What Older People Like to Play: Genre Preferences and Acceptance of Casual Games

Improving Adherence to Physical Therapy in the Development of Serious Games: Conceptual Framework Design Study

BACKGROUND

Insufficient levels of treatment adherence can have adverse effects on the outcomes of physical rehabilitation. To address this issue, alternative approaches to traditional therapies, such as serious games, have been designed to enhance adherence. Nevertheless, there remain gaps in the development of serious games concerning the effective implementation of motivation, engagement, and the enhancement of treatment adherence.

OBJECTIVE

This study aims to design a conceptual framework for the development of serious games that incorporate essential adherence factors to enhance patient compliance with physical rehabilitation programs.

METHODS

We formulated a conceptual framework using iterative techniques inspired by a conceptual framework analysis. Initially, we conducted a comprehensive literature review, concentrating on the critical adherence factors in physical rehabilitation. Subsequently, we identified, categorized, integrated, and synthesized the concepts derived from the literature review to construct the conceptual framework.

RESULTS

The framework resembles a road map, comprising 3 distinct phases. In the initial phase, the patient's characteristics are identified through an initial exploration. The second phase involves the development of a serious game, with a focus on enhancing treatment adherence by integrating the key adherence factors identified. The third phase revolves around the evaluation of the serious game. These phases are underpinned by 2 overarching themes, namely, a user-centered design and the GameFlow model.

CONCLUSIONS

The conceptual framework offers a detailed, step-by-step guide for creating serious games that incorporate essential adherence factors, thereby contributing to improved adherence in the physical rehabilitation process. To establish its validity, further evaluations of this framework across various physical rehabilitation programs and user groups are necessary.

Higher working memory capacity and distraction-resistance associated with strategy (not action) game playing in younger adults, but puzzle game playing in older adults

Superior attention and Working Memory (WM) have been reported for habitual action video gamers compared to other gamers or non-players. With an online experiment we measured visuo-spatial WM capacity and ability to ignore distraction, and participants listed the video games they played. Categorising the 209 young adult participants (18-30 years) according to the game type they predominantly played revealed superior WM capacity for strategy and action gamers compared to non-players. However, re-categorising the games according to their constituent game types revealed superior WM capacity and distraction resistance associated with strategy but not action game components. In contrast to younger adults, data from 181 older adults (60-81 years) showed superior WM capacity and distractor-resistance for puzzle gamers, which was equivalent to that of younger adults. The results highlight the need to consider component game types in games research and inform the design of age-appropriate cognitive interventions.

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.

Association Between Internet Use, Cognitive Function, and Globus Pallidus Volumes: A Study Among the Elderly in Chinese Communities

Background

Previous studies have linked internet use with several beneficial outcomes for brain health, but there is little data on this among older Chinese.

Objective

The goal of this study was to explore the association between internet use and cognitive impairment and to explore the possible mechanisms by which internet use prevents cognitive decline.

Methods

The current study consisted of two cohorts: one from the China Longitudinal Aging Study (CLAS), which included 610 older adults with mild cognitive impairment (MCI), 192 with dementia, and 2,218 healthy older adults; the second cohort included 39 healthy adults from the Shanghai brain health foundation (SHBHF2016001), who underwent T1 cranial magnetic resonance imaging at baseline, from which their volumes of the hippocampus, amygdala, and globus pallidus were calculated. Moreover, they were also followed up for 1 year. Through standardized questionnaires, detailed general demographic information and internet use information was obtained. The cognitive diagnosis of each participant was made by attending psychiatrists at baseline, and their overall cognitive function was assessed by the mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA).

Results

In cohort 1, after controlling age, gender, smoker, tea drinker, take exercise, diabetes, and hypertension, we found that internet use was associated with MCI (P = 0.015, OR = 0.478, 95% CI: 0.264~0.867), but not for dementia (P = 0.205, OR = 0.393, 95% CI: 0.093~1.665). In cohort 2, we found that the globus pallidus volume of internet users was significantly larger than that of non-users, and the MMSE change score was lower (P < 0.05). The results of partial correlation analysis (controlled for sex, age and education) showed that the change of MMSE value was positively correlated with the volume of left globus pallidus (r = 0.547, P = 0.004).

