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

Abstract

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.

What Media Helps, What Media Hurts: A Mixed Methods Survey Study of Coping with COVID-19 Using the Media Repertoire Framework and the Appraisal Theory of Stress

“…One of the aims of this survey is to address the question of what screen-mediated interventions are needed to respond to the stress caused by the COVID-19 pandemic. Our position is that, in designing and promoting any digital health interventions, we must first ask whether the digitized intervention risks becoming a stressor in and of itself, and then mitigate those risks in design [ 27 , 32 ].…”

“…This process of appraisal is repeated recursively until an individual finds a solution (or fails) [ 23 ]. We have previously proposed a conceptual mixed methods framework for studying interactions between media (such as serious games) and stress [ 27 ]. We repeat this iterative process here by recursively asking questions about sources of actual, perceived, or anticipated stress while investigating individuals’ differences in use and preferences.…”

For Whom the Games Toll: A Qualitative and Intergenerational Evaluation of What is Serious in Games for Older Adults

“…On the post-game questionnaire, almost everyone stated that the experience of different sessions (in Phase 1) was enjoyable and interesting (Khalili-Mahani et al 2020). However, some games were more stressful to some than others.…”

Effective Gamification of the Stop-Signal Task: Two Controlled Laboratory Experiments

“…Serious games are also used in the context of health care education to support desirable behavior [ 1 , 4 - 7 ]. The use of games or game-like tasks makes it possible to enhance voluntary engagement and decrease participant drop-out rates [ 8 , 9 ]; in fact, a recent study showed that the experience of playing digital games as compared with standard cognitive tasks was perceived as less stressful [ 10 ]. A high dropout rate, especially in difficult-to-obtain samples, can lead to difficulties interpreting the results, for example, due to decreased statistical power [ 11 - 14 ].…”