1. The study evaluated older adults' perceptions and attitudes towards digital brain training games and control puzzle games played on tablets over one month. 2. Participants found the brain training games to be more frustrating and less enjoyable than the control puzzle games. However, adherence was high for both. 3. Perceived cognitive benefits from gameplay, enjoyment, and challenge positively predicted motivation to play, which trended towards predicting adherence. Digital games should balance enjoyment and cognitive engagement for older adults.

1. Acknowledgements, credits, or disclosures can go here.
Abstract
The Gamification of Cognitive Training:
Older Adults’ Perceptions of and Attitudes toward Digital Game-
Based Interventions
Anthony Zeng, Walter R. Boot, Dustin Souders, Neil Charness, Kenneth Blocker, Nelson Roque, Thomas
Vitale
Introduction
Discussion
Methods
55 participants (65 years of age or older)
Randomly assigned to Brain Training Games group or Control
Condition Games Group
• Brain Training Games were gamified version of
interventions with success in the literature
• “Wild West” theme
• Control Games were word and number puzzle games
Experimental and control interventions were tablet-based (Acer
Iconia A700 10 inch)
After training in the lab, participants were asked to take the game
home and play
• 7 sessions per week, 45 minutes per session, for 1 month
Diaries were kept to monitor adherence
Cognition assessed before and after 1 month of training (not the
main focus of the current poster)
After training, participants were surveyed about:
• Motivation to do well in the intervention
• Game Enjoyment
• Game Challenge
• Game Frustration
• Perceived benefits to cognition from gameplay
Perceptual and cognitive abilities decline with age 1
• These declines associated with difficulty performing important
everyday tasks 2
The extent to which these declines can be reduced or reversed has been
controversial
• Two “consensus statements” signed by many scientists came to the
exact opposition conclusion regarding the efficacy of brain training
3,4
• Some studies find that digital game experience can help boost
cognition5
A separate issue is related to using digital games to improve cognition of
older adults
• Digital games typically not designed for older adults
• Older adults have less experience with the technology
• The types of digital games older adults enjoy are very different from
the types of games that younger adults play
If these game are effective at improving cognition, how do we enhance
intervention adherence to digital game-based interventions
• A recent intervention involving older adults and digital games may
not have been successful in part because of low adherence 6
• Participant's asked to play 60 hours of a digital game at home
over three months, yet on average only played 20 hours
Current Study
What are the factors that best predict digital game intervention adherence
and intervention motivation in older adults?
• From models of technology adoption:
• Perceived benefits likely important in shaping adherence
• E.g., A belief that games can improve cognition
• From a previous study:
• Enjoyment
• Challenge
• Frustration
Study represented a secondary analysis of data collected as part of a
brain training intervention, both intervention and control group were
digital games
Brain Training Games Control Condition Games
Results
1. Park, D.C., & Schwarz, N. (Eds.) (2000).Cognitive aging: A primer. Philadelphia, PA:Psychology Press.
2. Ball K., Owsley C., Sloane M., Roenker D., Bruni J. (1993). Visual attention problems as a predictor of vehicle crashes in older drivers. Invest.
Ophthalmol. Vis. Sci. 34, 3110–3123.
3. http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community/
4. http://www.cognitivetrainingdata.org/
5. Green, C. S., & Bavelier, D. (2015). Action video game training for cognitive enhancement. Current Opinion in Behavioral Sciences, 4, 103-108.
6. Boot, W. R., Champion, M., Blakely, D. P., Wright, T., Souders, D. J., & Charness, N. (2013). Video games as a means to reduce age-related
cognitive decline: Attitudes, compliance, and effectiveness. Frontiers in Psychology, 4, 1-9.
Unfortunately older adults found the Brain Training
Games to be more frustrating and less enjoyable
compared to the Control Games (Figure 1)
• Perhaps not surprising, Control Games were
specifically designed for entertainment purposes
• Brain Training Games were designed to challenge,
push players outside of their comfort zone
Participants in the Brain Training Games condition perceived
their games as being less likely to improve cognition compared
to the Control Games
• Low perceived value may decrease adherence
• However, this is good news for the cognitive intervention
study
• If cognitive benefits are found for the Brain Training
Games group, they are unlikely due to differential
expectations between groups (placebo effect)
• Brain Training Group expected less improvement
• Adherence was high for both groups (>70% sessions
completed), and did not differ between groups.
Contrary to predictions, no perceptions or attitudes
predicted adherence.
• However, perceived benefits to cognition,
intervention enjoyment, frustration, and challenge
all predicted motivation to do well in the intervention
(Table 1)
• There was a trend for a positive relationship
between intervention motivation and adherence
(r = .24, p = .08)
Digital games should be enjoyable, not be frustrating to promote
game-based intervention motivation and adherence
• Unfortunately, brain training likely needs to be effortful (i.e.,
somewhat frustrating) for it to work
Perceived benefit should be emphasized to promote adherence
Future studies of adherence would benefit from a longer
intervention period (> 1 month) to increase adherence variability
Advertised as brain training games, game training applications claim to improve
cognitive ability (e.g., memory, reaction time). This claim has become controversial. A
separate issue, however, is how best to design these types of interventions, often
involving digital games, for older adults. This study evaluated the perceptions and
attitudes of older adults (ages 65+) as they played cognitively engaging games.
Participants played games (experimental or control games) on a tablet they took home
for one month. Their attitudes and perceptions of the games were evaluated using
surveys. Older adults were more drawn to familiar games (puzzle games) compared to
digital brain training games that have demonstrated some success in the literature.
The more engaging the game, and the more they perceived the games would be
beneficial to cognition, the more likely participants were to be motivated to play.