Conclusions

Internet use might be a protective factor for mild cognitive impairment among the Chinese elderly, and it may prevent a decline in cognitive decline by affecting the volume of the globus pallidus.

Teaching Disaster Evacuation Management Education to Nursing Students Using Virtual Reality Mobile Game-Based Learning

The purpose of this study was to explore the effectiveness of a virtual reality mobile game-based application for teaching disaster evacuation management education to nursing students. A pre-test, post-test, and final-test study design was used to compare traditional lecture group and game group instructional knowledge delivery effectiveness and instructional mode satisfaction. The statistical comparison of pre-test and post-test knowledge and decision-making scores did not reveal significant group differences for short-term improvement (P ≥ .05); however, final test scores revealed that the virtual reality mobile game-based application group had significantly higher knowledge and decision-making retention scores compared with the traditional lecture group (P = .000). The game group also had significantly higher instructional mode satisfaction scores for course interest and cooperation with others (P < .05). The virtual reality mobile game-based application was more effective for teaching nursing students about disaster evacuation management educational training than lecture instruction. The greater satisfaction expressed by nursing students when using this instructional mode suggests that it may better facilitate self-initiated lifelong disaster evacuation learning behaviors.

Virtual reality and well-being in older adults: Results from a pilot implementation of virtual reality in long-term care

Introduction

This paper describes the findings of a pilot implementation project that explored the potential of virtual reality (VR) technology in recreational programming to support the well-being of older adults in long-term care (LTC) homes.

Methods

32 Adults in four LTC homes participated in a pilot implementation project where they viewed VR experiences of popular locations in Canada created especially for this project. Data in this paper are based on multiple viewing experiences (n = 102) over a two-week period.

Results

VR appeared to be an effective distraction from pain for the participants. Participants of this study found the VR experiences to be enjoyable and were relaxed and happy while viewing them. Most participants were attentive or focused while viewing the VR experiences, and the experiences were found to be a source of reminiscence for some of the participants. Participants related well to others around them during a majority of the experiences and the VR experiences were a point of conversation between the staff and the participants.

Conclusion

The findings from this pilot implementation reveal that VR shows potential to enhance the physical, emotional, cognitive, and social well-being of older adults living in LTC, including those living with cognitive impairment.

AnemiaAR: a serious game to support teaching of haematology

Serious games can be suitable tools for educational support in different areas of knowledge, such as Medicine. These applications, combined with technologies like mixed and augmented reality, provide a differentiated user experience that can keep or improve the interest and motivation of students and teachers during the teaching and learning process. In this context, this study aimed to present the development of AnemiaAR, a mixed reality serious game to support the teaching of haematology, helpful for students and professors in the visualisation and presentation of anaemia concepts. Fourteen medical students from the University of Passo Fundo participated in a pilot study to evaluate the application, considering a sociodemographic questionnaire, a questionnaire based on the Technology Acceptance Model, and two modules of the Game Experience Questionnaire. The preliminary results were satisfactory, showing good acceptance and positive experience of the game, besides improvements. The study also pointed out differences in the game evaluation among participants, considering the prior experience in games, the previously attended haematology subject, and the time spent performing the game tasks.

