Play,Learn,Connect

Abstract

This mixed-methods study examined the social gameplay and learning experience of 50 adults aged 60 years or more during 4 weeks of playing a multiplayer, educational digital Bingo game with embedded learning content about nutrition and health. The first phase consisted of 4 weeks of gameplay with quantitative data collection using pretests and posttests; the second phase used postgame interviews of selected players to collect qualitative data. The results of this study showed significant improvement in players' scores for knowledge, social connectedness, and attitudes toward digital games from the pretest to the posttest. The interview data confirmed these increases and provided insights on the importance of learning, social connectedness, coplaying, and general enjoyment from playing a digital educational game. The results of this study were also consistent with earlier research studies on older adults' needs, experiences, and preferences for digital gameplay.

Keywords

digital games educational games seniors older adults social connectedness

As the world's population has aged, much attention has been focused on improving older adults' quality of life. Digital technologies have been widely proposed to counter the negative effects of physical, cognitive, and social problems faced by seniors (Bouwhuis, 2003) and to meet their changing needs for entertainment, learning, and communication.

Researchers are increasingly interested in the potential of digital games for helping older adults (De Schutter & Vanden Abeele, 2010; Gajadhar, Nap, de Kort, & IJsselsteijn, 2010; Marston, 2013; Nap, de Kort, & IJsselsteijn, 2009). Digital games offer enjoyment and can also incorporate serious educational aims and content (Griffiths, 2005). There is evidence that they can help to improve seniors' mental and physical health and socioemotional well-being (Basak, Boot, Voss, & Kramer, 2008; Bleakley et al., 2015; Goldstein et al., 1997; Zhang & Kaufman, 2016a, 2016b). Moreover, seniors are increasingly drawn to digital games purely for enjoyment (De Schutter & Brown, 2016). Integrating educational and multiplayer components into games offers seniors an opportunity to learn and socialize through enjoyable activities.

In light of these benefits, this research used an enhanced digital Bingo game to study the learning and social effects of multiplayer digital gameplay for older adults. Our goal was to provide new insights on how familiar games, with digital enhancements, can support more entertaining, meaningful, and beneficial gameplay for this population.

Background

Digital Games

In 2006, the Federation of American Scientists issued a widely publicized report stating that digital games' features make them a powerful new educational tool. The report asserted that “success of complex video games demonstrates that games can teach higher order thinking skills such as strategic thinking, interpretative analysis, problem solving, plan formulation and execution, and adaptation to rapid change” (p. 3). The report outlined several attributes of games that could be useful for learning applications, including high time-on-task; motivation and goal orientation, even after failure; and providing learners with cues, hints, and partial solutions to keep them progressing through learning.

In a recent literature review, Young et al. (2012) identified 300+ articles related to video games and academic achievement. They found some evidence for positive effects of video games on language learning, history, and physical education (for exergames) but little support for video games' academic value in science and math.

A recent meta-analysis synthesized research on digital games to systematically examine their efficacy for learning (Clark, Tanner-Smith, & Killingsworth, 2014). Because of the rapid development of digital games for learning over the past decade, the authors focused on research published between 2000 and 2012. Their study expanded upon three earlier meta-analyses by focusing on an overlapping but distinct cross-section of the research literature. Findings from media comparisons indicated that digital games significantly enhanced student learning relative to nongame control conditions. However, findings from value-added comparisons clearly demonstrated the importance of design beyond the medium when evaluating the learning impact of digital games.

Older Adults and Digital Games

Older adults play games for a variety of reasons and to satisfy diverse needs (De Schutter, Brown, & Vanden Abeele, 2015; De Schutter & Malliet, 2014). The ability to engage and immerse oneself in digital gameplay appeals not only to younger players but also to the older audience (Entertainment Software Association of Canada, 2012).

One aspect that draws older players to engage in gameplay is the ability to interact socially with other players (De Schutter, 2011; Delwiche & Henderson, 2013). Social interaction during gameplay with other players is capable of leading to powerful, deep learning (Gee, 2003). However, until recently the social context surrounding older adult players has been largely neglected by researchers (Gajadhar, de Kort, & IJsselsteijn, 2008). Modern digital gameplay can be carried out in many different social contexts, locations, and modes of play, including online coplaying with other players and with virtual game agents. Social events during gameplay directly affect players' enjoyment in a social gameplay session (Gajadhar et al., 2008). Gajadhar, de Kort, IJsselsteijn, and Poels (2009) reported on senior players' acceptance of digital game coplaying in various multiplayer settings but stressed the need for research to study their social needs in a multiplayer environment, particularly in terms of the social and physical presence of other players with whom they could interact.

Games and Social Connectedness

Social connections are important for older adults' subjective and objective quality of life (Adams, Leibbrandt, & Moon, 2011; Bowling & Dieppe, 2005; Reichstadt, Sengupta, Depp, Palinkas, & Jeste, 2010; Theurer & Wister, 2010). Digital game playing often involves social interaction (Mahmud, Mubin, Shahid, & Martens, 2010), and older players value this social contact (De Schutter & Vanden Abeele, 2010; Schell, Hausknecht, Zhang, & Kaufman, 2016). Playing digital games has been found to increase social connectedness, defined as a person's feelings of belonging and being able to relate to others, and to decrease feelings of loneliness (De Schutter, 2011; Hausknecht, Schell, Zhang, & Kaufman, 2015; van Bel, Smolders, IJsselsteijn, & de Kort, 2009).

Digital Games and Learning

Continual learning has long been encouraged for older adults. Learning has been considered important for older people as a way of participating in society and maintaining a positive quality of life (Ardelt, 2000; World Health Organization, 2002, 2012).

From an adult learning theory perspective, older learners want learning outcomes to be practical and transferable to their everyday lives (Knowles, 1980). This applies to playing digital games, when they are likely to gauge, through an implicit cost-benefit analysis, whether it is worth investing their time and effort to play (McLaughlin, Gandy, Allaire, & Whitlock, 2012). Older adults are keen to use technology when they find it beneficial (Melenhorst, Rogers, & Bouwhuis, 2006). Recent studies have reported that older adults positively accept digital games that offer cognitive exercise and learning objectives; they value the learning experience beyond that of simply playing for entertainment (Nap et al., 2009; Pearce, 2008; Wang, Lockee, & Burton, 2011). De Schutter and Maillet (2014) and Kaufman, Sauvé, Renaud, Sixsmith, and Mortenson (2016) found that large proportions of their survey respondents saw playing games as a useful form of mental exercise.

