Empathy towards ageing and physical limitations: the TrajeMax

Have you ever been queuing in the supermarket behind an elderly person, who was taking an awful long time to pay and put the shopping away, and felt the irrepressible impulse to help them to go faster? Or have you been in the situation of waiting to get on the bus while someone with a disability was slowly climbing the steps of the main entrance, and thought of offering them your arm so that they could reach their goal as soon as possible? Perhaps he imagined that coming to his aid would be a commendable action and worthy of applause from those who were going through the same ordeal while waiting. He would have been a hero, but a hero without any empathy for those he thought he was supposed to rescue.  

Stephan Biel is an expert when it comes to empathy. A nurse by profession - specialising in gerontology -, consultant and trainer in social gerontological innovation from a humanist perspective based on ACP and ADP, this German based in Barcelona has been teaching companies, universities, administrations, hospitals and residences for more than thirty years how to be more empathetic towards people living with physical limitations through his personal brand Biel Consulting. For Stephan, empathy is a complex social skill that allows us to perceive, share and understand what others feel. Training it means making an effort to be able to put yourself in other people's shoes, understanding that there is no such thing as normal, only diversity in all its splendour. 

Biel understood a long time ago that empathy was the key to changing our perception of ageing and the current geriatric care model. That is why, from his gerontological consultancy, he offers courses to work on empathy in dealing with older adults and people with different degrees of disability through awareness and, more importantly, experimentation. What better way to learn what it means to face the world with age or disability-related limitations than by putting ourselves in the shoes of those who suffer from them? Stephan achieves this not only by passing on his wisdom, but also by putting on the TrajeMax (suit).

The modular ageing simulation suit MAX (Modulärer Alterssimulationsanzug Xtra MAX), presented in Spain for the first time at the OrtoProcare trade fair in 2010 by the Volkswagen car company, is a garment that limits body functionality through ten adjustable modules that mimic different levels of physical deterioration. The elements that make it up are as follows: 

• Glasses that decrease visual acuity and field of vision and change colour perception. 

• Hearing protectors that reduce hearing ability. 

• Neck braces that restrict movement of the cervical vertebrae. 

• Elbow pads that limit the strength and mobility of the elbow. 

• Waistcoats and belts that restrict shoulder flexibility and trunk muscle strength. 

• Cuffs that reduce the strength and movement of the wrists.

• Gloves that reduce finger sensitivity. 

• Trousers that reduce the flexibility of the hips and knees. 

• Knee pads that impair the strength and mobility of the knees.

• Boots that increase ankle stiffness and cause instability. 

Although it is not the only known ageing simulation suit, it is the most complete to date because of those adjustable modules capable of representing up to three different degrees of deterioration for each of these areas of the body. At the lowest level, green, the limitations are 20%. These are those typical of people in the 50-60 age range - in probabilistic terms, because age alone is by no means a determining factor - or who have been slightly incapacitated by accidents or illness. The yellow level corresponds to 40% limitation, frequent from 61 to 70 or in more severe cases of disability. Finally, red does justice to people aged 71 to 80 or with severe limitations of up to 60%. Real as life itself, the SuitMax allows us to feel what, for example, a 75-year-old with knee problems and cataracts, but with acceptable strength and flexibility in the upper body, feels. It also distinguishes between the sexes, because the physical limitations faced by men and women are not the same. 

The suit was originally designed to improve the ergonomic working conditions of Volkswagen's older employees. The company, aware of the demographic change that will lead us all to postpone the retirement age, wanted to put itself in the place of its employees in order to be able to adapt its workplaces to their needs. It knew that this would make its employees happier, increase productivity and reduce sick leave. So he commissioned the Unit for Work Science and Innovation Management at the Technical University of Chemnitz to bring together a team of experts in medicine, gerontology, sports science and psychology to develop the ultimate ageing simulator. 

MAX proves to be valuable not only in the work environment. Its use also generates knowledge about the ins and outs of the ageing process and what it means to have physical limitations, facilitating the creation of new ideas to promote a healthier, more active and autonomous life. More than 200 scientific studies (see, for example, Rueffert and Bullinger, 2019) demonstrate its effectiveness in testing the extent to which our environments, products and services are adapted and friendly enough to those who are more physically limited. From cities and their buildings, to public toilets, supermarkets, means of transport, to the design of technological devices, the SuitMax helps entrepreneurs, researchers, administrators, designers and service providers to feel what many - and very different - people with different physical abilities feel. 

Biel assumed that the suit could become an essential tool in raising awareness of what it means to age with varying degrees of physical impairment and improve empathy. Five years after the MAX was launched in Spain, Stephan managed to obtain the only licence to use it as part of his experimental training. Since then, it has made it possible for more than 2,300 professionals in the healthcare, hospital, university, administrative and production sectors nationwide to feel limited for a while and experience reality as those they support on a daily basis and for whom they launch their products and services, helping them to orient their professional performance towards a more sensitive practice. 

The simulator instantly transforms us into subjects with physical limitations. But what exactly does this mean? Each case is unique, of course. Generally speaking, however, the TrajeMax makes us feel that our mobility and strength are diminished, that we are less flexible, that we are tired and our bodies weigh us down, that we find it difficult to see and hear what is happening in our context, and that the ground we walk on is unstable and insecure. But it doesn't end there. All these physical sensations are accompanied by a psychic correlate that translates into the experience of fear and helplessness, disorientation and anxiety, loneliness and lack of control, self-effacement and lack of autonomy. 

