of physical representations). However, the role of visualizations in supporting aging in place remains largely unexplored.

Objective: To synthesize and identify gaps in the literature evaluating visualizations (data visualizations and visualizations of physical representations), for informatics tools to support healthy aging.

Methods: We conducted a search in CINAHL, Embase, Engineering Village, PsycINFO, PubMed, and Web of Science using a priori defined terms for publications in English describing community-based studies evaluating visualizations used by adults aged ≥65 years.

Results: Six out of the identified 251 publications were eligible. Most studies were user studies and varied methodological quality. Three visualizations of virtual representations supported performing at-home exercises. Participants found visual representations either (a) helpful, motivational, and supported their understanding of their health behaviors or (b) not an improvement over alternatives. Three data visualizations supported understanding of one’s health. Participants were able to interpret data visualizations that used precise data and encodings that were more concrete better than those that did not provide precision or were abstract. Participants found data visualizations helpful in understanding their overall health and granular data.

Conclusions: Studies we identified used visualizations to promote engagement in exercises or understandings of one’s health. Future research could overcome methodological limitations of studies we identified to develop visualizations that older adults could use with ease and accuracy to support their health behaviors and decision-making.


Aged; consumer health information; data display; informatics; visualization

Full Text:



National Institute on Aging. Global Health and Aging. NIH Publication no. 11-7737. Bethesda, MD: National Institutes of Health, 2011.

Vincent GK and Velkoff VA. The Next Four Decades: The Older Population in the United States: 2010 to 2050. Report P25-1138. Washington, D.C.: US Census Bureau. 2010.

Administration on Aging. A Profile of Older Americans: 2014. Report, US Department of Health and Human Services, USA. 2014.

Congressional Budget Office. Rising Demand for Long-Term Services and Supports for Elderly People. Report, Congress of the United States, USA; 2014.

Hanson GJ, Takahashi PY and Pecina JL. Emerging technologies to support independent living of older adults at risk. Care Management Journals 2013;14:58–64. PMid:23721044.

Chi NC, Demiris G. A systematic review of telehealth tools and interventions to support family caregivers. Journal of Telemedicine and Telecare. 2015; 21:37-44.

Demiris G, Thompson H, Boquet J, Le T, Chaudhuri S and Chung J. Older adults’ acceptance of a community-based telehealth wellness system. Informatics for Health and Social Care 2013;38:27-36.

Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J and Ten Have T. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist 2012; 52:541–52.

Demiris G and Hensel BK. Technologies for an aging society: a systematic review of “smart home” applications. Yearbook of Medical Informatics 2008:33–40. PMid:18660873.

Reeder B, Meyer E, Lazar A, Chaudhuri S, Thompson HJ and Demiris G. Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review. International Journal of Medical Informatics 2013;82:565–79.

Bertin J. Semiology of Graphics: Diagrams, Networks, Maps. Madison, WI: University of Wisconsin Press, 1983. PMCid:PMC2714599.

Card SK, Mackinlay J and Shneiderman B. Readings in Information Visualization: Using Vision to Think. San Francisco, CA: Morgan Kaufmann,1999.

Few S. Now You See It: Simple Visualization Techniques for Quantitative Analysis. Oakland, CA: Analytics Press, 2009.

Heer J, Bostock M and Ogievetsky V.A. Tour through the Visualization Zoo: A survey of powerful visualization techniques, from the obvious to the obscure. Graphics. 2010; 8(5).

Elting LS, Martin CG, Cantor SB and Rubenstein EB. Influence of data display formats on physician investigators’ decisions to stop clinical trials: prospective trial with repeated measures. British Medical Journal 1999;318:1527–31. PMid:10356010 PMCid:PMC27896.

Feldman-Stewart D, Brundage MD and Zotov V. Further insight into the perception of quantitative information: judgments of gist in treatment decisions. Medical Decision Making 2007;27:34–43. PMid:17237451.

Feldman-Stewart D, Kocovski N, McConnell BA, Brundage MD and Mackillop WJ. Perception of quantitative information for treatment decisions. Medical Decision Making 2000;20:228–38. 0.1177/0272989X0002000208. PMid:10772360.

Gaissmaier W, Wegwarth O, Skopec D, Müller AS, Broschinski S and Politi MC. Numbers can be worth a thousand pictures: individual differences in understanding graphical and numerical representations of health-related information. Journal of Health Psychology 2012;31:286–96. PMid:21842998.

Garcia-Retamero R, Okan Y and Cokely ET. Using visual aids to improve communication of risks about health: a review. ScientificWorldJournal 2012;2012:562637. PMid:22629146 PMCid:PMC3354448.

Hoeke JO, Bonke B, van Strik R and Gelsema ES. Evaluation of techniques for the presentation of laboratory data: support of pattern recognition. Methods of Information in Medicine 2000;39:88–92. PMid:10786077.

Morrow DG, Hier CM, Menard WE and Leirer VO. Icons improve older and younger adults’ comprehension of medication information. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 1998;53:P240–54.

Shneiderman B, Plaisant C and Hesse BW. Improving health and healthcare with interactive visualization methods.Computer.2013. Available from:

Zikmund-Fisher BJ, Witteman HO, Dickson M, Fuhrel-Forbis A, Kahn VC, Exe NL et al. Blocks, ovals, or people? icon type affects risk perceptions and recall of pictographs. Medical Decision Making 2014;34:443–53.