Effect of Cognitive Control on Age-Related Positivity Effects in Attentional Processing - Evidence From an Event-Related Brain Potential Study

Studies investigating age-related positivity effects during facial emotion processing have yielded contradictory results. The present study aimed to elucidate the mechanisms of cognitive control during attentional processing of emotional faces among older adults. We used go/no-go detection tasks combined with event-related potentials and source localization to examine the effects of response inhibition on age-related positivity effects. Data were obtained from 23 older and 23 younger healthy participants. Behavioral results showed that the discriminability index (d') of older adults on fear trials was significantly greater than that of younger adults [t(44)=2.37, p=0.024, Cohen's d=0.70], whereas an opposite pattern was found in happy trials [t(44)=2.56, p=0.014, Cohen's d=0.75]. The electroencephalography results on the amplitude of the N170 at the left electrode positions showed that the fear-neutral face pairs were larger than the happy-neutral ones for the younger adults [t(22)=2.32, p=0.030, Cohen's d=0.48]; the older group's right hemisphere presented similar tendency, although the results were not statistically significant [t(22)=1.97, p=0.061, Cohen's d=0.41]. Further, the brain activity of the two hemispheres in older adults showed asymmetrical decrement. Our study demonstrated that the age-related "positivity effect" was not observed owing to the depletion of available cognitive resources at the early attentional stage. Moreover, bilateral activation of the two hemispheres may be important signals of normal aging.

Nationwide Deployment of a Serious Game Designed to Improve COVID-19 Infection Prevention Practices in Switzerland: Prospective Web-Based Study

Background

Lassitude and a rather high degree of mistrust toward the authorities can make regular or overly constraining COVID-19 infection prevention and control campaigns inefficient and even counterproductive. Serious games provide an original, engaging, and potentially effective way of disseminating COVID-19 infection prevention and control guidelines. Escape COVID-19 is a serious game for teaching COVID-19 infection prevention and control practices that has previously been validated in a population of nursing home personnel.

Objective

We aimed to identify factors learned from playing the serious game Escape COVID-19 that facilitate or impede intentions of changing infection prevention and control behavior in a large and heterogeneous Swiss population.

Methods

This fully automated, prospective web-based study, compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was conducted in all 3 main language regions of Switzerland. After creating an account on the platform, participants were asked to complete a short demographic questionnaire before accessing the serious game. The only incentive given to the potential participants was a course completion certificate, which participants obtained after completing the postgame questionnaire. The primary outcome was the proportion of participants who reported that they were willing to change their infection prevention and control behavior. Secondary outcomes were the infection prevention and control areas affected by this willingness and the presumed evolution in the use of specific personal protective equipment items. The elements associated with intention to change infection prevention and control behavior, or lack thereof, were also assessed. Other secondary outcomes were the subjective perceptions regarding length, difficulty, meaningfulness, and usefulness of the serious game; impression of engagement and boredom while playing the serious game; and willingness to recommend its use to friends or colleagues.

Results

From March 9 to June 9, 2021, a total of 3227 accounts were created on the platform, and 1104 participants (34.2%) completed the postgame questionnaire. Of the 1104 respondents, 509 respondents (46.1%) answered that they intended to change their infection prevention and control behavior after playing the game. Among the respondents who answered that they did not intend to change their behavior, 86.1% (512/595) answered that they already apply these guidelines. Participants who followed the German version were less likely to intend to change their infection prevention and control behavior (odds ratio [OR] 0.48, 95% CI 0.24-0.96; P=.04) and found the game less engaging (P<.001). Conversely, participants aged 53 years or older had stronger intentions of changing infection prevention and control behavior (OR 2.07, 95% CI 1.44-2.97; P<.001).

Conclusions

Escape COVID-19 is a useful tool to enhance correct infection prevention and control measures on a national scale, even after 2 COVID-19 pandemic waves; however, the serious game's impact was affected by language, age category, and previous educational training, and the game should be adapted to enhance its impact on specific populations.

Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review

BACKGROUND

Using commercial off-the-shelf video games rather than custom-made computer games could have several advantages for reducing stress and anxiety, including their low cost, advanced graphics, and the possibility to reach millions of individuals worldwide. However, it is important to emphasize that not all commercial video games are equal, and their effects strongly depend on specific characteristics of the games.

OBJECTIVE

The aim of this systematic review was to describe the literature on the use of commercial off-the-shelf video games for diminishing stress and anxiety, examining the research outcomes along with critical variables related to computer game characteristics (ie, genre, platform, time of play).