It is worthwhile to review the testimonies of some of those who have tried it. David Cabrero, director of the San Jerónimo Residence in Estella, said that, wearing the suit, he found it difficult to get up and felt insecure. Mertxe Aguilar, from the Ítaca Residence in Barcelona, said that she felt slow and frustrated. From the Joviar Residence, in Lérida, workers said they felt powerless, isolated and abandoned. Lluví Farré, a researcher on ageing at the Universitat Oberta de Catalunya, confirmed that the suit forced him to make an extra effort to relate to his surroundings. Sylvia Hoppe and Iris Luchs, nursing consultants at Knappschaft, admitted that climbing stairs, bending down to pick up an object or driving was a real pain.

At the fair, Stephan himself wore the suit for 5 hours straight. In an interview for CENIE readers, he tells us that the first thing that struck him when he tried the MAX was that his body posture had completely changed. He was leaning forward, hunched over, as we see older people do on many occasions. His movements were slow and he walked very slowly. "I had to bend my head down and look at the ground all the time because I couldn't see well. I also had trouble hearing what others were saying around me," says Biel. The most shocking thing was discovering that you may know the theory about physical limitations very well, but it is not until you experience them in your own flesh that you are able to know how others feel. "I realised that when a person with limitations says they can't do something, it's because they can't do it, no matter how hard we try to push the machine. 

I was lucky enough to accompany him in one of his trainings in a residence in Madrid a couple of months ago. Although I was not able to live the experience to the full, I did use some of the modules and I can confirm all of the above. Specifically, I tried the acuity and visual field reduction goggles, the ear protectors to simulate hearing loss and the phalangeal desensitisation gloves. This alone gave me an idea of how difficult it can be to perform certain everyday activities such as eating, dressing or participating in a group conversation when you live with physical limitations. 

The best thing about the TrajeMax is that, as Daniel López - another UOC researcher - pointed out, although it "does not replace the experience of the elderly [or people with limitations], it enables a space for dialogue between [them] and those around them". It is a starting point to start thinking about how we can support them and integrate them into society without depriving them of their autonomy or giving them a hard time. All those who have taken part in the simulator agree that, after receiving this reality bath, it has become clear to them that it is necessary to make an effort to change both our practices and the way in which we design and create spaces, services and products that aspire to be inclusive and respectful of individual differences. 

At The Éden Alternative, we call this moment of clarity that is reached after training empathy through experimentation a eureka moment. Participants of the Biel trainings with the TrajeMax have experienced many revelations. Some say that they have suddenly understood that we are the ones who have to adapt to the pace of people with physical limitations, never the other way around: "When we do things quickly in order to finish quickly, we make them feel powerless, useless and dependent"; "Giving them food at full speed or transferring them in a wheelchair from one room to another at high speed causes them fear and disorientation"; "Changing them in the crane, eager to finish the task as soon as possible, causes them pain and frustration"; "Talking to them from certain angles to which they do not have visual access makes them feel uncomfortable and isolated"; "Turning them sharply in bed makes them dizzy"; "If we push them to finish dressing in less than five minutes, we overwhelm and disempower them". How often we demand more from others than they can give without even being aware of it! 

The experimentation offered by Stephan is a lesson in empathy and humanisation that teaches us that we must be more patient, understanding and sensitive in order to adapt to the different situations in which people find themselves; that we have to talk more with those we intend to support and, above all, give them more information and transmit more security to them; that we must always ask them, get to know them and take an interest in their preferences and their biographies; that we must value the effort made daily by those who live with limitations to remain active and autonomous; that we must rethink the architecture and the environments in which we live to assess whether they are sufficiently friendly, and also that it is essential to work in groups and to train continuously to improve little by little. This is what the TrajeMax contributes to!

We all think we are empathetic enough, until we try the MAX ageing simulator. Then we realise that there is much more we can do, that we still need to think about how we act and how we deal with those who are out of the norm. But the SuitMax also gives us a better understanding of what it will mean for each of us to live with limitations in the future: those of us who are young now will also want to remain active and independent as time and the vicissitudes of life take their toll on our bodies, and we will want others to understand us! 

Stephan Biel describes the process of improving our empathy through the use of the SuitMax as a journey into the future. I believe this is a journey we should all embark on as soon as possible. At the risk of being extreme, I believe that we should all try this simulator, from young people in schools to adults at the height of their autonomy and independence, if we really want to become more empathetic. The experience is available to us through the following resources: 

• Through the course “Experimental training. Improving empathy and awareness in caring for people with the TrajeMax Aging and Empathy Simulation Modular Suit, in its advanced mode (8 hours for a maximum of 16 people) or reduced (4 hours for groups of no more than 9 people).

• By renting the TrajeMax for designs, conferences and events related to demographic change, ageing and the improvement of the quality of life of people with physical limitations.

• By contacting Biel by telephone or by mail to request a specific quotation in other environments such as domestic, educational, administrative or sporting, to mention a few possibilities.

The TrajeMax is not for sale, so any institution or individual wishing to embark on this journey into the future will have to put themselves in the hands of the empathy expert to lead them on their adventure successfully. While we think about it, here is an invitation to watch some of his webinars and BC Express on ACP and ADP, demographic change, ageist language or dementia, among other topics of interest, to whet your appetite. We are just one suit away from becoming more empathetic!