Game Characteristics That Motivate Play

Given these potential benefits, what factors encourage and motivate older adults to play digital games? While much of the early literature on digital games for older adults has focused on improving digital games' design and playability, scholars have also noted the importance of understanding how older players' perceptions and preferences affect their acceptance and enjoyment of digital gameplay (IJsselsteijn, Nap, de Kort, & Poels, 2007). To meet their expectations, older adult players want more than just good ergonomics and game design.

Whitlock, McLaughlin, and Allaire (2011) and McLaughlin et al. (2012) suggested that building on social enhancements, together with playability, can enhance gameplay for this group of players. Hwang, Hong, Hao, and Jong (2011) found that female older players preferred playing with others to playing alone, and their flow experiences (playing games uninterruptedly and with focus) came from the process of sharing and interacting with others. In contrast, male older players in this study preferred playing alone, and their flow experiences came from indulging in their preferred personal playing style. Mubin, Shahid, and Al Mahmud (2008) concluded that to effectively motivate seniors to play, digital games should be simple yet fun to play and should incorporate ways to encourage players to be more active participants and to interact. De Schutter (2011) advocated for further research from both gerontology and design perspectives to study the playing experiences of older adult players, and De Schutter and Maillet (2014) identified connectedness, with family and friends as well as the broader community, as one of five categories of perceived needs motivating older adult game players.

Combining Social Gameplay With Learning

It has been generally accepted that most players below age 60 years aim for achievement in playing games, chasing after rewards based on accomplishing higher levels of gaming tasks, game scores, or fame in gaming communities. For older adult players, however, the learning and enjoyment of playing with other players are two of the top motivations that lead them to play digital games regularly (IJsselsteijn et al., 2007). This was confirmed by Vasconcelos, Silva, Casiero, Nunes, and Teixeira (2012), who found that it was not the rewards or achievement of gaming tasks that were most important to older gamers but, rather, the fun of playing together, along with the social and gaming skills gained from multiplayer social games. Besides the improved user interface and physical form factor of the tablet digital game system used by Vasconcelos et al. (2012), it was learning that made the gameplay engaging and enjoyable. These researchers also found that learning new skills through accumulated gameplay led older adults to play the game repeatedly. Their study found that when senior players kept playing a simple, tablet-based cognitive puzzle game, they developed better concentration, which eventually transferred to their everyday handling of daily activities faster and with better attention.

Marston (2013) found that older adults identified a number of motivating benefits of digital games, including social enjoyment, competitiveness, feeling connected, and education for oneself and other players (p. 116). She recommended integrating both player interaction and learning content into digital games, supported by multiple levels of game tasks and positive feedback to aid in learning and improving self-confidence.

The research reviewed here argues that digital games are likely to be appealing to older adults when they provide a combination of enjoyment, learning, and social interaction. Our study investigated these recommendations from the point of view of players themselves, so that we could better understand both gameplay outcomes and players' gameplay experience with a multiplayer, educational digital game.

Purpose and Research Questions

The purpose of this study was to extend ongoing research on learning and social connectedness in the field of digital games for older players. The following research questions guided the researchers in conducting the investigation (Creswell, 2013):

Are there increases in older adults' knowledge, social connectedness, and positive attitudes toward digital games as a result of playing a multiplayer, educational, digital Bingo game?

What is the social experience of older adult players while playing a multiplayer, educational, digital Bingo game?

Which elements contribute to a positive gameplay experience for older adults while playing a multiplayer, educational, digital Bingo game?

Methods

Research Approach

The study used a concurrent mixed-methods quantitative and qualitative approach (Creswell, 2013). Participants played an enhanced online “Bingo Nutrition and Health” game for four weekly sessions after first playing for one familiarization session with a similar “Bingo Canada” game with different learning content. Quantitative data were collected using pretests and posttests for knowledge of the game's learning content and for changes in participants' social connectedness. It should be noted that research that averages several players' data across the pretests and posttests tends to mask some important learning dynamics of gameplay, such as individual strategy goals, changing play intentions, and important contextualizing social interactions, such as discussions of the game outside of play. Studies that treat gameplay as a standard intervention for all players may mislead by reducing data across key variables. However, this method does give us a standard quantitative (quasi-experimental) approach to determining whether there were changes as a result of the Bingo gameplay.

Qualitative data on the players' gameplay experiences and preferences were collected through semistructured postgame interviews. This helped us to better understand the issues identified above as limitations of the quantitative approach.

Recruitment

Participants were recruited from six independent or assisted living homes and two community centers in greater Vancouver, Canada, with the permission of center directors. Candidates were excluded who were younger than 60 years, new to the centers (and therefore somewhat unsettled physically or socially), or had physical or mental conditions that precluded using the game equipment. Recruitment was challenging, as many seniors did not feel adequately skilled in using computers and were reluctant to participate. We spent more than a month visiting residential seniors centers to recruit 55 participants. Two participants dropped out at an early stage, and three did not complete both the pretest and posttest, leaving a total of 50 participants.

Ethical Considerations

Ethical approval was obtained from the Office of Research Ethics at Simon Fraser University. A letter of explanation was issued to each center manager or coordinator outlining the reasons and purposes for conducting the research. The centers formally granted permission for researchers to enter the sites, recruit participants, and conduct the study on their premises. Before entering the sites, the researcher and research assistants acknowledged, and agreed to comply with, the centers' conditions. After addressing any concerns with members of the research team, each participant signed a consent form that guaranteed confidentiality and allowed members of the team to observe, record interviews, interact, and exchange information with them during the period of this study. To encourage participation in the study, cash rewards were provided for game winners.

Bingo Game Software

The Bingo Nutrition and Health game chosen for this study is a replica of traditional Bingo that has been digitized as a multiplayer online game and extended into a “frame game”—an educational game template that allows the input of questions, with feedback, to embed learning on any desired topic into the gameplay (Sauvé, 2005). Our team developed this game following a user-centered design process, applying ergonomic principles that were appropriate for the older adult audience (Sauvé, Renaud, Duplàa, & Kaufman, 2014; Sauvé, Renaud, Kaufman, & Duplàa, 2015a, 2015b).

The flash-based game was hosted on a networked server in Quebec, Canada, and players logged in and connected to the server in order to play the game. Due to server limitations, gameplay during this study was limited to eight players at one time. As in traditional Bingo, each player had a Bingo card or board, of five columns, with five rows of numbers, and a score panel that displayed all players' scores. The game was modified to include pop-up educational content in the form of questions, working as follows: When a Bingo number is “called” by the game (e.g., “B 13”), a player checks on their Bingo board's column B to see if the number matches. If the number matches, the player clicks on the number on the board and receives a question in a pop-up frame. The number is registered or covered if she or he answers correctly, and feedback appears on the answer. Players need to have a row of numbers registered or covered—horizontally, vertically, or diagonally—in order to win. Points are also awarded to the player based on question difficulty, and the player with the most points when “Bingo” is called is declared the winner of the game. An individual game can be set to a “Basic, Medium, or Difficult” level according to the difficulty of questions posed during the game. The game thus includes learning and challenge features not present in traditional Bingo.