METHODS

A systematic search of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The search databases were PsycINFO, Web of Science, Medline, IEEExplore, and the Cochrane Library. The search string was: [("video game*") OR ("computer game*")] AND [("stress") OR ("anxiety") OR ("relaxation")] AND [("study") OR ("trial") OR ("training")].

RESULTS

A total of 28 studies met the inclusion criteria for the publication period 2006-2021. The findings demonstrate the benefit of commercial off-the-shelf video games for reducing stress in children, adults, and older adults. The majority of the retrieved studies recruited young adults, and fewer studies have involved children, middle-aged adults, and older adults. In addition to exergames and casual video games, other genres of commercial off-the-shelf games helped to reduce stress and anxiety.

CONCLUSIONS

Efficacy in reducing stress and anxiety has been demonstrated not only for exergames and casual video games but also for other genres such as action games, action-adventure games, and augmented reality games. Various gaming platforms, including consoles, PCs, smartphones, mobile consoles, and virtual reality systems, have been used with positive results. Finally, even single and short sessions of play had benefits in reducing stress and anxiety.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202130081; https://inplasy.com/?s=INPLASY202130081.

Standardizing the Development of Serious Games for Physical Rehabilitation: Conceptual Framework Proposal

Background

Serious games have been used as supportive therapy for traditional rehabilitation. However, most are designed without a systematic process to guide their development from the phases of requirement identification, planning, design, construction, and evaluation, which reflect the lack of adaptation of rehabilitation requirements and thus the patient’s needs.

Objective

The aim of this study was to propose a conceptual framework with standardized elements for the development of information systems by using a flexible and an adaptable process centered on the patient’s needs and focused on the creation of serious games for physical rehabilitation.

Methods

The conceptual framework is based on 3 fundamental concepts: (1) user-centered design, which is an iterative design process focused on users and their needs at each phase of the process, (2) generic structural activities of software engineering, which guides the independent development process regardless of the complexity or size of the problem, and (3) gamification elements, which allow the transformation of obstacles into positive and fun reinforcements, thereby encouraging patients in their rehabilitation process.

Results

We propose a conceptual framework to guide the development of serious games through a systematic process by using an iterative and incremental process applying the phases of context identification, user requirements, planning, design, construction of the interaction devices and video game, and evaluation.

Conclusions

This proposed framework will provide developers of serious games a systematic process with standardized elements for the development of flexible and adaptable software with a high level of patient commitment, which will effectively contribute to their rehabilitation process.

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.

Gamified money: exploring the effectiveness of gamification in mobile payment adoption among the silver generation in China

Purpose

This study investigates the use of gamification in promoting the silver generation's adoption of mobile payment technology through the gamified cultural practice of gifting red packets. It considers the effectiveness of using gamification in a cultural context to promote technology acceptance among older adults. This crossover between digital technology and cultural traditions brings unique gaming elements to the adoption of technology.

Design/methodology/approach

Drawing upon technology acceptance Model (TAM) and prospect theory, a research model is evaluated using structural equation modeling. Data were collected via survey from elderly consumers who are current users of WeChat but are yet to use its mobile payment functions.

Findings

The results reveal the perceived effectiveness of gamification is determined by the perceived enjoyment of the game and contributes to users' attitude development, directly and through its perceived usefulness. Perceived risks were identified as a barrier to converting positive attitude into adoption intention.

Research limitations/implications

The findings contribute to the conceptualization and understanding of the effectiveness of gamification in technology adoption, specifically among the silver generation.

Originality/value

In contrast with previous gamification studies on gamified experience, this study introduces a new conceptualization of the perceived effectiveness of gamification and its measurement. This study validates game engagement as being effective in encouraging seniors to adopt a technology. In an era of an aging population where digitization is a norm, improving the digital literacy and digital inclusion of elders by encouraging them to adopt technology is essential to developing a more accessible and inclusive social environment.

