Mobile game design for the elderly: A study with focus on the motivation to play

Meaningful learning: motivations of older adults in serious games

Social sustainability is the generation of significant behaviors through balanced levels of education, learning and awareness so that the population has a good standard of living, achieves self-improvement and supports society. This can be achieved with various strategies, one of which is learning through games, which has gained popularity in recent years due to positive results. This is effectively achieved through serious gaming, which is growing steadily, mostly in education and healthcare. This type of strategy has been typically used in young populations with a transparent interaction with technological processes that facilitate its application. However, one cannot neglect other populations such as the elderly, who may experience a technology gap and may not perceive this type of initiative in the best light. The purpose of this article is to identify the different motivations that can encourage older adults to use serious games to encourage learning processes through technology. For this purpose, different previous research on gaming experiences with older adults has been identified, from which it was possible to categorize a series of factors that motivate this population. Subsequently, we represented these factors by means of a model of motivation for the elderly and, to be able to use it, we have defined a set of heuristics based on this model. Finally, we used the heuristics by means of a questionnaire to evaluate the design of serious gaming for older adults, obtaining positive results for the use of these elements to guide the design and construction of serious games for learning in older adults.

Using Digital Technology to Design a Simple Interactive System for Nostalgic Gaming to Promote the Health of Slightly Disabled Elderly People

An interactive digital gaming system with simple tangible interfaces is proposed for use by slightly disabled elderly people to promote their health and enjoyment of playful aging. The system simulates a rice threshing machine with nostalgic and entertaining functions expected to bring better life quality to older adults. Initially, pieces of literature were reviewed to derive relevant design principles. A prototype system was constructed accordingly and refined according to the invited older users' comments. The refined system was performed subsequently by slightly disabled elderly people, followed by a questionnaire survey conducted to collect their opinions. The opinion data were analyzed statistically by SPSS and AMOS to be reliable and valid. In addition, interviews were conducted with the users and experts were invited to collect comments on the system's usability, which were then evaluated to reveal several findings about the system's effectiveness: (1) digital products related to life experiences are more acceptable to slightly disabled elderly people, promoting their willingness to play games to achieve active aging; (2) simple system interfaces requiring no complicated limb functions are appropriate for the slightly disabled elderly people; and (3) digital gaming has the effects of training slightly disabled elderly peoples' cognitive and motor abilities as well as strengthening their body and mind.

Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions

Objective

The use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies.

Methods

To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being.

Results

The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions.

Conclusion

This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.

Effects of Healthcare Technologies on the Promotion of Physical Activities in Older Persons: A Systematic Review

This study aimed to explore the effects of health technologies on the promotion of health through physical activities of older persons. Following PRISMA guidelines, a systematic review of relevant articles published prior to 2020 was conducted from selected indices such as COCHRANE, PubMed, Science Direct, Proquest, including the use of hand search procedure. Twenty-seven articles were analyzed with significant findings influential to older people nursing: types of health technologies used for promoting physical activity; effects of technology use in promoting physical activity of older person care; and aspects that need to be considered in technology use among older persons. Characteristics of technologies were accuracy, usefulness, reliability, comfort, safety, and relevancy. Most technologies promoting physical activities for older people were wearable technologies that use artificial intelligence. Altogether, these technologies influenced overall healthcare behaviors of older persons. With healthcare technology efficiencies, proficiencies, and dependencies, technology-based healthcare have served older people well. Most technologies for older people care, such as wearables, reliably produce characteristics enhancing dependency and accuracy of bio-behavioral information influencing physical activities of older persons. Health technologies foster the values of physical activities among older persons thereby promoting healthy living.

Empirical Study of Virtual Reality to Promote Intergenerational Communication: Taiwan Traditional Glove Puppetry as Example

Based on glove puppetry, a traditional cultural pursuit of Taiwan, this study designed a virtual reality (VR) intergenerational game to bring together the elderly and young participants. In the game, a system of cooperation and sharing was constructed which would lead to an exchange between experience and knowledge of traditional culture and digital technology and result in intergenerational interaction and communication learning. Through interviews with eight subjects after the empirical study, this study explored the operation and experience of this game, the perception of interaction and dialogue, and the cultural heritage and learning. According to the research findings, VR game cultural elements and technology learning positively influence intergenerational relations and communication. Key factors of VR intergenerational games include the following: (1) the game content must be attractive for the elderly; (2) the operating procedure of the game and affordance of the interface for the elderly must be simplified; and (3) the game must establish a sense of achievement for players.