Bingo was chosen as the game for this study because it is a common, yet, traditional game, popularly played by many older adults. Its embedded educational content and competition encourage players to learn the topics embedded in the game and at the same time have fun playing socially with other players. Although the game could be played without a computer, the affordances provided by the digital version make it much easier for older adults to play, even without a game facilitator. The immediate feedback, pop-up windows, scoring system, and touch screen capability provide a comfortable and smooth game experience for older adults.

Figures 1 and 2 show the game's interface and learning content with feedback.

Figure 1.

Bingo nutrition and health: Game interface with score display.

Figure 2.

Bingo nutrition and health: Learning content and feedback.

Learning Content

The Bingo game's learning content covered nutrition and health topics derived from the Canadian Food Guide, Public Health Agency of Canada, and HealthLink British Columbia. The content was modified from an earlier version, in French, that was used in a previous study, and translated into an English language version for this study. The questions were in true or false and multiple-choice formats with easy, medium, and difficult levels. The questions were entered into the game by the researchers and fell into the four categories of nutrition, physical exercise, socializing, and prevention.

Gameplay Procedures

Each gameplay session lasted for about 30 to 45 minutes. Each week, each group played two game sessions at their respective centers. Players played seated around a table in a group of four to eight, using touchscreen laptop computers that were logged into the Bingo game server. Each player had an individual laptop for gameplay. Players were free to collaborate or socialize during the gameplay but were not specifically instructed to do so.

During the first week, each group played two basic-level games, followed by a second week of one basic and one medium-level game. These were followed by third and fourth weeks of one medium and one difficult-level game each.

Data Collection

Quantitative data

Quantitative data were collected with pretests, administered before the first session of gameplay in each center, and posttests administered after the four gameplay sessions. The pretest asked about participant backgrounds. Both pretests and posttests included sections on knowledge of the game's learning content, participants' social connectedness, and their attitudes toward digital games.

Knowledge pretests and posttests were used to assess participants' knowledge of nutrition and health topics. For the tests, a set of 15 questions were chosen from the Bingo game content and standardized as multiple-choice questions.

The pretest and posttest social connectedness questionnaire used a 5-point Likert scale ranging from strongly disagree to strongly agree. This was a revision of a questionnaire used in previous research projects on the social connectedness of older adult digital game players. This instrument was adapted from the Overall Social Connectedness Scale (van Bel et al., 2009), which was designed to assess respondents' perspectives about being connected or disconnected from their social world. The questionnaire section on participants' attitudes toward digital games had also been developed for earlier research on older adults and digital games.

The pretests and posttests were pilot tested with nonparticipating older adults before being used in the experiment. The posttest items were the same as those in the pretest, but the order of the items was changed to avoid any carryover effects. The final test versions incorporated feedback received from the pilot tests to improve readability, font size, wording clarity, test structure, and question formatting. Cronbach's alphas for the pretests were .67 for the social connectedness test and .69 for the game attitude test. For the posttests, these were .73 and .89, respectively. Table 1 provides an overview of the quantitative instruments and selected sample items.

Table 1.

Instrument Summaries and Sample Questions.

Quantitative items
Categories of items in pretest and posttest scale • Demographic information • Gameplay patterns • Opinions about playing digital games • Sociability • About my social connectedness
Sample social connectedness items (scored on a 5-point Likert scale) • I would like to have a larger circle of friends. • I feel a lack of contact with people in my social network.
Sample items from the knowledge test (multiple-choice questions) 1. Which of these foods contains the most fiber? • White rice • Steak • Whole grain pasta • Carrots 2. Which activity requires the least physical effort? • Mowing the lawn • Taking a dance class • Playing a card game • Walking the dog
Qualitative items
Face-to-face interview topics • Social gameplay experience • Game content knowledge • General comments and suggestions
Sample questions about the social gameplay experience (open-ended) • What did you think about playing this digital game together in a group rather than playing alone? • Can you describe which part of the gaming sessions you liked the most?
Sample questions about game content knowledge (open-ended) • What did you think about learning about nutrition and health in a Bingo game? • Will you make any nutrition and health changes after playing the game?

Qualitative data

Postgameplay interviews were used to collect qualitative data. The open-ended, semistructured, face-to-face interviews asked about participants' perceptions of their gameplay experience and about learning socially with other players. These were done with a representative convenience sample of 10 participants. Table 1 provides an overview of the qualitative instruments and samples of the qualitative interview questions.

Data Analysis

Both descriptive and inferential statistics were reported for the quantitative data. Descriptive statistics included frequencies, percentages, means, and standard deviations. The inferential analysis used paired-samples t tests to compare participant scores on the pretests and posttests.

To analyze the qualitative data, the open-ended interview responses were coded into categories, which were then merged into relevant themes. This process used Saldaña's (2013) two-cycle coding approach, with the first cycle used for initial coding and recoding of data and the second cycle for classification, integrating, synthesizing, abstracting, and eventually theory building. During the first phase, the author and another researcher manually read line-by-line each of the participants' interview transcripts and used spreadsheet software to tag each statement of the transcript with a representative phrase or sentence, including “in vivo” phrases of the actual words used by the participants. They also tried to cut down the numbers of phrases by using repeating and similar phrases that represented common meanings that the participants were trying to express. This went on until the entire interview transcript was analyzed and reviewed a second time to ensure that nothing was missing.

For the second coding cycle, the researchers chose a focused coding method to further analyze the data recorded in the first cycle. Focused coding helped to further organize and crystallize the data, eventually resulting in the coding of the data analytically into categories and themes (Saldaña, 2013). NVivo software, with its useful features of displaying the nodes and coding results, made discussing and reviewing of the focused coding easier and more productive, especially when renaming and making corrections to the codes being generated.

Results

Participant Backgrounds

The participants in this study were 50 adults aged 60 years or older; 13(26%) were male, and 37(74%) were female. Twenty-two (44%) reported that they did not play digital games.

Research Question 1: Is there an increase in knowledge, social connectedness, and positive attitudes toward digital games for older adults as a result of playing a multiplayer, educational, digital Bingo game?

Table 2 shows the results of paired-samples t tests on participants' knowledge of game content, social connectedness, and attitudes toward digital games.

Table 2.

Paired-Samples t Test Results.