Serious video games and virtual reality for prevention and neurorehabilitation of cognitive decline because of aging and neurodegeneration

PURPOSE OF REVIEW

Cognitive decline because of aging and neurodegeneration has become increasingly prevalent. This calls for the implementation of efficacious, motivating, standardized and widely available cognitive interventions for the elderly. In this context, serious video games and virtual reality may represent promising approaches. Here, we review recent research on their potential for cognitive prevention and neurorehabilitation of age-related cognitive decline and mild cognitive impairment (MCI).

RECENT FINDINGS

The majority of currently available data in this evolving domain lacks the methodological quality to draw reliable conclusions on the potential of novel technology for cognitive training in older people. However, single well designed randomized controlled trials have reported promising effects of cognitive interventions involving serious video games and virtual reality. The cognitive benefits of exergames promoting physical exercise with and without combined cognitive training remain unclear.

SUMMARY

The immersion into stimulating and motivating environments along with training content based on neuroscientific and neuropsychological models may represent a significant advance as compared with conventional computerized cognitive training. Additional research with sound methodology including sufficient sample sizes, active control groups and meaningful outcome measures of everyday function is needed to elucidate the potential of serious video games and virtual reality in multifactorial neurorehabilitation of cognitive decline in aging and neurodegeneration.

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)

Assessing the Effect of Training on the Cognition and Brain of Older Adults: Protocol for a Three-Arm Randomized Double-Blind Controlled Trial (ACTOP)

BACKGROUND

To prevent age-related cognitive impairment, many intervention programs offer exercises targeting different central cognitive processes. However, the effects of different process-based training programs are rarely compared within equivalent experimental designs.

OBJECTIVE

Using a randomized double-blind controlled trial, this project aims to examine and compare the impact of 2 process-based interventions, inhibition and updating, on the cognition and brain of older adults.

METHODS

A total of 90 healthy older adults were randomly assigned to 1 of 3 training conditions: (1) inhibition (Stroop-like exercises), (2) updating (N-back-type exercises), and (3) control active (quiz game exercise). Training was provided in 12 half-hour sessions over 4 weeks. First, the performance gain observed will be measured on the trained tasks. We will then determine the extent of transfer of gain on (1) untrained tasks that rely on the same cognitive process, (2) complex working memory (WM) measurements hypothesized to involve 1 of the 2 trained processes, and (3) virtual reality tasks that were designed to mimic real-life situations that require WM. We will assess whether training increases cortical volume given that the volume of the cortex is determined by cortical area and thickness in regions known to be involved in WM or changes task-related brain activation patterns measured with functional magnetic resonance imaging. Dose effects will be examined by measuring outcomes at different time points during training. We will also determine whether individual characteristics moderate the effect of training on cognitive and cerebral outcomes. Finally, we will evaluate whether training reduces the age-related deficit on transfer and brain outcomes, by comparing study participants to a group of 30 younger adults.

RESULTS

The project was funded in January 2017; enrollment began in October 2017 and data collection was completed in April 2019. Data analysis has begun in June 2020 and the first results should be published by the end of 2020 or early 2021.

CONCLUSIONS

The results of this study will help understand the relative efficacy of 2 attentional control interventions on the cognition and the brain of older adults, as well as the moderating role of individual characteristics on training efficiency and transfer.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03532113; https://clinicaltrials.gov/ct2/show/NCT03532113.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20430.

Rationale and protocol of the StayFitLonger study: a multicentre trial to measure efficacy and adherence of a home-based computerised multidomain intervention in healthy older adults

Background

In older adults, multidomain training that includes physical and cognitive activities has been associated with improvement of physical and cognitive health. The goal of the multisite StayFitLonger study is to assess a home-based computerised training programme, which combines physical exercises, stimulating cognitive activities and virtual coaching.