Duke JD, Li X and Grannis SJ. Data visualization speeds review of potential adverse drug events in patients on multiple medications. Journal of Biomedical Informatics 2010;43:326–31.

Hugine AL, Guerlain SA and Turrentine FE. Visualizing surgical quality data with treemaps. Journal of Surgical Research 2014;191:74–83.

Bieryla KA. Xbox Kinect training to improve clinical measures of balance in older adults: a pilot study. Aging Clinical and Experimental Research.2016;28(3):451–7. [Epub ahead of print]. PMid:26386865.

Chao YY, Scherer YK and Montgomery CA. Effects of using Nintendo Wii™ exergames in older adults: a review of the literature. Journal of Aging and Health 2015;27:379–402.

Laufer Y, Dar G, Kodesh E. Does a Wii-based exercise program enhance balance control of independently functioning older adults? A systematic review. Journal of Clinical Interventions in Aging 2014;9:1803–13.

Molina KI, Ricci NA, de Moraes SA and Perracini MR. Virtual reality using games for improving physical functioning in older adults: a systematic review. Journal of Neuro Engineering and Rehabilitation 2014;11:156.

Moher D, Liberati A, Tetzlaff J, Altman DG and PRISMA Group. Preferred reporting items for systematic reviews and metaanalyses: the prisma statement. PLoS Med. 2009;6:e1000097. doi:10.1371/journal.pmed1000097.

Ayoade M, Uzor S and Baillie L. The development and evaluation of an interactive system for age related musculoskeletal rehabilitation in the home. Kotzé P, Marsden G, Lindgaard G, Wesson J, Winckler M (Ed). 14th IFIP TC 13 International Conference on Human-Computer Interaction, INTERACT 2013,2–6 September 2013; Cape Town, South Africa. (8120):1–18.

Bruun-Pedersen JR, Pedersen KS, Serafin S and Kofoed LB. Augmented exercise biking with virtual environments for elderly users: a preliminary study for retirement home physical therapy. In: 2nd Workshop on Virtual and Augmented Assistive Technology, VAAT 2014 –Co-located with the 2014 Virtual Reality Conference,30 March 2014, Minneapolis, Minnesota, USA. 23–27.

Gronvall E and Verdezoto N. Understanding challenges and opportunities of preventive blood pressure self-monitoring at home. 31st European Conference on Cognitive Ergonomics: Work, Education, Society, ECCE 2013,26–28 August 2013, Toulouse, France. Paper no. 31, New York: ACM.

Le T, Reeder B, Chung J, Thompson H and Demiris G. Design of smart home sensor visualizations for older adults. Technol Health Care 2014;22:657–66.

Le T, Reeder B, Yoo D, Aziz R, Thompson HJ and Demiris G. An evaluation of wellness assessment visualizations for older adults. Telemedicine Journal and E-Health. 2015;21:9–15.

Uzor S and Baillie L. Exploring designing tools to enhance falls rehabilitation in the home. 31st Annual CHI Conference on Human Factors in Computing Systems: Changing Perspectives, CHI 2013,27 April 2013 to 2 May 2013; Paris, France.1233–1242;

Norman DA. Emotional design why we love (or hate) everyday things. New York: Basic Books,2004.

Shah P and Hoeffner J. Review of Graph Comprehension Research: Implications for Instruction. Educational Psychology Review 2002;14:47–69.

Lewis JR. Sample Sizes for Usability Studies: Additional Considerations Human Factors. Human Factors 1994;36:368–78,

Cleveland WS and McGill R. An experiment in graphical perception. International Journal of Man-Machine Studies 1986;25:491–500.

Cleveland WS and McGill R. Graphical Perception: Theory, Experimentation, and Application to the Development of Graphical Methods. Journal of the American Statistical Association. 1984;79.387:531–54.

Le T, Aragon C, Thompson HJ and Demiris G. Elementary graphical perception for older adults: a comparison with the general population. Perception 2014;43:1249–60. PMid:25638940.

Shneiderman B. The eyes have it: a task by data type taxonomy for information visualizations. IEEE Symposium on Visual Languages,3–6 September 1996, Boulder, Colorado, USA; Los Alamitos, CA: IEEE Computer Society Press,1996:336–343.

Le T, Thompson H and Demiris G. A Comparison of Health Visualization Evaluation Techniques With Older Adults. IEEE Computer Graphics and Applications 2015. [Epub ahead of print].

Nayak JG, Hartzler AL, Macleod LC, Izard JP, Dalkin BM and Gore JL. Relevance of graph literacy in the development of patient-centered communication tools. Patient Education and Counseling 2015. pii: S0738-3991(15)30075–6. [Epub ahead of print].



  • There are currently no refbacks.

This is an open access journal, which means that all content is freely available without charge to the user or their institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal starting from Volume 21 without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open accessFor permission regarding papers published in previous volumes, please contact us.

Privacy statement: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.

Online ISSN 2058-4563 - Print ISSN 2058-4555. Published by BCS, The Chartered Institute for IT