	Pretest		Posttest		t	p
	M	SD	M	SD	t	p
Knowledge of game content	10.14	2.20	12.22	2.06	5.93	.001
Social connectedness	3.54	.43	3.73	.48	2.32	.024
Attitudes toward digital games	3.65	.59	4.09	.68	3.80	.000

Knowledge of game content

The paired-samples t test found a significant difference in participants' knowledge scores before (M = 10.14, SD = 2.20) and after (M = 12.22, SD = 2.06) playing the Bingo Nutrition and Health game (t = 5.93, p = .001). The Cohen's effect size value (d = 0.97) suggests a very high practical significance.

Social connectedness

Participants' scores on social connectedness showed a significant increase from before (M = 3.54, SD = 0.43) to after (M = 3.73, SD = 0.48) their gameplay (t = 2.32, p = .024). The Cohen's effect size value (d = 0.45) suggests a moderate practical significance.

Players' attitudes toward digital games

The paired-samples t test for attitudes toward digital games found a significant difference in participants' scores before (M = 3.65, SD = .59) and after (M = 4.09, SD = .68) playing the Bingo Nutrition and Health game (t = 3.80, p = .000). The Cohen's effect size value (d = .69) suggests moderate to high practical significance.

Research Question 2: What is the social experience of older adult players while playing a multiplayer, educational, digital Bingo game?

Participants' social gameplay experiences were richly described in our postgameplay interviews, where their comments produced two broad themes: “playing with others” and “making new friends.” Table 3 presents the two themes and the subthemes uncovered from the interview data and gives sample quotes for each subtheme.

Table 3.

Themes and Subthemes Related to Players' Social Experience.

Theme	Subtheme	Sample quotes
Playing with others (23 mentions by all 10 interviewees)	Player connectedness	Player 31: “I would like to continue playing the game with the same group – we became very close doing it. Good to come out of my room to socialize and do other things, be connected with others … ” Player 37: “The players – we all connected really well and got along; we were happy for each other when somebody got the answer.”
	Player interactivity	Player 17: “I am more interested to play with others – much better than playing alone. It's better because I could communicate with others and interact with them.” Player 24: “The interactions I enjoy, you hear them trying to figure out the questions.”
	Player collaboration	Player 17: “Yes, teamwork is emphasized and I've learn to co-operate with others in the game.” Player 31: “It's a game you are playing together, working together … It's teamwork.”
	Talking to other players	Player 32: “Yes, I like playing with the group, you are talking to them, playing and sitting with them, you feel comfortable.” Player 10: “Playing, I talk to people who play with me, and we talk about playing, about the food and something like that.”
	Positive coplaying experience	Player 02: “Playing in a group, I have more fun and can hear the sounds of other players. It also improves your mood while playing … ” Player 10: “It's very good for people, who like to think, and talking to lot of people about this thing, about Bingo, about playing something, talking about something. It's very very good for us.”
Making new friends (11 mentions by 6 interviewees)		Player 21: “I can see how other elderly people are playing and get to know others I haven't met before. They can share their life stories, too.” Player 31: “I'm a social person. I like being with people. That's why I come down. While playing the game I get to know others.” Player 37: “I really enjoy it in a group; being alone is quite isolating. Playing in a group is more ideal because you are interacting with people, you are meeting new people, and you are having conversation … One of the ladies – we meet, we go for lunch now. We made new friends. That was very positive, that social connection … ”

Playing with others

The theme “playing with others” encompassed a number of subthemes about participants' social coplay, including player connectedness, interactivity, collaboration, talking to other players, and general comments about a positive coplaying experience. Themes in this group were mentioned 23 times and mentioned by all 10 interviewees. Participants reported that they acquired relevant knowledge while making new friends and enjoying the experience. Social connectedness was clearly evident, and some participants planned to meet their new friends after the gameplay.

Consistent with these comments, the theme “making new friends” also stood out as important for participants. This theme was mentioned 11 times by six participants. The ability to develop new friendships through gameplay was highly sought after by this group of older adult players and was a key reason that they had positive experiences during the social gameplaying sessions.

These results strongly support those found in the quantitative analysis. It was clear from these and other examples that our participants appreciated the social aspects of their gameplay. Their social interactions were reflected in the significant increase in their quantitative social connectedness scores, which indicated that they saw themselves as more socially connected after the Bingo game sessions than they had been before.

Research Question 3: Which elements contribute to a positive gameplay experience for older adults while playing a multiplayer, educational, digital Bingo game?

Table 4 summarizes the main themes in participants' comments about their gameplay experience.

Table 4.

Themes and Subthemes Related to Players' Gameplay Experience.

Theme	Subtheme	Sample quotes
Elements of a positive experience (24 mentions by 8 interviewees)	Feeling of excitement; enjoyment of winning and rewards	Player 20: “I learned one other thing in the game play – a lot of people were excited! They love the game, some of them won the Bingo, even myself; the points! They were happier, we cheered one another on … ” Player 21: “I'm very happy when I win and learn to answer the questions.”
	Feeling comfortable	Player 31: “ [I played with] the same group and we became very close doing it and comfortable with one another.” Player 32: “Yes, I like playing with the group, you are talking to them, playing and sitting with them, you feel comfortable.”
	Feeling of accomplishment	Player 17: “Yes, teamwork is emphasized and I've learn to co-operate with others in the game.” Player 31: “It's a game you are playing together, working together … It's teamwork.”
	Feeling of fun	Player 17: “Because there are people playing together with me, it was more fun playing the digital game.”
	Feeling of enthusiasm	Player 20: “I am just enthusiastic. My answer is I never stop playing and learning.” Player 24: “ … yes, extremely interesting especially the questions, and I like to be with people and to see how they behave and how they are thinking.”
	Feeling of challenge and competition	Player 20: “And it is competitive, it is fun and enjoyable. The more you put into it the more you get out of it.”
Value of the learning content (58 mentions by all 10 interviewees)		Player 02: “I think I have learned quite a lot from the nutrition and health content, despite that I study a lot about those topics. The particular helpful portion is when the content from the Canadian Food Guide corrected my previous understanding of what I know, which are incorrect or outdated, including those I am not aware of.” Player 10: “Absolutely. I learn a lot, and I think a lot of it. It's very good for me.” Player 17: “Yes, I learned a lot through the Bingo nutrition guide example – Vitamin D, alcohol, beer proportions. Bingo is an open-book test.” Player 24: “Yes, what I learn apply to my daily life, about food and what to eat. … I learn much about nutrition and health. Yes, I will make some changes on my food intake and nutrition. I stop eating meat as I thought eating fish is better.”
Keeping the mind active (22 mentions by 9 interviewees)		Player 10: “This one on the computer is better, because there are questions that you must think about – more thinking.” Player 17: “The Bingo game is different than other games. Bingo changes game after game … it cause me to think and not be addictive.” Player 20: “This one works with your mind. You are doing something – you got to concentrate and you focus more attention on the Bingo than other games. Very good!” Player 21: “I find playing this game I can understand and stimulate my mind to be active.”