Methods

One hundred twenty-eight cognitively healthy older adults will be recruited from the community in Switzerland, Canada and Belgium. The study will comprise (1) a 26-week double-blind randomized controlled efficacy trial and (2) a 22-week pragmatic adherence sub-study. In the efficacy trial, participants will be randomly assigned to an experimental or an active control intervention. In the experimental intervention, participants will use the StayFitLonger programme, which is computerised on a tablet and provides content that combines physical activities with a focus on strength and balance, as well as divided attention, problem solving and memory training. Outcomes will be measured before and after 26 weeks of training. The primary efficacy outcome will be performance on the “Timed-Up & Go” test. Secondary outcomes will include measures of frailty, cognition, mood, fear of falling, quality of life, and activities of daily living. Age, sex, education, baseline cognition, expectation, and adherence will be used as moderators of efficacy. Following the 26-week efficacy trial, all participants will use the experimental programme meaning that participants in the control group will ‘cross over’ to receive the StayFitLonger programme for 22 weeks. Adherence will be measured in both groups based on dose, volume and frequency of use. In addition, participants’ perception of the programme and its functionalities will be characterised through usability, acceptability and user experience.

Discussion

This study will determine the efficacy, adherence and participants’ perception of a home-based multidomain intervention programme and its functionalities. This will allow for further development and possible commercialization of a scientifically validated training programme.

Trial registration

ClinicalTrials.gov, NCT04237519 Registered on January 22, 2020 - Retrospectively registered.

Development and Evaluation of Maze-Like Puzzle Games to Assess Cognitive and Motor Function in Aging and Neurodegenerative Diseases

There is currently a need for engaging, user-friendly, and repeatable tasks for assessment of cognitive and motor function in aging and neurodegenerative diseases. This study evaluated the feasibility of a maze-like Numberlink puzzle game in assessing differences in game-based measures of cognition and motor function due to age and neurodegenerative diseases. Fifty-five participants, including young (18-31 years, n = 18), older (64-79 years, n = 14), and oldest adults (86-98 years, n = 14), and patients with Parkinson's (59-76 years, n = 4) and Huntington's disease (HD; 35-66 years, n = 5) played different difficulty levels of the Numberlink puzzle game and completed usability questionnaires and tests for psychomotor, attentional, visuospatial, and constructional and executive function. Analyses of Numberlink game-based cognitive (solving time and errors) and motor [mean velocity and movement direction changes (MDC)] performance metrics revealed statistically significant differences between age groups and between patients with HD and older adults. However, patients with Parkinson's disease (PD) did not differ from older adults. Correlational analyses showed significant associations between game-based performance and movement metrics and performance on neuropsychological tests for psychomotor, attentional, visuospatial, and constructional and executive function. Furthermore, varying characteristics of the Numberlink puzzle game succeeded in creating graded difficulty levels. Findings from this study support recent suggestions that data from a maze-like puzzle game provide potential "digital biomarkers" to assess changes in psychomotor, visuoconstructional, and executive function related to aging and neurodegeneration. In particular, game-based movement measures from the maze-like puzzle Numberlink games are promising as a tool to monitor the progression of motor impairment in neurodegenerative diseases. Further studies are needed to more comprehensively establish the cognitive validity and test-retest reliability of using Numberlink puzzles as a valid cognitive assessment tool.

Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study

BACKGROUND

The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants' motivations to adopt these technologies.

OBJECTIVE

This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework.

METHODS

A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S₁-BrainGame, S₂-CarRace, and S₃-Exergame). Each session included an identical sequence of activities (t₁-Baseline, t₂-Picture encode, t₃-Play, t₄-Stroop test, t₅-Play, and t₆-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire.

RESULTS

Session×activity effects were significant on all ambulatory measures (χ²₁₀>20; P<.001) other than cortisol (P=.37). Compared with S₁ and S₂, S₃ was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S₁, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S₃. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (χ²₁>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group.

CONCLUSIONS

Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed.

A usability study of a multicomponent video game-based training for older adults

Background

Aging is often accompanied by a decline in sensory, motor and cognitive functions. These age- and lifestyle-related impairments may lead to reduced daily life functioning including gait disturbances, falling and injuries. Most daily life activities, e.g. walking, are tasks which require the concurrent interplay of physical and cognitive functions. Promising options for combined physical-cognitive training are video game-based physical exercises, so-called exergames. This study aimed to [i] determine the usability of a newly developed multicomponent exergame and [ii] explore its effects on physical functions, cognition and cortical activity.