Serious Gaming for Behaviour Change: A Systematic Review

Over the years, there has been a significant increase in the adoption of game-based interventions for behaviour change associated with many fields such as health, education, and psychology. This is due to the significance of the players’ intrinsic motivation that is naturally generated to play games and the substantial impact they can have on players. Many review papers measure the effectiveness of the use of gaming on changing behaviours; however, these studies neglect the game features involved in the game design process, which have an impact of stimulating behaviour change. Therefore, this paper aimed to identify game design mechanics and features that are reported to commonly influence behaviour change during and/or after the interventions. This paper identified key theories of behaviour change that inform the game design process, providing insights that can be adopted by game designers for informing considerations on the use of game features for moderating behaviour in their own games.

A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study

Background

There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population.

Objective

The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain.

Methods

A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane’s trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game.

Results

A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and “real” in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session.

Conclusions

The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology.

Seniors' adoption of digital devices and virtual event platforms in Singapore during Covid-19

In Singapore, with the nationwide implementation of Covid-19 physical restrictions and safe management measures (SMMs) in place because of the pandemic, the seniors' regular routines and daily social activities have been disrupted. Prior research on seniors' adoption of digital technologies has primarily focused on health-related purposes such as nutrition and exercise and managing old-age related diseases. However, there is limited research done to understand how seniors use digital technologies for other purposes, such as social networks or leisure activities, that can help seniors socialise and reduce loneliness despite ongoing SMMs and restrictions on social distancing and physical interactions because of the Covid-19 pandemic. In particular, the use of virtual event platforms can make it easier for seniors to communicate and socialise with their peers, thus keeping social isolation and loneliness at bay. In this paper, we discuss seniors' relationship with technology, guided by the social exchange theory. We also share the methodological framework that guided this small-scale study on the use of virtual event platforms, along with the research instruments and measurements required for data collection. The research findings of this study, conducted with 144 respondents aged 60 years old and above, are discussed and further analysed with their theoretical contributions and implications for practice.

Interaction Preference Differences between Elderly and Younger Exergame Users

Existing motion capture technology can efficiently track whole-body motion and be applied to many areas of the body. This whole-body interaction design has gained the attention of many researchers. However, few scholars have studied its suitability for elderly users. We were interested in exercise-based whole-body interactive games, which can provide mental and physical exercise for elderly users. We used heuristic evaluation to measure participants' actions during exergame tasks and analyzed preference differences between elderly and younger users through the distribution of actions in four dimensions. We found that age affected the actions performed by users in exergame tasks. We discuss the mental model of elderly users during the process of performing these tasks and put forward some suggestions for interactive actions. This model and these suggestions theoretically have guiding significance for the research and application of exergame design for elderly users and may help designers develop more effective exergames or other whole-body interaction interfaces suitable for elderly users.

Mobile Game Design Guide to Improve Gaming Experience for the Middle-Aged and Older Adult Population: User-Centered Design Approach

Background

The number of older adult gamers who play mobile games is growing worldwide. Earlier studies have reported that digital games provide cognitive, physical, and socioemotional benefits for older adults. However, current mobile games that understand older adults’ gameplay experience and reflect their needs are very scarce. Furthermore, studies that have analyzed older adults’ game experience in a holistic manner are rare.

Objective

The purpose of this study was to suggest mobile game design guidelines for adults older than 50 years from a holistic gaming experience perspective. Adopting a human-centric approach, this study analyzes middle-aged and older adults’ gameplay experience and suggests practical design guides to increase accessibility and satisfaction.

Methods

We organized a living laboratory project called the “Intergenerational Play Workshop.” In this workshop, 40 middle-aged and older adults (mean age 66.75 years, age range 50-85 years) played commercial mobile games of various genres with young adult partners for 1 month (8 sessions). Using a convergent parallel mixed-method design, we conducted a qualitative analysis of dialogue, game diaries, and behavioral observations during the workshop and a quantitative analysis of the satisfaction level of the game elements for the mobile games that they played.