Elements of a positive experience

Eight players explicitly described positive aspects of their gameplay with 24 comments highlighting feelings of fun, enthusiasm, excitement, comfort, accomplishment, or enjoyment of the game's challenges, rewards, and winning. These comments clearly show that participants were highly engaged and greatly enjoyed the game experience. The key elements of successful games appeared to be present, namely challenge, enjoyment, competition, and winning and rewards.

Value of the learning

Comments related to players' learning, and the positive value and personal relevance of the game's learning content, arose in the interviews with surprising frequency: These were mentioned 58 times and by all 10 participants. The comments expressed participants' appreciation of their new knowledge about nutrition and health, their learning about technology, the applicability of this knowledge to their daily lives, the accuracy of the game's learning content, the game itself as a new learning method, and the quality of game questions and feedback. These aspects clearly contributed to an overall positive experience for players.

Keeping the mind active

Nine participants made 22 comments about how the game helped them to keep their minds active, clearly appreciating the opportunities that it provided for mental exercise and challenge.

To summarize, a positive experience for the participants in this study centered not only on their social experiences (reported earlier) but also on their positive feelings during gameplay, together with the value that they saw in the game's learning content, learning design, and the opportunity for mental exercise and challenge through gameplay.

General Comments and Suggestions

Interviewees actively commented on the Bingo game in general and the value they found in this gameplay. Five players commented 11 times on the overall value to them (cognitive, social, or otherwise) of spending time playing the game. In particular, several noted that they had improved their computer skills and knowledge of the technology that ran the Bingo game. Ten comments from nine interviewees stated their intention to continue playing, to introduce their friends to the game, or to find and try new games, providing further confirmation that their gameplay experience had been positive and worthwhile. Finally, 19 comments from seven players suggested improvements to the game and new types of games that would be of interest to them.

Discussion

This study adds to evidence about the use of digital games to improve the well-being of older adults. Through the use of a customized digital Bingo game with embedded learning content, we were able to learn more about how older players can experience and benefit from digital gameplay. Although some earlier research has found that embedding learning content in digital games has limited potential, as it does not leverage the more powerful learning mechanics of games (Clark et al., 2014; Young et al., 2012), our study showed the contrary. This is perhaps because our digital game is a “frame” game specifically designed to support learning (Sauvé, 2005), has embedded a number of motivational elements, and has been designed specifically for this target audience (Sauvé et al., 2014, 2015a, 2015b).

Knowledge and Learning

Our findings support earlier research on the cognitive benefits of digital gameplay for older adults (Kaufman, Sauvé, Renaud, & Duplàa, 2014; Zhang & Kaufman, 2016a, 2016b). Participants in this study learned while playing, enjoyed doing so, and valued their new knowledge. The statistically significant increase in knowledge of the Bingo game's learning content confirmed their learning about nutrition and health topics. Our qualitative data confirmed that participants appreciated learning these topics, which were practical and relevant to their current needs, and welcomed the opportunity to “keep the mind active.” These findings are consistent with Knowles' (1980) adult learning theory, which argues that older adults are particular about what they can gain from a learning activity and expect their learning to be practical and relevant to their current needs. The findings also echo earlier research conclusions that learning and mental exercise are key reasons that older adults play digital games (De Schutter & Maillet, 2014; Kaufman et al., 2016; Nap et al., 2009; Pearce, 2008). For this game, the learning content provided objectives for the gameplay; its learning challenges kept players focused and engaged, helping them and helped to build both knowledge and self-confidence. The quantitative results were supported strongly by the qualitative results, as participants made many comments related to their learning and the relevance of the game's learning content. These expressed participants' appreciation of their new knowledge about nutrition and health, their learning about technology, the applicability of this knowledge to their daily lives, the accuracy of the game's learning content, the game itself as a new learning method, and the quality of game questions and feedback.

Our participants also valued the effective questions and feedback built into the game design. The design of questions, answers, and feedback in educational games for older players can affect players' learning outcomes, and relevant feedback can further educate player and reinforce the learning, whether questions are answered correctly or not (Ogomori, Nagamachi, Ishihara, Ishihara, & Kohchi, 2011; Wu, Miao, Tao, & Helander, 2012). Participants' comments confirm that these were important aspects of their learning experience in this study.

Our players reported in their interviews that in addition to learning about nutrition and health, they added to their technology knowledge and skills. This is consistent with Nap et al.'s (2009) findings that older players, especially those who have very basic computer skills, appreciate digital educational games both for their learning content and as ways to improve their technology literacy. It also agrees with Wang et al.'s (2011) report of digital game players' increased understanding of, and interest in, Internet and digital game technology. Since nearly half (44%) of our participants had not played digital games before this study, Bingo Nutrition and Health might have been their first exposure to playing and learning from an online educational digital game and a new opportunity to learn about the technology itself.

Social Connectedness and the Social Gameplay Experience

Our older players' descriptions of their social experience give us insights into the significant increase in their social connectedness scores from before to after their gameplay. They greatly enjoyed playing with others, highlighted this as making gameplay more fun, and appreciated the communication and teamwork required. These findings agree with others' observations that social interaction and connectedness are important features of gameplay for older players (De Schutter & Maillet, 2014; De Schutter & Vanden Abeele, 2010; Hwang et al., 2011; Marston, 2013; McLaughlin et al., 2012). We see specific aspects of this connectedness in our players' descriptions of their interaction, collaboration, and conversation, which helped to promote their positive gameplay experience. Once again, the interview comments strongly support the results of the quantitative analysis. One example is a comment made by one participant, who stated that “Yes, I like playing with the group, you are talking to them, playing and sitting with them, you feel comfortable.” This connectedness naturally extended into making new friends in the course of the gameplay sessions, which was highly regarded by the older players. De Schutter and Vanden Abeele (2010) pointed out that aging can make it difficult for seniors to maintain contact with long-time friends as physical decline, illness, and death reduce their social circles; games can offer a way to develop new friendships to help combat loneliness. For our players, new friendships helped to make their gameplay a positive experience.

Attitudes Toward Digital Games

In describing their gameplay experience, players moved beyond the educational and social aspects of their gameplay to emphasize more general features of the game, as well as their subjective feelings while playing. They identified enjoyable aspects that echo the conclusions of game design researchers, highlighting challenge, reward, and winning as keys to engagement and flow during gameplay (Gajadhar et al., 2010; IJsselsteijn et al., 2007). This study provides new evidence that these conclusions apply to older players as well as the younger ones that have typically been the focus of game designers.