Methods

Twenty-one healthy and independently living older adults were included (10 female, 71.4 ± 5.8 years, range: 65–91) and performed 21 training sessions (each 40 min) over seven weeks. The multicomponent exergame included strength and balance training with Tai Chi-inspired and dance exercises. Participants rated the usability of the exergame (System Usability Scale) and reported on their emotional experience (Game Experience Questionnaire). Attendance and attrition rates were calculated to determine training compliance. Before and after the intervention, physical and cognitive functions as well as resting state electroencephalography (EEG) were assessed.

Results

Results showed a high training attendance rate (87.1%, 18/21 training sessions on average) and a low attrition rate (9.5%, 2 drop-outs). System usability was rated high with a mean score of 75/100. Affective game experience was rated favorable. Gait speed under dual-task condition, lower extremity muscle strength and reaction times in a cognitive task (divided attention) showed significant improvements (p < .05). No significant pre-post differences were found for resting state EEG.

Conclusions

The newly developed exergame seems usable for healthy older adults. Nevertheless, some aspects of the exergame prototype can and should be improved. The training showed to positively influence physical and cognitive functions in a small convenience sample. Future trials are warranted which evaluate the feasibility and usability of the exergame training in a more “real-life” in-home setting and assess the behavioral and neuroplastic changes in a larger population after a longer training period with comparison to a control group.

A Pilot Study of an In-Home Multicomponent Exergame Training for Older Adults: Feasibility, Usability and Pre-Post Evaluation

Aging is associated with sensory, motor and cognitive impairments that may lead to reduced daily life functioning including gait disturbances, falls, injuries and mobility restrictions. A strong need exists for implementing effective evidence-based interventions for healthy aging. Therefore, the aim of this study was to (i) evaluate the feasibility and usability of an in-home multicomponent exergame training and (ii) explore its effects on physical functions, cognition and cortical activity. Twenty-one healthy and independently living older adults were included (11 female, 74.4 ± 7.0 years, range: 65-92 years) and performed 24 trainings sessions (each 40 min) over eight weeks. The first part was conducted in a living lab (home-like laboratory environment), the second part at participants' home. The multicomponent exergame included Tai Chi-inspired exercises, dance movements and step-based cognitive games to train strength, balance and cognition. Attendance and attrition rates were calculated and safety during training was evaluated to determine feasibility. Participants rated the usability of the exergame (System Usability Scale) and reported on their game experience (Game Experience Questionnaire). Physical and cognitive functions and cortical activity (resting state electroencephalopathy) were assessed pre and post intervention. Results showed a high training attendance rate for the living lab and the home-based setting (91.7 and 91.0%, respectively) with a rather high attrition rate (28.6%, six drop-outs). Half of the drop-out reasons were related to personal or health issues. System usability was rated acceptable with a mean score of 70.6/100. Affective game experience was rated favorable. Significant improvements were found for minimal toe clearance, short-term attentional span, and information processing speed (p < 0.05). No significant pre-post differences were found for cortical activity. To summarize, the exergame is generally feasible and usable for healthy older adults applied in an in-home setting and provides an overall positive emotional game experience. Nevertheless, flawless technical functionality should be a mandatory consideration. Additionally, the training might have potential positive influence on specific functions in older adults. However, the efficacy has to be evaluated in a future randomized controlled trial assessing the behavioral and neuroplastic changes in a larger population after a longer training period.