Results

This project was active from April 2019 to December 2021, and the data were collected at the workshops from July 1 to August 28, 2019. Based on the identified themes of positive and negative experiences from the qualitative data, we proposed 45 design guides under 3 categories: (1) cognitive and physical elements, (2) psychological and socioemotional elements, and (3) consumption contextual elements. Our empirical research could reaffirm the proposals from previous studies and provide new guidelines for improving the game design. In addition, we demonstrate how existing commercial games can be evaluated quantitatively by using the satisfaction level of each game’s elements and overall satisfaction level.

Conclusions

The final guidelines were presented to game designers to easily find related information and enhance the overall understanding of the game experience of middle-aged and older adults.

A Gamification Framework for Cognitive Assessment and Cognitive Training: Qualitative Study

Background

Cognitive tasks designed to measure or train cognition are often repetitive and presented in a monotonous manner, features that lead to participant boredom and disengagement. In this situation, participants do not put forth their best effort to do these tasks well. As a result, neuropsychologists cannot draw accurate conclusions about the data collected, and intervention effects are reduced. It is assumed that greater engagement and motivation will manifest as improved data quality. Gamification, the use of game elements in nongame settings, has been heralded as a potential mechanism for increasing participant engagement in cognitive tasks. Some studies have reported a positive effect of gamification on participant performance, although most studies have shown mixed results. One reason for these contrasting findings is that most studies have applied poor and heterogeneous design techniques to gamify cognitive tasks. Therefore, an appropriate gamification design framework is needed in these tasks.

Objective

This study aimed to propose a framework to guide the design of gamification in cognitive tasks.

Methods

We employed a design science research (DSR) approach to provide a framework for gamifying cognitive assessments and training by synthesizing current gamification design frameworks and gamification works in cognitive assessment and training, as well as incorporating field experiences. The prototypes of the framework were iteratively evaluated with 17 relevant experts.

Results

We proposed a framework consisting of 7 phases: (1) preparation; (2) knowing users; (3) exploring existing tools for assessing or training a targeted cognitive context and determining the suitability of game-up and mapping techniques; (4) ideation; (5) prototyping using the Objects, Mechanics, Dynamics, Emotions (OMDE) design guideline; (6) development; and (7) disseminating and monitoring.

Conclusions

We found that (1) an intermediate design framework is needed to gamify cognitive tasks, which means that game elements should be selected by considering current cognitive assessment or training context characteristics since game elements may impose an irrelevant cognitive load that, in turn, can jeopardize data quality; (2) in addition to developing a new gamified cognitive task from scratch, 2 gamification techniques are widely used (first, adding game elements to an existing cognitive task and second, mapping an existing game to a cognitive function or impairment to assess or train it); and (3) further research is required to investigate the interplay of cognitive processes and game mechanics.

Senior Consumer Motivations and Perceived Value of Robot Service Restaurants in Korea

This research empirically tested a theoretical model by defining senior customers’ intentions to use robot service restaurants emerging in South Korea. Non-face-to-face services have become increasingly important for seniors. Therefore, restaurant marketers should cater to senior customers’ needs by sustaining robot service restaurants. The study analyzed 243 questionnaires to verify the reliability and validity of the measurement items. The research hypotheses were examined using structural equation modeling (SEM). The suggested model comprised three stages: motivated consumer innovativeness (MCI), perceived value, and planned behavior (attitude, intention to use). The results revealed that senior customers’ perceived values positively influenced attitude and were enhanced by hedonically MCI (hMCI) and socially MCI. Moreover, the hedonic and social elements of motivation improved the attitude and usage intentions of robot service restaurants for senior customers. However, these relationships differed in terms of the income level of the customer groups. For the low-income senior-level group, hMCI was more influential on the perceived value. This study is meaningful because it analyzes the effect of MCI of seniors on the perceived value of robot service restaurants, which are growing rapidly in South Korea. It has empirically proved the moderating effect of different income groups, providing practical implications.