Subthemes identified in players' comments give us new insights into the range of (self-described) positive feelings that they experienced, including fun playing with others, enthusiasm, excitement, comfort in the group, and accomplishment through learning. While we cannot tell from these comments specifically how the game produced or enhanced these feelings, the comments do confirm that the gameplay experience was positive for our players. This adds to evidence from Allaire et al. (2013) who reported that older adult players who moderately and regularly played digital games performed significantly better in tests on quality of life, mood, and depression.

We find more evidence of our players' positive experience in the significant increase in their positive attitudes toward digital games from before to after the Bingo game sessions. This is consistent with their comments that it was worthwhile spending time playing the game and that they would continue to play this and similar games. McLaughlin et al. (2012) noted that older adults carry out a form of cost-benefit analysis to gauge whether it is worth investing their time and effort playing a game; our players appear to have concluded that the Bingo game's benefits outweighed costs for them, particularly since they enjoyed its social aspects and learned practical knowledge that was useful in their daily lives. This was also consistent with reports by Melenhorst et al. (2006) that older adults are more likely to use technology when they find it helpful in addressing their current concerns.

It is worth noting that these positive results were achieved using a game that was not specifically designed for social play and that contained no design features to promote social interaction. Players played with the goal of winning individually, naturally interacting as they shared the game's challenges and competition. This differs from gameplay in which social interaction is built into externally structured team play, as in Schell et al.'s (2016) Wii Bowling study, or designed into the gameplay mechanisms as in Oksanen (2013). This suggests that the learning, social, and enjoyment benefits seen in our study are available to groups of friends, family, senior-center residents, and others who can create their own colocated play sessions or access facilitated ones. It especially argues for the value of facilitated sessions with digital educational games for seniors in residential centers, who may face increased isolation and decreased mental stimulation.

Conclusions

This research adds to evidence that certain types of digital games can be both entertaining activities and valuable resources for older adults. Participants in this study expanded their social connectedness; acquired new and useful knowledge; and valued the enjoyment, learning, and socializing that took place during their digital Bingo gameplay. As a result, they finished the study with more favorable attitudes toward digital games. In terms of our research questions, qualitative data from participant interviews reinforced and help to explain the quantitative evidence of benefits achieved through gameplay. These results are especially interesting because nearly half of the participants were not digital game players before the experiment and so had little or no prior knowledge or experience to build on for the activities in this study.

Several factors limit our ability to generalize these study results. Participants were volunteers, rather than randomly selected, and were 74% women, compared with 53.5% of women in the general Canadian population aged 60 years and older (Statistics Canada, 2015). We also did not take into account their technological skills nor computer self-efficacy. Technical issues with the game server limited the size of each player groups to a maximum of eight people, so we could not examine the impact of larger social groups during gameplay. From a research perspective, a nonintervention group was not included to control for the possibility of other factors that could influence our results. Since the participants played only one type of digital game, that is, an educational game modeled after the game Bingo, generalizing to digital games in general is not appropriate. This is a particularly important point because the careful design of this game and the motivational and ergonomic elements incorporated into the game may have affected the results.

This study has a number of practical implications. Caregivers and others working with older adults, such as managers and staff of retirement homes and community centers, may wish to consider adding this game to their activity schedule. The game is currently freely available, and staff and players are able to add their own questions in a content domain of their choice (see http://www.savie.qc.ca/CVJE2/accueil2.asp?NoLangue=1). Although these types of educational games may be too slow or may lack motivational elements for young players, those looking to design or facilitate similar game-based activities with older adults may find the game very appropriate. However, more research is needed to investigate this claim.

There are several directions for future research to better explain the appeal and impacts for older adults of playing digital educational games in a social context. First, the data from this study should be analyzed in more detail to determine associations between participants' background variables and their changes in knowledge, social connectedness, and attitudes toward digital games. Second, further studies should have people play in larger groups and have team competitions within the game so that these can be compared with individual outcomes. Third, this study should be replicated with different types of games. Researchers need to ask not if but how games can support learning (Clark et al., 2014). Research on games and game-based learning should shift emphasis from proof-of-concept studies (“can games support learning?”) and media-comparison analyses (“are games better or worse than other media for learning?”) to value-added comparisons and cognitive-consequences studies exploring how theory-driven design decisions influence learning outcomes (Clark et al., 2014).

These proposed studies, with more detailed data collection, would help us to understand in greater depth the factors that could make digital gameplay appealing to older adults and, at the same time, valuable tools for learning and meeting their needs for social connectedness.

Footnotes

Acknowledgments

The authors thank Dr. Alice Ireland for her contributions to the literature review and revisions of this manuscript.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded in part by grants from the Social Sciences and Humanities Research Council of Canada and from AGE-WELL NCE Inc., a member of Canada’s Networks of Centres of Excellence program.

Author Biographies

Erik Tiong Wee Seah recently graduated with his PhD from the Educational Technology and Learning Design program at Simon Fraser University’s Faculty of Education. This article describes part of his doctoral research.

David Kaufman is a university professor in the Faculty of Education, Simon Fraser University. Kaufman has presented and published extensively in medical education, problem-based learning, simulations and games for learning, and learning technologies. He is a coleader of the AGE-WELL workpackage WP4 TECH-APS and of its CONNECT-PLAY project on digital games. His research currently focuses on the use of digital games and digital storytelling to enhance older adults’ social connectedness and cognitive skills.

Louise Sauvé is a professor of educational technology in the Department of Education at Télé-Université, the University of Québec (TÉLUQ). She is also president of the Society for Lifelong Learning (SAVIE), director of SAVIE’s center of expertise and research on lifelong learning, and codirector of the CONNECT-PLAY project in the AGE-WELL Network of Centres of Excellence. Her interests include many aspects of online education, such as distance and online learning, continual learning, virtual games for learning, study perseverance, and digital games for older adults.

Fan Zhang is a PhD graduate of the Educational Technology and Learning Design program at Simon Fraser University’s Faculty of Education and a postdoctoral scholar for the AGE-WELL NCE’s CONNECT-PLAY project. Her research focuses on the social, cognitive, and emotional impacts of digital games for older adults and intergenerational relationships.

References

Adams

K. B.

Leibbrandt

Moon

(2011) A critical review of the literature on social and leisure activity and wellbeing in later life. Ageing & Society 31(4): 683–712. doi:10.1017/S0144686X10001091.

Allaire

J. C.

McLaughlin

A. C.

Trujillo

Whitlock

L. A.

LaPorte

Gandy

(2013) Successful aging through digital games: Socioemotional differences between older adult games and non-gamers. Computers in Human Behavior 29: 1302–1306. doi:10.1016/j.chb.2013.01.014.