Potential of video games for the promotion of neuroadaptation to multifocal intraocular lenses: a narrative review

Multifocal intraocular lenses (IOLs) are currently usually implanted for the treatment of cataracts because they have been proved to be superior to monofocal IOLs with respect to spectacle independence. In turn, they are associated with a higher prevalence of dysphotopsia symptoms that is one of the most common causes of patient dissatisfaction. Neuroadaptation seems to play a major role in the optimal adaptation to multifocal IOLs. In this context, the development of strategies that facilitate the neuroadaptation process to multifocality might be an effective strategy to reduce patients' dissatisfaction. Video games have been proved to be effective for the improvement of visual acuity and for the promotion of neuroplasticity in elderly subjects and other populations with cortical-related visual impairment. This narrative review highlights the physiological potential of video games as a perceptual strategy to improve visual acuity and promote neuroplasticity in patients using multifocal IOLs, although research is still needed to confirm these benefits in this specific population, with only one comparative study to this date providing evidence of them.

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.

Search and Match Task: Development of a Taskified Match-3 Puzzle Game to Assess and Practice Visual Search

Background

Visual search declines with aging, dementia, and brain injury and is linked to limitations in everyday activities. Recent studies suggest that visual search can be improved with practice using computerized visual search tasks and puzzle video games. For practical use, it is important that visual search ability can be assessed and practiced in a controlled and adaptive way. However, commercial puzzle video games make it hard to control task difficulty, and there are little means to collect performance data.

Objective

The aim of this study was to develop and initially validate the search and match task (SMT) that combines an enjoyable tile-matching match-3 puzzle video game with features of the visual search paradigm (taskified game). The SMT was designed as a single-target visual search task that allows control over task difficulty variables and collection of performance data.

Methods

The SMT is played on a grid-based (width × height) puzzle board, filled with different types of colored polygons. A wide range of difficulty levels was generated by combinations of 3 task variables over a range from 4 to 8 including height and width of the puzzle board (set size) and the numbers of tile types (distractor heterogeneity). For each difficulty level, large numbers of playable trials were pregenerated using Python. Each trial consists of 4 consecutive puzzle boards, where the goal of the task is to find a target tile configuration (search) on the puzzle board and swap 2 adjacent tiles to create a line of 3 identical tiles (match). For each puzzle board, there is exactly 1 possible match (single target search). In a user study with 28 young adults (aged 18 to 31 years), 13 older (aged 64 to 79 years) and 11 oldest (aged 86 to 98 years) adults played the long (young and older adults) or short version (oldest adults) of the difficulty levels of the SMT. Participants rated their perception and the usability of the task and completed neuropsychological tests that measure cognitive domains engaged by the puzzle game.

Results

Results from the user study indicate that the target search time is associated with set size, distractor heterogeneity, and age. Results further indicate that search performance is associated with general cognitive ability, selective and divided attention, visual search, and visuospatial and pattern recognition ability.

Conclusions

Overall, this study shows that an everyday puzzle game–based task can be experimentally controlled, is enjoyable and user-friendly, and permits data collection to assess visual search and cognitive abilities. Further research is needed to evaluate the potential of the SMT game to assess and practice visual search ability in an enjoyable and adaptive way. A PsychoPy version of the SMT is freely available for researchers.

Immersive Virtual Reality for the Management of Pain in Community-Dwelling Older Adults

Immersive virtual reality (VR) can provide a high level of engagement and distraction analgesia to address pain. However, community-based applications of this technology for older adults have not been studied. The objective of this study was to examine the applicability and effectiveness of an immersive VR intervention for pain, depression, and quality of life (QOL) in older adults. This pretest–posttest, mixed-methods design included senior center members ( n = 12) with pain that interfered with daily functioning. The outcomes included the Numeric Pain Rating Scale, Patient-Reported Outcomes Measurement Information System (PROMIS®) depression scale, World Health Organization Quality of Life Scale Brief Version (WHO QOL-BREF), and open-ended questions. The VR intervention (15- to 45-min sessions, 12 sessions over 6 weeks) was well accepted with no dropouts. There was a significant decrease in pain ( p = .002, d = −1.54) with no effect on depression and QOL. There were no adverse effects, and positive perceptions of VR were reported. The 6-week immersive VR intervention was applicable and effective in reducing pain intensity for community-dwelling older adults.