Promoting Physical Activity in Japanese Older Adults Using a Social Pervasive Game: Randomized Controlled Trial

Background

Pervasive games aim to create more fun and engaging experiences by mixing elements from the real world into the game world. Because they intermingle with players’ lives and naturally promote more casual gameplay, they could be a powerful strategy to stimulate physical activity among older adults. However, to use these games more effectively, it is necessary to understand how design elements of the game affect player behavior.

Objective

The aim of this study was to evaluate how the presence of a specific design element, namely social interaction, would affect levels of physical activity.

Methods

Participants were recruited offline and randomly assigned to control and intervention groups in a single-blind design. Over 4 weeks, two variations of the same pervasive game were compared: with social interaction (intervention group) and with no social interaction (control group). In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Changes in the weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity.

Results

A total of 20 participants were recruited (no social interaction group, n=10; social interaction group, n=10); 18 participants remained active until the end of the study (no social interaction group, n=9; social interaction group, n=9). Step counts during the first week were used as the baseline level of physical activity (no social interaction group: mean 46,697.2, SE 7905.4; social interaction group: mean 45,967.3, SE 8260.7). For the subsequent weeks, changes to individual baseline values (absolute/proportional) for the no social interaction group were as follows: 1583.3 (SE 3108.3)/4.6% (SE 7.2%) (week 2), 591.5 (SE 2414.5)/2.4% (SE 4.7%) (week 3), and −1041.8 (SE 1992.7)/0.6% (SE 4.4%) (week 4). For the social interaction group, changes to individual baseline values were as follows: 11520.0 (SE 3941.5)/28.0% (SE 8.7%) (week 2), 9567.3 (SE 2631.5)/23.0% (SE 5.1%) (week 3), and 7648.7 (SE 3900.9)/13.9% (SE 8.0%) (week 4). The result of the analysis of the group effect was significant (absolute change: η²=0.31, P=.04; proportional change: η²=0.30, P=.03). Correlations between both absolute and proportional change and the play activity were significant (absolute change: r=0.59, 95% CI 0.32 to 0.77; proportional change: r=0.39, 95% CI 0.08 to 0.64).

Conclusions

The presence of social interaction design elements in pervasive games appears to have a positive effect on levels of physical activity.

Trial Registration

Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://tinyurl.com/y5nh6ylr (Archived by WebCite at http://www.webcitation.org/761a6MVAy)

Playability and Player Experience in Digital Games for Elderly: A Systematic Literature Review

A higher number of people increasingly uses digital games. This growing interest in games, with different objectives, justifies the investigation of some aspects and concepts involved, such as product quality (game), usability, playability, and user or player experience, topics investigated by the multidisciplinary area called Human–Computer Interaction (HCI). Although the majority of users of these games are children and young people, an increasing number of older adults join technology and use different types of digital games. Several studies establish the increase in learning, socialization and exercise promotion, and cognitive and psychomotor skills improvement, all within the context of active and healthy aging. The objective of this work is to carry out a systematic literature review investigating the player experience of the elderly in digital games. The work allowed answering five research questions that were formulated. The evolution and maturity level of the research area are studied together with the research methods used. The factors that motivate adults to play were also analyzed; what are the recommended technical characteristics for games and some tools and metrics with which games are evaluated for older adults? Research gaps were detected in the area; there are not many specific studies on playability and player experience applied to the older adult, nor are there proven tools and metrics to evaluate them. Particular techniques for assessing and designing games focused on older adults are lacking, and quantitative studies that better identify the factors that affect the playability and experience of older adults in digital games.

Effects of Social Interaction Mechanics in Pervasive Games on the Physical Activity Levels of Older Adults: Quasi-Experimental Study

BACKGROUND

The novel genre of pervasive games, which aim to create more fun and engaging experiences by promoting deeper immersion, could be a powerful strategy to stimulate physical activity among older adults. To use these games more effectively, it is necessary to understand how different design elements affect player behavior.

OBJECTIVE

The aim was to vary a specific design element of pervasive games for older adults, namely social interaction, to test the effect on levels of physical activity.

METHODS

Over 4 weeks, two variations of the same pervasive game were compared: social interaction for the test group and no social interaction for the control group. In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity.