Ardelt

(2000) Intellectual versus wisdom-related knowledge: The case for a different kind of learning in the later years of life. Educational Gerontology 26(8): 771–789. doi:10.1080/036012700300001421.

Basak

Boot

W. R.

Voss

M. W.

Kramer

A. F.

(2008) Can training in a real-time strategy video game attenuate cognitive decline in older adults?. Psychology and Aging 23(4): 765–777. doi:10.1037/a0013494.

Bleakley

C. M.

Charles

Porter-Armstrong

McNeill

M. D. J.

McDonough

S. M.

McCormack

(2015) Gaming for health: A systematic review of the physical and cognitive effects of interactive computer games in older adults. Journal of Applied Gerontology 34(3): NP166–NP189. doi:10.1177/0733464812470747.

Bouwhuis

D. G.

(2003) Design for person-environment interaction in older age: A gerontechnological perspective. Gerontechnology 2(3): 232–246. doi:10.4017/gt.2003.02.03.002.00.

Bowling

Dieppe

(2005) What is successful ageing and who should define it?. BMJ 331(7531): 1548–1551. doi:10.1136/bmj.331.7531.1548.

Clark

D. B.

Tanner-Smith

E. E.

Killingsworth

(2014) Digital games, design and learning: A systematic review and meta analysis (Executive summary), Menlo Park, CA: SRI International.Retrieved from https://www.sri.com/sites/default/files/publications/digital-games-design-and-learning-executive_summary.pdf.

Creswell

J. W.

(2013) Qualitative inquiry and research design: Choosing among five approaches, 3rd ed. Thousand Oaks, CA: SAGE.

10.

De Schutter

(2011) Never too old to play: The appeal of digital games to an older audience. Games and Culture 6(2): 155–170. doi:10.1177/1555412010364978.

11.

De Schutter

Brown

J. A.

(2016) Digital games as a source of enjoyment in later life. Games and Culture 11: 28–52. doi:10.1177/1555412015594273.

12.

De Schutter

Brown

J. A.

Vanden Abeele

(2015) The domestication of digital games in the lives of older adults. New Media & Society 17(7): 1170–1186. doi:10.1177/1461444814522945.

13.

De Schutter

Maillet

(2014) The older player of digital games: A classification based on perceived need satisfaction. Communications 39(1): 67–88. doi:10.1515/commun-2014-0005.

14.

De Schutter

Vanden Abeele

(2010) Designing meaningful play within the psycho-social context of older adults. In: Vanden Abeele

Zaman

Obrist

IJsselsteijn

(eds) Fun and Games 10: Proceedings of the 3rd International Conference on Fun and Games, New York, NY: ACM, pp. 84–93.

15.

Delwiche

A. A.

Henderson

J. J.

(2013) The players they are a-changin': The rise of older adult MMO gamers. Journal of Broadcasting & Electronic Media 57(2): 205–223. doi:10.1080/08838151.2013.787077.

16.

Entertainment Software Association of Canada (2012) Essential facts 2012. Retrieved from http://theesa.ca/wp-content/uploads/2015/08/Essential-Facts-2012-EN.pdf.

17.

Federation of American Scientists (2006) Summit on educational games 2006: Harnessing the power of video games for learning. Retrieved from https://fas.org/programs/ltp/policy_and_publications/summit/Summit%20on%20Educational%20Games.pdf.

18.

Gajadhar

B. J.

de Kort

Y. A.

IJsselsteijn

W. A.

(2008) Shared fun is doubled fun: Player enjoyment as a function of social setting. In: Markopolous

IJsselsteijn

Rowland

(eds) Fun and games, Berlin, Germany: Springer, pp. 106–117.

19.

Gajadhar

B. J.

de Kort

Y. A. W.

IJsselsteijn

W. A.

Poels

(2009) Where everybody knows your game: The appeal and function of game cafés in Western Europe. In ACE ‘09: Proceedings of the International Conference on Advances in Computer Entertainment Technology, New York, NY: ACM, pp. 28–35.

20.

Gajadhar

B. J.

Nap

H. H.

de Kort

Y. A.

IJsselsteijn

W. A.

(2010) Out of sight, out of mind: Co-player effects on seniors' player experience. In Fun and Games '10: Proceedings of the 3rd International Conference on Fun and Games, New York, NY: ACM, pp. 74–83.

21.

Gee

J. P.

(2003) What video games have to teach us about learning and literacy, New York, NY: MacmillanRetrieved from https://learn.it.uts.edu.au/31002/Autumn04/support/learnfromgames.pdf.

22.

Goldstein

G. H.

Cajko

Oosterbroek

Michielsen

Van Houten

Salverda

(1997) Videogames and the elderly. Social Behavior and Personality: An International Journal 25(4): 345–353. doi:10.2224/sbp.1997.25.4.345.

23.

Griffiths

(2005) The therapeutic value of video games. In: Raessens

Goldstein

(eds) Handbook of computer game studies, Cambridge, MA: The MIT Press, pp. 161–171.

24.

Hausknecht

Schell

Zhang

Kaufman

(2015) Building seniors' social connections and reducing loneliness through a digital game. In: Helfert

Restiva

M. T.

Svacek

Uhomoibhi

(eds) Proceedings of the 7th International Conference on Computer Supported Education, Setúbal, Portugal: Science and Technology Publications, Lda, pp. 276–284.

25.

Hwang

M. Y.

Hong

J. C.

Hao

Y. W.

Jong

J. T.

(2011) Elders' usability, dependability, and flow experiences on embodied interactive video games. Educational Gerontology 37(8): 715–731. doi:10.1080/03601271003723636.

26.

IJsselsteijn

Nap

H. H.

de Kort

Poels

(2007) Digital game design for elderly users. In: Kapralos

Katchabaw

Rajnovich

(eds) Future Play 07: Proceedings of the 2007 Conference on Future Play, New York, NY: ACM, pp. 17–22.

27.

Kaufman

Sauvé

Renaud

Duplàa

(2014) Cognitive benefits of digital games for older adults. In: Herrington

Viteli

Leikomaa

(eds) Proceedings of the World Conference on Educational Media and Technology (EdMedia) 2014, Waynesville, NC: Association for the Advancement of Computing in Education, pp. 289–297.

28.

Kaufman

Sauvé

Renaud

Sixsmith

Mortenson

(2016) Digital gameplay by older adults: Patterns, benefits, and challenges. Simulation & Gaming 47(4): 475–489. doi:10.1177/1046878116645736.

29.

Knowles

M. S.

(1980) The modern practice of adult education: From pedagogy to andragogy, Englewood Cliffs, NJ: Prentice Hall/Cambridge.

30.

Mahmud

A. A.

Mubin

Shahid

Martens

J. B.

(2010) Designing social games for children and older adults: Two related case studies. Entertainment Computing 1(3–4): 147–156. doi:10.1016/j.entcom.2010.09.001.

