Older people's needs for soft exoskeletons: a human-centered, participatory study

Exoskeletons offer significant potential to enhance mobility and support independent living in older adults. However, their widespread adoption is hindered by a limited understanding of the diverse user needs and design requirements. To address this gap, we conducted a two-stage human-centered participatory study to identify user needs, preferences, and design requirements for soft exoskeletons design and evaluation. Stage 1 comprised six co-design workshops with older adults with mobility challenges and their family caregivers (n = 14), focusing on lived experiences, physio-psychosocial needs, and design expectations. Stage 2 involved laboratory-based assessments with 157 older adults to collect behavioral, functional, and biomechanical parameters relevant to exoskeleton performance requirements. The study identified four core physio-psychosocial needs, 13 design requirements, and nine objective performance benchmarks. Key priorities include facilitating daily task performance and mobility to foster independence and prevent injury; ensuring comfort, personalization, and durability; supporting competence and self-esteem through ease of use, aesthetic design, and affordability; promoting social connectedness and inclusion; and upholding ethical and moral integrity through accessibility, data security, and transparency. The nine evaluation benchmarks encompass biomechanical, functional, and behavioral parameters, including step length, stride length, handgrip strength, knee maximal voluntary contraction at multiple angles, walking speed, chair stand performance, and Short Physical Performance Battery scores. The finding offers a practical, evidence-based framework for aligning soft exoskeletons with the complex physical, psychological, and social needs of older adults, thereby promoting usability, acceptance, and adoption in aging societies.