Designing Serious Computer Games for People With Moderate and Advanced Dementia: Interdisciplinary Theory-Driven Pilot Study

Abstract

BackgroundThe field of serious games for people with dementia (PwD) is mostly driven by game-design principals typically applied to games created by and for younger individuals. Little has been done developing serious games to help PwD maintain cognition and to support functionality.ObjectivesWe aimed to create a theory-based serious game for PwD, with input from a multi-disciplinary team familiar with aging, dementia, and gaming theory, as well as direct input from end users (the iterative process). Targeting enhanced self-efficacy in daily activities, the goal was to generate a game that is acceptable, accessible and engaging for PwD.MethodsThe theory-driven game development was based on the following learning theories: learning in context, errorless learning, building on capacities, and acknowledging biological changes—all with the aim to boost self-efficacy. The iterative participatory process was used for game screen development with input of 34 PwD and 14 healthy community dwelling older adults, aged over 65 years. Development of game screens was informed by the bio-psychological aging related disabilities (ie, motor, visual, and perception) as well as remaining neuropsychological capacities (ie, implicit memory) of PwD. At the conclusion of the iterative development process, a prototype game with 39 screens was used for a pilot study with 24 PwD and 14 healthy community dwelling older adults. The game was played twice weekly for 10 weeks.ResultsQuantitative analysis showed that the average speed of successful screen completion was significantly longer for PwD compared with healthy older adults. Both PwD and controls showed an equivalent linear increase in the speed for task completion with practice by the third session (P<.02). Most important, the rate of improved processing speed with practice was not statistically different between PwD and controls. This may imply that some form of learning occurred for PwD at a nonsignificantly different rate than for controls. Qualitative results indicate that PwD found the game engaging and fun. Healthy older adults found the game too easy. Increase in self-reported self-efficacy was documented with PwD only.ConclusionsOur study demonstrated that PwD’s speed improved with practice at the same rate as healthy older adults. This implies that when tasks are designed to match PwD’s abilities, learning ensues. In addition, this pilot study of a serious game, designed for PwD, was accessible, acceptable, and enjoyable for end users. Games designed based on learning theories and input of end users and a multi-disciplinary team familiar with dementia and aging may have the potential of maintaining capacity and improving functionality of PwD. A larger longer study is needed to confirm our findings and evaluate the use of these games in assessing cognitive status and functionality.

User Experience of Interactive Technologies for People With Dementia: Comparative Observational Study

“…Despite the existence of several efforts aimed at providing recommendations to develop SGs [ 48 - 50 ], there is still a lack of usability studies that aim to understand how people with dementia interact and accept different types of technologies to perform specific tasks [ 51 , 52 ]. Although elderly individuals are capable of learning and handling new technologies [ 53 ], using novel technology can lead to anxious behaviors among elderly populations [ 54 ] or lead to undesirable side effects, such as cybersickness [ 55 ] and fatigue [ 28 ].…”

Focusing on Emotional and Social Intelligence Stimulation of People With Dementia by Playing a Serious Game—Proof of Concept Study

“…In our original study, we presented MBW, a low cost, easy to deploy serious game, co-designed with and developed especially for PwD. Our major goal was to bridge the transfer gap between "game designers" practice and knowledge and neuro-psychosocial scientific knowledge of aging and dementia (Tziraki et al, 2017). The overall aim of our gaming approach was to facilitate people with moderate and advanced dementia to arrive at an increased sense of self efficacy, which, according to recent research in neuropsychology, directly contributes to psychological, cognitive, and physical health, and thus serves as a key enabler in augmenting and prolonging functionality (Choi and Twamley, 2013).…”

“…Users are asked to sort, find, drag, and move items on a tablet, using the simple and easy to use qualities of a touch screen. The original study (Tziraki et al, 2017) was designed to answer the following questions: (1) Are serious computer games acceptable, accessible and engaging for people with moderate and advanced dementia? (2) Are people with moderate and advanced dementia able to use a tablet?…”

“…management and data collection system around it. We used the development process theory described at length previously (Tziraki et al, 2017), aiming to create a theory-based SG4D, with input from a multi-disciplinary team familiar with aging, dementia, user experience design, gaming theory, and technology, as well as direct input from end users (using the iterative process, see Valdez et al, 2015) and data collected automatically by the system.…”

“…This is true especially in dementia, leading the current study to focus on emotional and social intelligence and dementia. Specifically, we aimed to show a proof of concept for a novel serious game for dementia SG4D, entitled "My Brain Works" (MBW) (Tziraki et al, 2017). We focused on whether PwD, even with severe dementia, can engage with a computerized game, enjoy the game and socially interact with it in a meaningful way.…”