31.

Marston

H. R.

(2013) Design recommendations for digital game design within an ageing society. Educational Gerontology 39(2): 103–118. doi:10.1080/03601277.2012.689936.

32.

McLaughlin

Gandy

Allaire

Whitlock

(2012) Putting fun into video games for older adults. Ergonomics in Design: The Quarterly of Human Factors Applications 20(2): 13–22. doi:10.1177/1064804611435654.

33.

Melenhorst

A. S.

Rogers

W. A.

Bouwhuis

D. G.

(2006) Older adults' motivated choice for technological innovation: Evidence for benefit-driven selectivity. Psychology and Aging 21(1): 190–195. doi:10.1037/0882-7974.21.1.190.

34.

Mubin

Shahid

Al Mahmud

(2008) Walk 2 Win: Towards designing a mobile game for elderly's social engagement. In: England

Beale

(eds) Proceedings of HCI (2008): Culture, Creativity, Interaction Vol. 2, Swinton, England: British Computer Society, pp. 11–14.

35.

Nap

H. H.

de Kort

Y. A. W.

IJsselsteijn

W. A.

(2009) Senior gamers: Preferences, motivations and needs. Gerontechnology 8: 247–262. doi:10.4017/gt.2009.08.04.003.00.

36.

Ogomori

Nagamachi

Ishihara

Kohchi

(2011) Requirements for a cognitive training game for elderly or disabled people. In Proceedings, 2011 International Conference on Biometrics and Kansei Engineering (ICBAKE), New York, NY: IEEE., pp. 150–154. doi:10.1109/ICBAKE.2011.30.

37.

Oksanen

(2013) Subjective experience and sociability in a collaborative serious game. Simulation & Gaming 44(6): 767–793. doi:10.1177/1046878113513079.

38.

Pearce

(2008) The truth about baby boomer gamers—A study of over-forty computer game players. Games and Culture 3(2): 142–174. doi:10.1177/1555412008314132.

39.

Reichstadt

Sengupta

Depp

Palinkas

L. A.

Jeste

D. V.

(2010) Older adults' perspectives on positive aging: Qualitative interviews. American Journal of Geriatric Psychiatry 18(7): 567–575. doi:10.1097/JGP.0b013e3181e040bb.

40.

Saldaña

(2013) The coding manual for qualitative researchers, 2nd ed. Thousand Oaks, CA: SAGE.

41.

Sauvé

(2005) Open and distance educational gaming: Using generic frame games to accelerate game design. In: Lionarakis

(ed.) Applications of Pedagogy and Technology: Proceedings of the 3rd International Conference on Open and Distance Learning, ICODL 2005, Patra, Greece: Greek Open University, pp. 393–398.

42.

Sauvé

Renaud

Duplàa

Kaufman D (2014) Building online digital games for seniors: The Bingo game revisited. In: Herrington

Viteli

Leikomaa

(eds) Proceedings of the World Conference on Educational Media and Technology (EdMedia) 2014, Waynesville, NC: Association for the Advancement of Computing in Education, pp. 2549–2566.

43.

Sauvé

Renaud

Kaufman

Duplàa

(2015a) Ergonomic criteria for creating online educational games for seniors. In: Sourina

Wortley

Kim

(eds) Subconscious learning via games and social media, Singapore: Springer, pp. 115–134.

44.

Sauvé

Renaud

Kaufman

Duplàa

(2015b) Validation of educational games for seniors: Live well, live healthy!. Procedia – Social and Behavioural Sciences, 674–682. doi:10.1016/j.sbspro.2015.01.526.

45.

Schell

Hausknecht

Zhang

Kaufman

(2016) Social benefits of playing Wii Bowling for older adults. Games and Culture 11(1–2): 81–103. doi:10.1177/1555412015607313.

46.

Statistics Canada (2015) Population by sex and age group, Ottawa, Canada: Statistics Canada.Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo10a-eng.htm.

47.

Theurer

Wister

(2010) Altruistic behaviour and social capital as predictors of well-being among older Canadians. Ageing and Society 30(1): 157–181. doi:10.1017/S0144686X09008848.

48.

van Bel

D. T.

Smolders

K. C.

IJsselsteijn

de Kort

(2009) Social connectedness: Concept and measurement. In: Callaghan

Kameas

Reyes

Royo

Weber

(eds) Intelligent Environments 2009: Proceedings of the 5th International Conference on Intelligent Environments, Amsterdam, The Netherlands: IOS Press, pp. 67–74.

49.

Vasconcelos

Silva

P. A.

Casiero

Nunes

Teixeira

L. F.

(2012) Designing tablet-based games for seniors: The example of CogniPlay, a cognitive gaming platform. In FnG ′12: Proceedings of the 4th International Conference on Fun and Games, New York, NY: ACM, pp. 1–10.

50.

Wang

Lockee

B. B.

Burton

J. K.

(2011) Computer game-based learning: Perceptions and experiences of senior Chinese adults. Journal of Educational Technology Systems 40(1): 45–58. doi:10.2190/ET.40.1.e.

51.

Whitlock

L. A.

McLaughlin

A. C.

Allaire

J. C.

(2011) Video game design for older adults: Usability observations from an intervention study. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 55(1): 187–191. doi:10.1177/1071181311551039.

52.

World Health Organization (2002) Active ageing: A policy framework. Retrieved from http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf.

53.

World Health Organization (2012) 10 facts on ageing and the life course. Retrieved from http://www.who.int/features/factfiles/ageing/en/index.html.

54.

Miao

Tao

Helander

M. G.

(2012) A curious companion for elderly gamers. In: Khalid

H. M.

Yeo

A. W.

Helander

M. G.

Lim

T. K.

(eds) Proceedings, Southeast Asian Network of Ergonomics Societies Conference (SEANES), Piscataway, NJ: IEEE, pp. 1–5.

55.

Young, M. F., Slota, S., Cutter, A. B., Jalette, G., Mullin, G., Lai, B., … Yukhymenko, M. (2012). Our princess is in another castle: A review of trends in serious gaming. Review of Educational Research, 82(1), 61–89. doi:10.3102/0034654312436980.

56.

Zhang

Kaufman

(2016a) Cognitive benefits of older adults' digital gameplay: A critical review. Gerontechnology 15(1): 3–16. Retrieved from https://dx-doi-org.web.bisu.edu.cn/10.4017/gt.2016.15.1.002.00.

57.

Zhang

Kaufman

(2016b) Physical and cognitive impacts of digital games on older adults: A meta-analytic review. Journal of Applied Gerontology 35(11): 1189–1210. doi:10.1177/0733464814566678.