Discussing on Gamification for Elderly Literature, Motivation and Adherence Jose Barambones1, Ali Abavisani1, Elena Villalba-Mora1;2, Miguel Gomez-Hernandez1;3 and Xavier Ferre1 1Center for Biomedical Technology, Universidad Politecnica´ de Madrid, Spain 2Biomedical Research Networking Centre in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Spain 3Aalborg University, Denmark Keywords: Gamification, Serious Games, Exergames, Elderly, Frailty, Discussion. Abstract: Gamification and Serious games techniques have been accepted as an effective method to strengthen the per- formance and motivation of people in education, health, entertainment, workplace and business. Concretely, exergames have been increasingly applied to raise physical activities and health or physical performance im- provement among elders. To the extend of our understanding, there is an extensive research on gamification and serious games for elderly in health. However, conducted studies assume certain issues regarding context biases, lack of applied guidelines or standardization, or weak results. We assert that a greater effort must be applied to explore and understand the needs and motivations of elderly players. Further, for improving the impact in proof-of-concept solutions and experiments some well-known guidelines or foundations must be adopted. In our current work, we are applying exergames on elderly with frailty condition in order to improve patient engagement in healthcare prevention and intervention. We suggest that to detect and reinforce such traits on elderly is adequate to extend the literature properly. 1 INTRODUCTION preserve the intrinsic capacity of the individual, its en- vironmental characteristics and their interaction. In In recent years, a rapid increase of consumer soft- parallel, by 2050 life expectancy will surpass 90 years ware inspired by the video-gaming has been per- and one in six people in the world will be over age 65 ceived. Gamification emerges from this phenomenon (WHO, 2019; UN, 2019). as a powerful tool for Human-Computer Interaction As far as we are concerned, although extensive research such playful design, serious games, purpose- research on gamification for health exists, there are ful games, pervasive games, and exergames, inter alia. many concerns about gamification focused on elderly. In a nutshell, gamification refers to game structures While there are remarkable research in this topic, i.a. and components to solve user problems. From an guidelines (Czaja and Lee, 2002; Ijsselsteijn et al., industry-based perspective, gamification and serious 2007), study of engagement and adherence (de Vette games methods have been used to increase participa- et al., 2015), and rehabilitation (Laver et al., 2017; tion and to encourage behavioural changes from the Skjæret et al., 2016), literature still remains poor due audience. From a scientific point of view, gamifica- to low-quality evidence, assumed biases, and lack of tion reinforces and improves behaviours and user ca- user adherence, among others. In addition, to ap- pacities with special focus on learning and health (Ka- ply gamification for ageing becomes challenging due surinen and Knutas, 2018). Concretely, exergames are to the lack of familiarity of the elderly with games a set of gamification components from the family of and its components, metaphors and mental processes, serious games defined as virtual games that require i.a. points, status, stages, badges. etc. However, ex- physical exertion to be played. ergames sound promising to fill this gap, motivating The World Health Organization (WHO) defines elders to do exercise because of its fun, aiming for “Healthy Ageing” as the process of developing and a proper adherence and motivation that enforce the maintaining the functional ability that enables well- mentioned capacities. being in older ages. In other words, to maintain and 308 Barambones, J., Abavisani, A., Villalba-Mora, E., Gomez-Hernandez, M. and Ferre, X. Discussing on Gamification for Elderly Literature, Motivation and Adherence. DOI: 10.5220/0009818003080313 In Proceedings of the 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 308-313 ISBN: 978-989-758-420-6 Copyright c 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved Discussing on Gamification for Elderly Literature, Motivation and Adherence We conducted a qualitative analysis using sec- motivational reinforcement), theoretical analysis of ondary data from a literature review that includes components, and applicability on e-learning educa- both scientific and grey literature. The search and tion (Seaborn and Fels, 2015; Kasurinen and Knu- the initial analysis were conducted separately by the tas, 2018). Most frequent objectives in the literature main researchers, whilst the discussion and position- are aimed to comprehend how gamification affects ing were concluded by the all the authors. As our user performance, mainly the intrinsic motivation and early conclusions, a greater effort on gamification for need satisfaction. Indeed, some effort has been ap- ageing must be conducted. Concretely, our position is plied to empirically study through experiments and twofold: to ensure usability for seniors through gam- evaluation in mentioned concepts from a psycholog- ification given their capacities as players and, in par- ical (Hamari et al., 2014; Sailer et al., 2017; Mekler allel, to explore and understand the needs and mo- et al., 2017) and neurological perspectives (Mondejar´ tivations of elderly players in order to improve user et al., 2016), among others. adherence and extend the current theory. In addition, further well-controlled studies are required to estab- 2.1 Gamification for Elderly lish unambiguously the effects gamification on dif- ferent types of elderly users. Moving forward, our Serious games are defined as any form of playful current work aims to extend exergaming to tailored resource, mainly interactive or computer-based, to intervention for elderly with frailty condition. Frailty be used with the intention to be more than enter- condition is an intermediate state in the ageing tra- tainment. Games for Health are a subset of serious jectory with increased vulnerability and preceding the games, where the purpose of the game is to improve onset of disability. In contrast to permanent disability, the health of the player, either via exercise inducing frailty advance can be potentially reversed through games or via promoting the health-enhancing activi- appropriate interventions (Fried et al., 2001). Accord- ties (Kasurinen and Knutas, 2018). Exergames are de- ingly, we aim to apply gamification techniques tai- fined as virtual games that require physical exertion to lored to elderly given their functional status and mo- be played and emerge from the hypothesis of motivat- tivational trait. Indeed, the long term goal is, through ing adults to do exercise because of its fun. Literature these techniques and extensions, be capable to recog- shows how gamification through exergames in health nize the motivational trait itself. Indeed, we want to has emerged as a popular strategy, both in commer- demonstrate that engagement and adherence on elders cial culture and research as a means of influencing are linked with concrete traits such personal mastery behaviors (Lister et al., 2014). Other studies aims to and failure avoidance. To do so, exergames are proved improve adherence through long-term and sustainable to be suitable to improve patients motivation as well user motivation to workout through exergames (Gobel¨ as their health. et al., 2010). As introduced below, to care and develop the in- trinsic capacity of the individual is crucial to maintain 2 BACKGROUND and preserve the functional ability on elderly. Intrin- sic capacity comprises all the mental and physical ca- Gamification is defined by the use of design elements pacities that a person can draw on and includes their from games in non-game contexts. This broader def- ability to walk, think, see, hear and remember. The inition emerges from the industry and research ap- level of intrinsic capacity is influenced by a number proaches, i.a. productivity games, surveillance enter- of factors such as the presence of diseases, injuries tainment, gameful/playful design, behavioral games, and age-related changes (WHO, 2019). Physical ac- serious games, and pervasive games. Over recent tivities are a vital element at all ages, particularly in years, gamification techniques have been accepted elders to manage their daily life. This includes an ad- as effective methods to develop the performance and equate strength, balance, and flexibility, among other motivation of people. Different research approaches requirements. Exergames have been increasingly ap- have applied gamified systems, such as education, plied to raise physical activities and health or physi- health, entertainment, business, and exercise (Deter- cal performance improvement among elders, through ding et al., 2011). motivating elder people to do exercise and mightily Several studies shows how gamification litera- acquire sufficient physical exertion (Kirk et al., 2013). ture are becoming popular in different research ar- Despite the remarkable set of casual games that eas. Trendiest approaches in gamification are stud- are not adequately designed in terms of speed, amount ies based on proof-of-concept prototypes (computer of information, and movement options (Wollersheim science education, ecology