RESULTS

A total of 32 participants were recruited (no social interaction=15, social interaction=17); 18 remained until the end of the study (no social interaction=7, social interaction=11). Step counts during the first week were used as the baseline (no social interaction: mean 17,099.4, SE 3906.5; social interaction: mean 17,981.9, SE 2171.1). For the following weeks, changes to individual baseline were as follows for no social interaction (absolute/proportional): 383.8 (SE 563.8)/1.1% (SE 4.3%), 435.9 (SE 574.5)/2.2% (SE 4.6%), and -106.1 (SE 979.9)/-2.6% (SE 8.1%) for weeks 2, 3, and 4, respectively. For social interaction they were 3841.9 (SE 1425.4)/21.7% (SE 5.1%), 2270.6 (SE 947.1)/16.5% (SE 4.4%), and 2443.4 (SE 982.6)/17.9% (SE 4.7%) for weeks 2, 3, and 4, respectively. Analysis of group effect was significant (absolute change: η²=.19, P=.01; proportional change: η²=.27, P=.009). Correlation between the proportional change and the play activity was significant (r=.34, 95% CI 0.08 to 0.56), whereas for absolute change it was not.

CONCLUSIONS

Social interaction design elements of the pervasive game may have some positive effects on the promotion of physical activity, although other factors might also have influenced this effect.

TRIAL REGISTRATION

Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=7274 (Archived by WebCite at http://www.webcitation.org/761a6MVAy).

Pervasive game design to evaluate social interaction effects on levels of physical activity among older adults

Introduction

Promoting active lifestyles among older adults can bring drastic benefits for their quality of life. The innovative mechanics of pervasive games – that mix real and virtual worlds – can further engage and motivate elderly people into that goal. Using social interaction as a study case, we designed and evaluated the feasibility of a pervasive game to investigate how game design elements can affect the levels of physical activity of older adults.

Methods

A mobile, location-based pervasive game was developed, and a study with community dwelling elderly volunteers from Kyoto, Japan was performed to evaluate its feasibility as an experiment system.

Results

Participants reported that the theme and visual style of the game was adequate, and that game rules and goals could be easily understood. The game was considered enjoyably challenging and engaging. Further analysis showed that next iterations of the system must pay special attention to the level of complexity of controls, and that new ways to connect players when there are few people playing or when they are too far apart are necessary.

Conclusions

The design allowed to test for variations on pervasive mechanics and was effective to engage elderly people, encouraging further investigation.

Cognition difference between players of different involvement toward the concrete design features in music games

When designing mobile games, how to understand preferences and cognition of players is a topic worth exploring. The main objectives of this paper are to obtain design features of music games on mobile devices, and explore players' perceptions toward music games. The results can serve as an orientation during decision-making in game design. Based on Miryoku Engineering and the Evaluation Grid Method, this study interviewed 22 frequent users to get concrete features of game design; Moreover, 210 subjects were divided into high, medium, and low involvement groups according to CIP measures, and then this study used Multiple Regression analysis to determine whether players with different levels of involvement had different perceptions of the design features of music games. The results found 44 concrete features and six original evaluations items of game design, and also discovered that there were perception differences in different involvement groups, and only two concrete design features significantly influenced all three groups: 'Extra games to earn more points after completing levels' and 'Playable without internet'.

Using technology to enhance and encourage dance-based exercise

This study investigated the role of Self-Service Technologies (SSTs) in dance-based exercise in order to begin exploring the motivations behind the use (or not) of SSTs by ordinary men and women in this context. The research approach employed interviews to gain insights into participants' use of SSTs and their exercise practices, in order to start establishing ways in which dance can be re/incorporated into people's lives through the design of appropriate SSTs. Findings from this study highlight the significant opportunity to further explore how the properties of music and dance can be integrated into the design of new SSTs. Literature suggests dance could be a beneficial exercise format for many people and self-service technology abounds for exercise but is often not used consistently. Our interviews asked participants about dance-based exercise and SSTs for exercise and showed that there is an opportunity to design SSTs to help people access dance-based exercise. SSTs should help people learn dance, build confidence, and dance alone or with others. SSTs could facilitate movement and increase engagement with physical activity whilst addressing issues around logistics, confidence and dance knowledge and experience.